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The effect of posterior spinal fusion (PSF) incorporating the pelvis on an ambulatory patient's ability to mobilize after the fusion is not well understood.To see whether a posterior spinal fusion with pelvic fixation using iliac or sacral alar iliac screws in ambulatory neuromuscular scoliosis (NMS) patients influences postoperative ambulatory ability.A retrospective review of all patients with NMS that underwent PSF with fixation incorporating the pelvis between January 1, 2012 and February 29, 2019. A total of 118 patients were eligible, including 11 ambulatory patients. The primary outcome was the maintenance of ambulatory status postoperatively. Secondary outcomes included postoperative curve magnitude, pelvic obliquity, and complications, comprising infections, instrumentation failure, and any unplanned returns to the operative room.The ambulatory function was maintained in all 11 ambulatory NMS patients. One patient had an improvement in functional status with equipment-free ambulation postoperatively. An average postoperative follow-up was 19 mo. The overall complication rate was 19.4% (Spinal fusion to the pelvis in ambulatory patients with NMS provides effective deformity correction without the reduction in ambulatory capabilities.

Orthopaedic surgery is the least diverse surgical subspecialty in medicine. However, to date, there is no literature that shows which medical schools have successfully contributed to improving orthopaedic surgeon diversity.The purpose of this study is to identify the top U.S. medical schools that have successfully matched black applicants into orthopaedic surgery residencies and juxtapose this ranking to the current top medical schools as ranked by the U.S. News and World Report (USNWR).The J. Robert Gladden Orthopaedic Society (JRGOS) database was queried for all orthopaedic surgeons, fellows, and residents who identified as black or multi-racial with black being one of the included races, yielding 938 physicians, of which 672 met our inclusion criteria. From this list, a ranking of the top 20 medical schools was generated.The top five medical schools ranked in the JRGOS database are Howard University College of Medicine (HUCOM), Meharry Medical College, Harvard Medical School (HMS), the University of Pennsylvania, and Morehouse School of Medicine (MSM). In addition, 10 (50%) of the medical schools ranked in the top 20 by the JRGOS database were also ranked by the USNWR. When ranking medical schools for black female applicants, HUCOM, MSM, HMS are the top three programs. Lastly, a ranking by region identified that the northeast contained the highest number of ranked medical schools.There are both historically black and non-historically black medical schools which have a proven track record of producing a significant number of future black orthopaedic surgery residents.

Kaposi Sarcoma (KS) is a Human Herpes Virus-8 (HHV-8) associated angio-proliferative disorder commonly seen in patients with HIV. It most commonly involves the skin as classic purple lesions but occasionally involves the gastrointestinal (GI) tract. To date, published data is scarce on primary GI KS. Using a national database, this study analyzes the incidence, demographics, and survival of primary GI KS. We conducted a retrospective analysis (1975-2019) on biopsy-proven primary GI KS cases from 17 registries from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database. A total of 685 patients with GI KS were identified. Female gender, Non-Hispanic Asian or Pacific Islander (NHAPI), married marital status, and large bowel site-specific primary KS to have better overall survival. Luminal gastrointestinal KS was more frequent (84.96%) than solid organ involvement (3.07% of all cases). This study is the most extensive population-based study about the epidemiological and survival data of patients with primary GI KS, revealing GI KS to be a young male disease with best outcomes in the large bowel and anal canal KS while inferior outcomes in extraintestinal GI KS.

Purpose The purpose of this study is to assess the current status of gender disparities in academic radiation oncology departments in the United States and the associated factors. Methods and Materials The data were collected from publicly available resources, including websites of individual radiation oncology programs, the Fellowship and Residency Electronic Interactive Database, the Accreditation Council for Graduate Medical Education, and the Association of American Medical Colleges. We collected data on the gender information of residents in each year (postgraduate years 2-5) and of the faculty (attendings, program director, and chair) during the academic year 2018 to 2019. Spearman’s rho test, Pearson’s chi-squared test, and Fisher exact tests were used for evaluating the correlation among variables using SPSS version 24. Results Women constituted 30.8% of radiation oncology residents in the United States in 2019. Eight programs (12.5%) did not have any female residents in their programs, whereas 6 programs (9%) had women constituting more than half of their resident class. The fraction of female medical students applying to radiation oncology over the last 7 years varied between 27% and 33%. Female attending physicians accounted for 30.5% of all the attending physicians in the academic programs. In the leadership positions of the department, the gender gap was wider where only 19 (20%) and 11 (12%) of programs had female program director or chair, respectively. There was a positive correlation between the number of attending physicians and the number of female residents in programs (P = .01). Conclusions A significant gender disparity continues to exist among the residents and physicians in the academic radiation oncology departments in the US. This disparity is pronounced in the leadership positions. The results of this study could be used as a benchmark to evaluate the progress that has been made by the efforts to improve gender disparities in radiation oncology.

