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Prognostic Impact of Socioeconomic Status Compared to Overall Stage for HPV-Negative Head and Neck Squamous Cell Carcinoma


Lenze, Nicholas R.; Farquhar, Douglas R.; Sheth, Siddharth; Zevallos, Jose P.; Lumley, Catherine; Blumberg, Jeffrey; Patel, Samip N.; Hackman, Trevor G.; Weissler, Mark Christian; & Yarbrough, Wendell G., et al. (2021). Prognostic Impact of Socioeconomic Status Compared to Overall Stage for HPV-Negative Head and Neck Squamous Cell Carcinoma. Oral Oncology, 119, 105377. PMCID: PMC8573717


OBJECTIVE: To estimate the relative prognostic ability of socioeconomic status (SES) compared to overall stage for HPV-negative head and neck squamous cell carcinoma (HNSCC).
MATERIALS AND METHODS: Data were obtained from the Carolina Head and Neck Cancer Epidemiology Study (CHANCE). An empirical 4-category SES classification system was created. Cox proportional hazards models, survival gradients, Bayesian information criterion (BIC), and Harrell's C index were used to estimate the prognostic ability of SES compared to stage on overall survival (OS).
RESULTS: The sample consisted of 1229 patients with HPV-negative HNSCC. Patients with low SES had significantly increased risk of mortality at 5 years compared to patients with high SES (HR 3.11, 95% CI 2.07-4.67; p < 0.001), and the magnitude of effect was similar to overall stage (HR 3.01, 95% CI 2.35-3.86; p < 0.001 for stage IV versus I). Compared to overall stage, the SES classification system had a larger total survival gradient (35.8% vs. 29.1%), similar model fit (BIC statistic of 7412 and 7388, respectively), and similar model discriminatory ability (Harrell's C index of 0.61 and 0.64, respectively). The association between low SES and OS persisted after adjusting for age, sex, race, alcohol, smoking, overall stage, tumor site, and treatment in a multivariable model (HR 2.96, 95% CI 1.92-4.56; p < 0.001).
CONCLUSION: SES may have a similar prognostic ability to overall stage for patients with HPV-negative HNSCC. Future research is warranted to validate these findings and identify evidence-based interventions for addressing barriers to care for patients with HNSCC.


Reference Type

Journal Article

Year Published


Journal Title

Oral Oncology


Lenze, Nicholas R.
Farquhar, Douglas R.
Sheth, Siddharth
Zevallos, Jose P.
Lumley, Catherine
Blumberg, Jeffrey
Patel, Samip N.
Hackman, Trevor G.
Weissler, Mark Christian
Yarbrough, Wendell G.
Olshan, Andrew F.
Zanation, Adam M.

Article Type




Data Set/Study

Carolina Head and Neck Cancer Epidemiology Study (CHANCE)


United States of America




Olshan - 0000-0001-9115-5128