Sex-Specific Survival and Treatment Delay in Oropharyngeal Squamous Cell Carcinoma

Sandhya Kalavacherla; Solene Poulhazan; Emily Funk; Assuntina G Sacco; Theresa Guo

doi:10.1002/ohn.795

Sex-Specific Survival and Treatment Delay in Oropharyngeal Squamous Cell Carcinoma

Otolaryngol Head Neck Surg. 2024 Apr 28. doi: 10.1002/ohn.795. Online ahead of print.

Authors

Sandhya Kalavacherla¹, Solene Poulhazan², Emily Funk^{1

3}, Assuntina G Sacco^{2

4}, Theresa Guo^{1

2}

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, UC San Diego Health, La Jolla, California, USA.
² Moores Cancer Center, UC San Diego Health, La Jolla, California, USA.
³ Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
⁴ Department of Internal Medicine, Division of Hematology-Oncology, UC San Diego Health, La Jolla, California, USA.

PMID: 38678390
DOI: 10.1002/ohn.795

Abstract

Objective: As the majority of oropharyngeal squamous cell carcinoma (OPSCC) is diagnosed in males, outcomes among females are not well-characterized. We identify sex-specific factors in OPSCC to refine female prognostication.

Study design: Retrospective cohort.

Setting: National Cancer Database (NCDB).

Methods: OPSCC cases from the 2004 to 2019 NCDB were identified. Sociodemographic, clinical, and treatment characteristics (including timing between diagnosis and treatment administration) were compared between sexes. Multivariable Cox proportional hazard regression models were constructed to characterize survival in overall and female-only cohorts. Similar multivariable binomial logistic regression and survival models were constructed to assess odds of treatment delays and their effects on survival, respectively.

Results: A total of 192,973 OPSCC patients were identified; 36,695 (19%) were female. Females had more human papillomavirus (HPV) negative, lower clinical T and N stage, and higher comorbidity disease. Females experienced lower survival in HPV negative (hazard ratio, HR = 1.11, P < .001) but not HPV-positive disease. Females were more likely to have any treatment initiated over the median of 28 days (odds ratio, OR = 1.04, P = .014) or delays in adjuvant radiotherapy initiation over 6 weeks (OR = 1.11, P = .032). Treatment delay over 60 days (HR = 1.17, P = .016) and delay in adjuvant therapy initiation (HR = 1.24, P = .02) were associated with worse survival among females.

Conclusion: In one of the largest analyses of OPSCC, females had poorer survival than males, specifically in HPV-negative disease, despite presentation with less advanced disease. Notably, delays in any treatment initiation and adjuvant radiotherapy initiation were more likely in HPV-negative women and associated with worse survival, highlighting potential systemic weaknesses contributing to poor prognosis among females.

Keywords: head and neck squamous cell carcinoma; human papillomavirus; oropharyngeal squamous cell carcinoma; sex‐based disparities; treatment delay; unknown primary.