There are limited data available regarding the management of oligometastatic squamous cell carcinoma of the head and neck (SCCHN) patients, and no consensus guidelines are available. The objective is to review the available literature for the management of oligometastatic SCCHN. Articles were selected from English Medline literature between 1995 and 2018, searched by using the keywords: oligometastatic SCCHN/metastasectomy/stereotactic body radiation treatment (SBRT). With the available data, oligometastatic SCCHN patients appear to behave differently and tend to have a better prognosis than those with widespread metastases. Retrospective evidence suggests that the aggressive treatment of the primary disease and local treatment of the metastatic sites improves survival in oligometastatic SCCHN at diagnosis. The definitive treatment of the distant metastatic sites using metastasectomy or SBRT correlates with better survival in oligorecurrent patients. Oligometastatic SCCHN patients may have a better prognosis if treated aggressively.

This study aims to determine the prevalence of metabolic disturbance in all fracture nonunion cases and identify the most common endocrine abnormalities seen using a simple screening algorithm.A retrospective review study was performed evaluating patients who underwent operative intervention for nonunion from January 2010 to December 2018 at 2 level-1 trauma centers. Preoperative laboratory values were recorded for a 9-test "nonunion panel." A metabolic or endocrine abnormality, specifically an abnormality in the thyroid or parathyroid axis, was evaluated.42% of patients had an undiagnosed metabolic laboratory abnormality. When multiple tests were used, the rate of metabolic dysfunction was between 60% and 75%, depending on the definition of vitamin D insufficiency vs deficiency used.Results indicate a relatively high prevalence of metabolic disturbance in patients with nonunion and suggest metabolic screening for all nonunion patients not only those without a mechanical or infectious cause.IV, retrospective case series.

BACKGROUND Obesity rates continue to rise among children and adolescents across the globe. A multicenter research consortium composed of institutions in the Southern US, located in states endemic for childhood obesity, was formed to evaluate the effect of obesity on pediatric musculoskeletal disorders. This study evaluates the effect of body mass index (BMI) percentile and socioeconomic status (SES) on surgical site infections (SSIs) and perioperative complications in patients with adolescent idiopathic scoliosis (AIS) treated with posterior spinal fusion (PSF). METHODS Eleven centers in the Southern US retrospectively reviewed postoperative AIS patients after PSF between 2011 and 2017. Each center contributed data to a centralized database from patients in the following BMI-for-age groups: normal weight (NW, 5th to

Introduction Extracapsular extension (ECE) in the lymph nodes for patients with head and neck cancer has been found to be a poor prognostic factor in multiple studies. The purpose of the study is to evaluate the predictive factors for ECE on computer tomography (CT) imaging for patients undergoing surgery and to analyze outcomes. Methods We conducted an Institutional Review Board-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective review of 82 patients with biopsy-proven squamous cell carcinomas of the head and neck who underwent definitive surgery without neoadjuvant chemotherapy or radiation therapy. CT scans were evaluated for the level of involvement, size, and presence or absence of central necrosis. Extracapsular extension in lymph nodes on the postoperative pathology was correlated with the central necrosis in the lymph nodes appreciated on the CT neck with contrast. Survival estimates were evaluated using the Kaplan-Meier test. Results ECE on postoperative pathology was seen in 74.07% of patients who had evidence of central necrosis in lymph nodes on preoperative CT neck compared to 46.43% without CT necrosis (p=0.013). The incidence of ECE is higher in poorly differentiated tumors and also nodal stages >N2c at presentation. Patents with ECE had inferior disease-free and overall survival (OS). Conclusions Our results reveal that patients with necrosis on CT and with moderately to poorly differentiated tumors have a high incidence of extracapsular extension. There was no difference in local control (LC) between the groups of patients, but the OS was inferior in patients with ECE. Predicting extracapsular extension upfront helps to formulate the appropriate treatment. We propose to study additional chemotherapy to improve outcomes in patients with positive extracapsular extension.

