Racial Differences in Stage and Survival in Head and Neck Squamous Cell Carcinoma.
Nichols, Anthony C. MD; Bhattacharyya, Neil MD, FACS
117(5):770-775, May 2007.
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Objectives: The goal of this study was to characterize differences in survival between black patients and white patients with squamous cell carcinoma of the head and neck (HNSCCA).
Design: Cases of oral tongue and glottic SCCA in black patients or white patients were extracted from the Surveillance, Epidemiology, and End Results (SEER) database (years 1988-2002). For each primary site, TNM staging was imputed, and staging distributions were compared between races. For each black patient, a randomly selected white control was matched for age at diagnosis, sex, stage, surgical treatment, and radiation. Kaplan-Meier survival comparisons for both overall and disease-specific survival were then conducted for the matched pairs.
Results: From 1,919 cases of carcinoma of the oral tongue, those of 151 black and 1,768 white patients were extracted. Black patients had a significantly elevated T stage (P = .001) and N stage (P = .002) at primary presentation. Of glottic carcinoma, 4,578 cases (625 black and 3,953 white patients) were extracted. Black patients again presented with significantly elevated T stage (P < .001) and N stage (P < .001) compared with white patients. For 43 matched pairs with tongue carcinoma, mean overall survival for black patients was 66.1 months versus 74.8 months for matched white controls (P = .502, log-rank test). Disease-specific survival was 91.1 months for black patients versus 109.6 months for white patients (P = .168). For 401 matched pairs with glottic carcinoma, mean overall survival for black patients was 96.6 months versus 114.5 months for white controls (P < .001). Similarly, the mean disease-specific survival was 149.4 months for black patients versus 167.1 months for white patients (P < .001)
Conclusion: Controlling for stage and treatment, black patients demonstrate poorer overall and disease-specific survival with SCCA, implying other intrinsic or extrinsic factors influencing survival.
(C) The American Laryngological, Rhinological & Otological Society, Inc.