Abstract A114: Does being Latino affect a patients outcome after being diagnosed with squamous cell carcinoma of the head and neck: An analysis of the SEER database
Authors: Abramowitz Matthew C. , Hu, Jennifer , Franzmann, Elizabeth J. , Santos Edgardo S. , Wright Jean L. , Weed Donald T. , Raez Luis E. , Goodwin Jarrard W. , Lally Brian E. 
Published: December 2010

Purpose/Objective(s): Ethnicity, marital status, and socioeconomic status have all been associated with outcomes in head and neck cancer. However, how Hispanic ethnicity relates to outcome is a question that remain without an established answer. Here, we attempt to evaluate the differences within the US various ethnicity groups diagnosed with head and neck cancer. We specifically focused on the clinical outcomes of patients with Hispanic background.

Material/Methods: We used the Surveillance, Epidemiology, and End Results (SEER) database to examine the clinical outcomes of patients with head and neck cancer by ethnicity, region of origin, place of birth, treatment modality (surgery, radiation or both), primary location (oral cavity, oral pharynx, hypopharynx or larynx), age, gender, and SEER tumor stage (in situ, local, regional, distant). We assembled a cohort of patients aged 21 years and older diagnosed from 1988 to 2002 and followed through 2006. The non-US born Hispanic populations were pooled for some analyses due to low numbers. A Cox proportional hazard model for overall survival was used.

Results: We selected a cohort of 45,324 patients. Stage was distributed as: 4.2% in situ disease, 33.4% local, 52.5% regional involvement, and 9.9% had distant disease. Male patients composed 72.4% of the cohort. Age was broken down to under 50 yrs old (12.8%), 50-70 (55.9%) and over 70 (31.3%). Caucasians made up 75.7% of the cohort, Blacks 11.9%, Mexicans 1.7%, Cuban/Dominican 0.3%, Central American 0.3%, South American 0.3% and US-born Hispanic 9.8%. Treatment consisted of surgery in 34%, radiation 29.8% and combined modality in 36.2%. The primary site was oral cavity in 33.1 %, oropharynx 32%, hypopharynx 7.6%, and larynx 27.3%. On the multivariate analysis of the entire population: Age (1.026,1.025-1.027); female gender (0.947,0.923-0.972), race; white (ref.), Black (1.407, 1.361-1.454), non-US born Hispanic (0.742,0.684-0.804), US born Hispanic (0.857,0.823-0.892); stage: in situ (0.515,0.483-0.548), localized (0.598,0.582-0.615), regional (ref.), distant (1.718,1.656-1.781); site: oral cavity (1.294,1.253-1.336), oropharynx (ref.), hypopharynx (1.406,1.347-1.467), larynx (0.955,0.925-0.985), and treatment modality: surgery (0.951,0.922-0.981), radiotherapy (1.361, 1.325-1.398), and combined modality (ref). When only patients with regional disease were assessed, surgery and surgery +radiation were not significantly different. Patients with radiation therapy did worse (1.368,1.321-1.417). The results for ethnicity were similar for the whole group. By site, oral cavity (1.472,1.412-1.534), hypopharynx (1.492, 1.418-1.571), and larynx (1.101,1.057-1.147) all did worse than oropharynx (ref.).

Conclusion: Ethnicity has been associated with clinical outcome in head and neck cancer in the past. Using the SEER database, we show that Hispanic population appears to have a better prognosis compared to their Caucasian peers while both do better than Blacks. This was observed across all stages and also in patients with regional disease. Furthermore, non-US born Hispanic did have the best prognosis followed by the US born Hispanic group. The cause of this disparity is unclear and warrants further investigation.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A114.