Race Impacts Outcome in Stage III/IV Squamous Cell Carcinomas of the Head and Neck After Concurrent Chemoradiation Therapy

BACKGROUND: The purpose of this study was to determine the impact of race on outcome in patients with stage III/IV squamous cell carcinoma of the head and neck (SCCHN) who have completed concurrent chemoradiotherapy. METHODS: The authors performed a retrospective analysis of 202 patients with stage III/IV SCCHN who were treated at the University of Maryland. Patients received daily radiation to a total dose of 70.2 Gray (Gy) (1.8 Gy/day), concurrently with weekly carboplatin (area under the curve [AUC] = 2) and paclitaxel (45 mg/m(2)) chemotherapy. RESULTS: There were 108 Caucasian (CA) and 94 African American (AA) patients. The median age was 56 years, and 81% were stage IV. The median follow-up was 33 months. The median overall survival (OS) and disease-free survival (DFS) were 33 months and 19 months, respectively. When analyzed by race, the median DFS was 33 months (CA) versus 12 months (AA) (P=.028). The median OS was 44 months (CA) versus 24 months (AA) (P=.071). The 3-year DFS for stage IV AA versus stage IV CA was 29% versus 50% (P=.031). The 3-year DFS for N2 disease in AA versus CA was 32% versus 51% (P=.046). The 3-year DFS for AA versus CA with oropharyngeal tumors was 30% versus 60% (P=.006). CONCLUSIONS: This analysis documents the inferior outcome for AA patients. They had inferior DFS and a trend toward worse OS. When stratified by several prognostic variables, the mediocre DFS in the AA patients remains. These data suggest that further investigation into the genetic characteristics of SCCHN in AA patients is warranted. Cancer 2009;115:1744-52. (C) 2009 American Cancer Society.