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.
METHODS: Retrospective cohort.
METHODS: 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.
CONCLUSIONS: 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.
METHODS: Retrospective cohort.
METHODS: 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.
CONCLUSIONS: 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.
摘要：
目的：由于大多数口咽鳞状细胞癌（OPSCC）被诊断为男性，女性的结局没有得到很好的表征。我们确定了OPSCC中的性别特异性因素，以改善女性预后。
方法：回顾性队列。
方法：国家癌症数据库（NCDB）。
方法：确定了2004年至2019年NCDB的OPSCC病例。社会人口统计学，临床,和治疗特征(包括诊断和治疗给药之间的时间安排)在性别之间进行比较。构建多变量Cox比例风险回归模型来表征总体和仅女性队列的生存率。构建了类似的多变量二项逻辑回归和生存模型来评估治疗延迟的几率及其对生存的影响。分别。
结果：共确认192,973名OPSCC患者；36,695名（19%）为女性。女性有更多的人乳头瘤病毒（HPV）阴性，较低的临床T和N分期，和更高的合并症。女性在HPV阴性时生存率较低(风险比，HR=1.11，P<.001），但不是HPV阳性疾病。女性更有可能在28天的中位数内开始任何治疗(比值比，OR=1.04，P=.014）或辅助放疗开始延迟超过6周（OR=1.11，P=.032）。超过60天的治疗延迟（HR=1.17，P=0.016）和辅助治疗开始延迟（HR=1.24，P=0.02）与女性生存率较差相关。
结论：在OPSCC的最大分析之一中，女性的存活率比男性差，特别是在HPV阴性疾病中，尽管表现为较不晚期的疾病。值得注意的是,任何治疗开始和辅助放疗开始的延迟在HPV阴性女性中更有可能发生,并且与较差的生存率相关,强调导致女性预后不良的潜在系统性弱点。
方法：回顾性队列。
方法：国家癌症数据库（NCDB）。
方法：确定了2004年至2019年NCDB的OPSCC病例。社会人口统计学，临床,和治疗特征(包括诊断和治疗给药之间的时间安排)在性别之间进行比较。构建多变量Cox比例风险回归模型来表征总体和仅女性队列的生存率。构建了类似的多变量二项逻辑回归和生存模型来评估治疗延迟的几率及其对生存的影响。分别。
结果：共确认192,973名OPSCC患者；36,695名（19%）为女性。女性有更多的人乳头瘤病毒（HPV）阴性，较低的临床T和N分期，和更高的合并症。女性在HPV阴性时生存率较低(风险比，HR=1.11，P<.001），但不是HPV阳性疾病。女性更有可能在28天的中位数内开始任何治疗(比值比，OR=1.04，P=.014）或辅助放疗开始延迟超过6周（OR=1.11，P=.032）。超过60天的治疗延迟（HR=1.17，P=0.016）和辅助治疗开始延迟（HR=1.24，P=0.02）与女性生存率较差相关。
结论：在OPSCC的最大分析之一中，女性的存活率比男性差，特别是在HPV阴性疾病中，尽管表现为较不晚期的疾病。值得注意的是,任何治疗开始和辅助放疗开始的延迟在HPV阴性女性中更有可能发生,并且与较差的生存率相关,强调导致女性预后不良的潜在系统性弱点。
