Propensity Score Matched Analysis on Survival Profile of Head and Neck Cancer in the U.S. Hispanic Population Open Access

Zhu, Xiting (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/8910jv37k?locale=en
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Abstract

Introduction: Head and neck cancer (HNC) ranks as the 10th most common cancer worldwide and the 7th most common cancer inducing mortality. It causes 300,000 deaths each year worldwide among 600,000 newly diagnosed cases. A better understanding of potential risk factors for the incidence of HNC should be completed as well as thorough survival analyses for each racial and ethnic population. Despite the continuous increase in the U.S. Hispanic population in the recent decade, however, limited data was published on the survival of HNC in the Hispanic population. The purpose of this paper is to compare overall survival (OS) and disease-specific survival between Hispanic and the general HNC patients of the United States and to identify prognostic factors that might affect the survival outcomes of HNC patients.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database was queried for HNC patients diagnosed between 2000 and 2013. Kaplan-Meier and log-rank test were performed to compare OS and disease-specific survival by racial-ethnical groups. A multivariable Cox proportional hazard model was fit to select prognostic factors.In addition, a multivariable model was fit to test for the impact of interaction between race-ethnic groups and age on survival outcomes. A method of propensity score matching was also implemented.

Results: A total of 113885 patients were identified in the study; 8132 (7.1%) were Hispanic, 12669 (11.1%) were non-Hispanic Black, 85995 (75.5%) were non-Hispanic White, and 7089 (6.2%) were non-Hispanic other. 31720 (27.9%) patients were diagnosed with laryngeal cancer, 49850 (43.8%) were oral cavity cancer, and 32315 (28.4%) were pharyngeal cancer. In patients with HNC, Hispanic race was associated with poor median OS and 5-year overall survival rate compared with non-Hispanic White (72 vs. 80 months; 53% vs. 56%; P < 0.0001). In the propensity score matched sample, a poorer OS for Hispanic patients versus non-Hispanic White patients was obtained (HR, 1.09; 95% CI, 1.01-1.16; P = 0.021). Inferior median OS and 5-year overall survival rate remained associated with Hispanic race (compared with non-Hispanic White: 64 months vs. 78 months; 51% vs. 55.6%; P < 0.0001).

Conclusions: Hispanic race was associated with poor OS and disease-specific survival in HNC patients. A series of prognostic factors resulting in inferior survival were found in Hispanic HNC patients.

Table of Contents

1. INTRODUCTION........................................................................................................... 1

1.1 Problem Statement......................................................................................... 1

1.2 Purpose Statement.......................................................................................... 2

1.3 Significance Statement.................................................................................. 2

2. BACKGROUND/LITERATURE REVIEW.................................................................. 3

Study Topic: Head and Neck Cancer in Hispanic Population.......... 3

2.1 Head and Neck Cancer Overview........................................................................ 3

2.2 Prognosis and Treatment..................................................................................... 5

2.3 Influence of Race/Ethnicity................................................................................ 6

Statistical Method: Propensity Score....................................................... 7

2.4 Overview.................................................................................................................. 7

2.5 Methodological decisions................................................................................... 7

2.6 Propensity Score Estimation for Multiple Treatments............................... 11

3. MATERIALS & METHODS........................................................................................ 13

3.1 Study Design......................................................................................................... 13

3.2 Statistical Analysis............................................................................................ 14

4. RESULTS...................................................................................................................... 17

5. DISCUSSION............................................................................................................... 22

5.1 Implications.......................................................................................................... 24

5.2 Strengths and Limitations................................................................................. 25

5.3 Recommendations................................................................................................ 26

REFERENCES.................................................................................................................. 27

Appendix: TABLES AND FIGURES........................................................................... 30

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