Abstract B86: Head and neck squamous cell carcinoma and disparities: A model for early detection.

Introduction: Oral cancer is a multifactorial disease marked by racial and economic disparities. The burden of oral cancer is greater for African Americans (AA) than for Whites (W) with both incidence and disease-specific mortality higher in AA. Soluble CD44 (solCD44) and total protein may be useful diagnostic markers for HNSCC. In this preliminary analysis we combine solCD44 and total protein with demographic data to derive a multivariate logistic model for oral cancer prediction.

Methods: Subjects included 150 oral cancer patients (25 AA, 124 W, 1 other) and 148 control patients (31 AA, 116 W, 1 other) recruited equally from University of Miami Hospital and Clinics (UMHC) and Jackson Memorial Hospital (JMH), a county hospital serving primarily low-income patients. An additional reference control group included 129 AA controls from Liberty City (LC), an impoverished community in north Miami-Dade County. We compared patient groups with respect to the distribution of potentially important covariates using the chi-square, Fisher's exact test, or t-test. Markers' mean levels were compared either by t-test or ANOVA, followed by pairwise multiple comparisons. Logistic regression analysis was used to evaluate predictivity of the salivary markers univariately and multivariately with adjustment for demographics. We report odds ratio (OR) estimates with corresponding 95% confidence interval (95% CI) and area under the curve (AUC) of the operating characteristic curve (ROC) for fitted models.

Results: The case-control groups did not differ in regards to age, gender, race, ethnicity, history of ever smoking, current alcohol use or county versus private hospital system. Within AA, LC controls did differ significantly from UMHC and JMH controls in regards to age (LC were younger, p=.022) and ethnicity (LC had less Hispanics, p=.013). With respect to log2CD44 and protein, there were no significant mean differences between UMHC/JMH Lip/oral cavity (Lip/OC) and oropharynx (OP) cases, however means of either subset of cases (p<0.03), as well as all cases (p<.0001), were significantly higher than for UMHC/JMH controls. Similarly, within AA, the overall group and both the Lip/OC and OP tumor groups had significantly higher marker levels than the 31 UMHC/JMH controls and 129 LC controls for both control groups (log2CD44 and protein, p<.0001). Significant between case group differences were seen in all cancer patients for log2CD44 by stage (III/IV higher than I/II), tumor (T4 higher than T0-T3) and node status (N1-N3 higher than N0, Nx) at p<.05. Neither levels of log2CD44 or protein showed significant differences with respect to p16 staining (surrogate for HPV status) in cancer patients. However, race and gender did have an effect on protein levels (p=.045 and p=.033, respectively). Models were better for men compared to women and AA compared to Whites. The best model included male AA cases versus male AA LC controls (AUC=0.983).

Conclusions: Our preliminary data on AA underserved populations show great promise for detecting HNSCC. In addition, our findings strongly suggest that solCD44, protein, race, gender and age are very important components for HNSCC early detection studies.

Citation Format: Lutecia H. Mateus Pereira, Isildinha Reis, Robert Duncan, Judy Wen, Erika Reategui, Laurian Walters, Aymee Perez, Elizabeth J. Franzmann. Head and neck squamous cell carcinoma and disparities: A model for early detection. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B86.