African Americans with oropharyngeal carcinoma have significantly poorer outcomes despite similar rates of human papillomavirus–mediated carcinogenesis

Summary We examined racial disparities among 102 oropharyngeal carcinoma (OPC) patients (30 African Americans and 72 whites) comparing rates of transcriptionally active human papillomavirus (HPV)16/18 and p16INK4a overexpression, with times to disease progression and disease-specific survival (DSS). Expression of HPV16/18 transcripts was assessed by reverse transcription and polymerase chain reaction using type-specific E6/E7 primers; p16INK4a was evaluated by immunohistochemistry. African Americans were significantly more likely to present with high T stage disease and receive nonsurgical treatment. HPV16/18 was present in 63% of patients; no racial differences were observed. Silenced p16INK4a in OPC was significantly more common in African Americans (15/24) than in whites (20/69) ( P = .004) and in HPV16+ African Americans (6/24) than in HPV+ whites (2/42) ( P = .023). Kaplan-Meier analysis for DSS revealed a protective effect for p16INK4a overexpression ( P = .0028; hazard ratio [HR], 0.23), HPV16+ ( P = .036; HR, 0.38), and whites ( P = .0039; HR, 0.27). Shorter DSS was associated with primary definitive chemoradiation ( P = .019; HR, 3.49) and T3/T4 disease ( P = .0001; HR, 7.75). A protective effect with respect to disease progression was observed for HPV16+ ( P = .007; HR, 0.27), whites ( P = .0006; HR, 0.197), and p16INK4a overexpression ( P = .0001; HR, 0.116). African Americans with OPC experience poorer outcomes likely due to p16INK4a silencing, higher T stage, and nonsurgical treatment but not lower rates of transcriptionally active HPV16/18.