Systematic review and meta-analysis of racial survival disparities among oropharyngeal cancer cases byHPVstatus

Background There is a well documented racial disparity in overall survival for oropharyngeal squamous cell carcinoma (OPSCC); however, it is unknown to what extent this disparity varies by HPV-status. Methods A literature search was conducted through December 2019 using Ovid Medline, Cochrane Library, Embase, Scopus, and . PRISMA guidelines were followed. A meta-analysis was conducted using random effects models to obtain pooled hazard ratios (HRs). Results Of 649 studies initially identified, 20 studies met criteria for the narrative review. There were four studies evaluating survival by race in HPV-positive OPSCC and five studies in HPV-negative OPSCC suitable for pooling. The pooled HR associated with black race was 1.10 (95% CI 0.96-1.23) among patients with HPV-positive (n = 23 608) and 1.50 (95% CI 1.12-1.88) among patients with HPV-negative (n = 12 112). There was notable heterogeneity (I-2= 83%) and publication bias among the HPV-negative OPSCC studies. Conclusions The racial disparity in OPSCC survival persists for HPV-negative disease and is nonsignificant for HPV-positive disease. Unmeasured differences in socioeconomic status and access to care may contribute to this disparity.