Human papillomavirus-active head and neck cancer and ethnic health disparities

Paul Maurice Weinberger, Mark A. Merkley, Sunny S. Khichi, Jeffrey R Lee, Amanda Psyrri, Lana L. Jackson, William S. Dynan

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Objectives/Hypothesis: Mortality for black males with head and neck squamous cell carcinoma (HNSCC) is twice that of white males or females. Human papillomavirus (HPV)-active HNSCC, defined by the concurrent presence of high-risk type HPV DNA and host cell p16INK4a expression, is associated with decreased mortality. We hypothesized that prevalence of this HPV-active disease class would be lower in black HNSCC patients compared to white patients. Study Design: Multi-institutional retrospective cohort analysis. Methods: Real-time polymerase chain reaction was used to evaluate for high-risk HPV DNA presence. Immunohistochemistry for p16INK4a protein was used as a surrogate marker for HPV oncoprotein activity. Patients were classified as HPV-negative (HPV DNA-negative, p16INK4a low), HPV-inactive (HPV DNA-positive, p16INK4a low), and HPV-active (HPV DNA-positive, p16INK4a high). Overall survival and recurrence rates were compared by Fisher exact test and Kaplan-Meier analysis. Results: There were 140 patients with HNSCC who met inclusion criteria. Self-reported ethnicity was white (115), black (25), and other (0). Amplifiable DNA was recovered from 102/140 patients. The presence of HPV DNA and the level of p16INK4a expression were determined, and the results were used to classify these patients as HPV-negative (44), HPV-inactive (33), and HPV-active (25). Patients with HPV-active HNSCC had improved overall 5-year survival (59.7%) compared to HPV-negative and HPV-inactive patients (16.9%) (P = .003). Black patients were less likely to have HPV-active disease (0%) compared to white patients (21%) (P = .017). Conclusions: The favorable HPV-active disease class is less common in black than in white patients with HNSCC, which appears to partially explain observed ethnic health disparities.

Original languageEnglish (US)
Pages (from-to)1531-1537
Number of pages7
JournalLaryngoscope
Volume120
Issue number8
DOIs
StatePublished - Aug 1 2010

Fingerprint

Head and Neck Neoplasms
Health
DNA
Cyclin-Dependent Kinase Inhibitor p16
Mortality
Oncogene Proteins
Kaplan-Meier Estimate

Keywords

  • Ethnic disparities
  • Etiology
  • Head and neck squamous cell carcinoma
  • Human papillomavirus

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Weinberger, P. M., Merkley, M. A., Khichi, S. S., Lee, J. R., Psyrri, A., Jackson, L. L., & Dynan, W. S. (2010). Human papillomavirus-active head and neck cancer and ethnic health disparities. Laryngoscope, 120(8), 1531-1537. https://doi.org/10.1002/lary.20984

Human papillomavirus-active head and neck cancer and ethnic health disparities. / Weinberger, Paul Maurice; Merkley, Mark A.; Khichi, Sunny S.; Lee, Jeffrey R; Psyrri, Amanda; Jackson, Lana L.; Dynan, William S.

In: Laryngoscope, Vol. 120, No. 8, 01.08.2010, p. 1531-1537.

Research output: Contribution to journalArticle

Weinberger, PM, Merkley, MA, Khichi, SS, Lee, JR, Psyrri, A, Jackson, LL & Dynan, WS 2010, 'Human papillomavirus-active head and neck cancer and ethnic health disparities', Laryngoscope, vol. 120, no. 8, pp. 1531-1537. https://doi.org/10.1002/lary.20984
Weinberger PM, Merkley MA, Khichi SS, Lee JR, Psyrri A, Jackson LL et al. Human papillomavirus-active head and neck cancer and ethnic health disparities. Laryngoscope. 2010 Aug 1;120(8):1531-1537. https://doi.org/10.1002/lary.20984
Weinberger, Paul Maurice ; Merkley, Mark A. ; Khichi, Sunny S. ; Lee, Jeffrey R ; Psyrri, Amanda ; Jackson, Lana L. ; Dynan, William S. / Human papillomavirus-active head and neck cancer and ethnic health disparities. In: Laryngoscope. 2010 ; Vol. 120, No. 8. pp. 1531-1537.
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abstract = "Objectives/Hypothesis: Mortality for black males with head and neck squamous cell carcinoma (HNSCC) is twice that of white males or females. Human papillomavirus (HPV)-active HNSCC, defined by the concurrent presence of high-risk type HPV DNA and host cell p16INK4a expression, is associated with decreased mortality. We hypothesized that prevalence of this HPV-active disease class would be lower in black HNSCC patients compared to white patients. Study Design: Multi-institutional retrospective cohort analysis. Methods: Real-time polymerase chain reaction was used to evaluate for high-risk HPV DNA presence. Immunohistochemistry for p16INK4a protein was used as a surrogate marker for HPV oncoprotein activity. Patients were classified as HPV-negative (HPV DNA-negative, p16INK4a low), HPV-inactive (HPV DNA-positive, p16INK4a low), and HPV-active (HPV DNA-positive, p16INK4a high). Overall survival and recurrence rates were compared by Fisher exact test and Kaplan-Meier analysis. Results: There were 140 patients with HNSCC who met inclusion criteria. Self-reported ethnicity was white (115), black (25), and other (0). Amplifiable DNA was recovered from 102/140 patients. The presence of HPV DNA and the level of p16INK4a expression were determined, and the results were used to classify these patients as HPV-negative (44), HPV-inactive (33), and HPV-active (25). Patients with HPV-active HNSCC had improved overall 5-year survival (59.7{\%}) compared to HPV-negative and HPV-inactive patients (16.9{\%}) (P = .003). Black patients were less likely to have HPV-active disease (0{\%}) compared to white patients (21{\%}) (P = .017). Conclusions: The favorable HPV-active disease class is less common in black than in white patients with HNSCC, which appears to partially explain observed ethnic health disparities.",
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