Systematic review and meta-analysis of racial survival disparities among oropharyngeal cancer cases by HPV status

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 Clinicaltrials.gov. 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 (I² = 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.