Table 3.
Multivariable adjusted hazard ratios for cancer-specific mortality among patients with M0 HNSCC and at least 1 month of follow-up (N=4,476)
| Characteristic | No. patients / No. Cancer-Deaths / No. Competing Deaths | Cancer-Specific Mortality | ||
|---|---|---|---|---|
| AHR (95% CI) | P | |||
| Race * HPV Status * Disease Sitea | 4,476/323/98 | 0.33 (0.24–0.45) | <0.001 | |
| HPV Positive Disease, Oropharynxb | 2,903/110/49 | |||
| White | 2,471/83/43 | 1.0 (ref) | ||
| Non-White | 432/27/6 | 1.82 (1.14–2.94) | 0.01 | |
| Private or other insurance | 2,541/81/42 | 1.0 (ref) | ||
| Uninsured | 73/7/2 | 3.12 (1.19–8.13) | 0.02 | |
| Medicaid | 255/15/5 | 1.73 (0.91–3.27) | 0.09 | |
| Unknown insurance | 34/7/0 | 3.62 (1.56–8.42) | 0.003 | |
| HPV Negative Disease, Oropharynxc | 1,014/148/34 | |||
| White | 745/110/22 | 1.0 (ref) | ||
| Non-White | 269/38/12 | 1.11 (0.74–1.67) | 0.60 | |
| Private or other insurance | 771/104/21 | 1.0 (ref) | ||
| Uninsured | 46/7/5 | 0.85 (0.36–2.05) | 0.72 | |
| Medicaid | 178/33/4 | 1.13 (0.73–1.75) | 0.59 | |
| Unknown insurance | 19/4/4 | 1.00 (0.22–4.73) | 0.99 | |
| HPV Positive Disease, Non-Oropharynxd | 180/19/3 | |||
| White | 135/15/3 | 1.0 (ref) | ||
| Non-White | 45/4/0 | 1.26 (0.18–8.75) | 0.82 | |
| Private or other insurance | 146/12/3 | 1.0 (ref) | ||
| Uninsured | 3/2/0 | 87.48 (5.02–1524.14 | 0.002 | |
| Medicaid | 29/4/0 | 1.51 (0.15–15.52) | 0.73 | |
| Unknown insurance | 2/1/0 | 139.5 (5.53–3520.18 | 0.003 | |
| HPV Negative Disease, Non-Oropharynxe | 379/46/12 | |||
| White | 191/27/4 | 1.0 (ref) | ||
| Non-White | 188/19/8 | 1.39 (0.73–2.62) | 0.31 | |
| Private or other insurance | 269/28/9 | 1.0 (ref) | ||
| Uninsured | 20/3/0 | 1.81 (0.50–6.51) | 0.37 | |
| Medicaid | 86/15/3 | 1.30 (0.60–2.81) | 0.50 | |
| Unknown insurance | 4/0/0 | |||
| Age at Diagnosis (per year increase) | 4,476/323/98 | 1.04 (1.03–1.05) | <0.001 | |
| Sex | ||||
| Female | 727/76/13 | 1.0 (ref) | ||
| Male | 3,749/247/85 | 0.67 (0.51–0.87) | 0.003 | |
| Smoking Propensity (per 10% increase) | 4,476/323/98 | 1.01 (0.99–1.03) | 0.38 | |
| High School Education (per 10% increase) | 4,476/323/98 | 1.02 (1.00–1.05) | 0.13 | |
| Median Household Income (per 10K increase) | 4,476/323/98 | 1.00 (1.00–1.00) | 0.03 | |
| Tumor Stage | ||||
| T1 | 1,041/32/11 | 1.0 (ref) | ||
| T2 | 1,512/60/24 | 1.37 (0.88–2.12) | 0.16 | |
| T3 | 764/71/21 | 3.10 (1.99–4.84) | <0.001 | |
| T4 | 654/125/30 | 5.30 (3.47–8.10) | <0.001 | |
| Unknown T | 486/35/12 | 1.81 (1.06–3.11) | 0.03 | |
| Nodal Stage | ||||
| N0 | 675/54/14 | 1.0 (ref) | ||
| N1 | 838/61/11 | 1.17 (0.79–1.73) | 0.44 | |
| N2a | 444/11/7 | 0.69 (0.36–1.31) | 0.27 | |
| N2b | 1,439/84/36 | 1.18 (0.80–1.72) | 0.41 | |
| N2c | 589/64/15 | 1.23 (0.80–1.89) | 0.35 | |
| N2 NOS | 116/11/4 | 1.64 (0.84–3.17) | 0.15 | |
| N3 | 233/25/5 | 1.81 (1.10–2.97) | 0.02 | |
| Unknown N | 142/13/7 | 0.93 (0.44–1.99) | 0.86 | |
| Definitive Treatment | ||||
| None | 204/67/10 | 1.0 (ref) | ||
| Surgery | 1,215/35/12 | 0.40 (0.27–0.60) | <0.001 | |
| Radiation Therapy | 4,001/221/80 | 0.22 (0.18–0.30) | <0.001 | |
| Chemotherapy | 3,223/197/62 | 0.80 (0.59–1.08) | 0.14 | |
Abbreviations: AHR, Adjusted Hazard Ratio; CI, confidence interval; HNSCC, Head and Neck Squamous Cell Carcinoma; HPV, Human Papillomavirus; N/A, not applicable
Interaction term was tested in multivariable analysis with HPV status, disease site, race, smoking propensity, high school education, median household income, tumor stage, nodal stage and definitive treatment. Following the identification of a statistically significant interaction amongst these variables, subgroups b-e were examined in separate models, excluding the aforementioned interaction term, to examine the effect of race on CSS in each subgroup.