Effective education of orthopedic residents requires an understanding of how they process information. To date however no literature has described resident learning styles based on the updated Kolb Learning Style Inventory (KLSI) v4.0. The purpose of this study is to identify common learning styles amongst orthopedic residents and attendings and evaluate the effect that race, gender, and resident/attending status have on learning styles.The KLSI v4.0 and a demographic survey were distributed to 103 orthopedic attendings and residents at two academic centers during the 2019 to 2020 academic year. Frequencies and descriptive statistics were reported. Learning styles based on gender, race, attending versus resident status, and institution were evaluated. A p-value0.05 was considered significant.This is a multi-center study performed at two academic, university based orthopedic surgery departments.Orthopaedic surgery residents and attending surgeons.At both institutions, the combined response rate for the KLSI v4.0 was 66% and 68% for the demographic surgery. The three most common learning styles recorded were: Deciding (26.5%), Acting (17.6%), and Thinking (17.6%). Learning styles were compared by gender, race, attending and/or resident status, and institution with no statistically significant difference found between any of the comparisons (p0.05).The majority of orthopedic surgeons have Deciding, Acting, or Thinking learning styles, which are categorized by motivation to achieve goals, disciplined and logical reasoning, and the use of theories and models to solve problems. However, not all residents and attendings utilize these common learning styles. A mismatch in learning styles between residents and attendings could result in poor educational experiences. Understanding the learning styles of orthopedic surgeons has implications for improving evaluation interpretation, mentorship pairing, quality of life, and resident remediation.

Background: Obese patients with adolescent idiopathic scoliosis (AIS) have been shown to present with larger curve magnitudes preoperatively. However, the effect of obesity on shoulder balance in AIS remains unknown. The purpose of our study was to determine if overweight and obese patients with AIS have worse radiographic shoulder balance on initial presentation when compared with normal weight patients. Methods: AIS patients Results: One hundred eighty-four patients (116 [63%] normal weight and 68 [37%] overweight/obese) were included. The mean age at surgery was 13.1 ± 2 years, and mean follow-up was 17.4 ± 13 months. Preoperative shoulder imbalance was significantly greater in the overweight/obese group compared to the normal weight group (1.9 ± 1 cm vs. 1.5 ± 1 cm, p = 0.04). The odds ratio of presenting with unbalanced shoulders was 2.0 (95% CI: 1.02–3.83, p = 0.04) for the overweight/obese group. No significant differences were found for postoperative shoulder balance, UIV selection, or major curve correction. Conclusions: Overweight and obese patients with AIS are twice as likely to present with unbalanced shoulders preoperatively; however, this difference is not clinically relevant with a mean difference of 0.4 cm between cohorts. Finally, the preoperative BMI percentile did not show a significant effect on the chosen UIV or curve magnitude correction. Level of Evidence: Level III: this is a retrospective case-control study.

Objective To identify racial disparities in survival outcomes among Stage III & IV patients with squamous cell carcinomas (SCCa) of the oropharynx treated with definitive radiation therapy (RT), with concurrent chemotherapy. Method This is a retrospective analysis of patients with stage III & IV SCCa of oropharynx treated with definitive RT at the State Academic Medical Center. All patients were treated to 70 Gy utilizing intensity-modulated radiation treatment (IMRT), and received concurrent chemotherapy with weekly cisplatin or cetuximab. Chi-square test was used to test the goodness of fit, overall survival (OS), and locoregional control (LRC) comparing races were generated by using Log-rank test & Kaplan-Meier method. The covariables associated with the OS and LRC were determined by the Cox regression model. A p-value of less than 0.05 was considered statistically significant. The SPSS 24.0 software (IBM Corp., Armonk, NY) was used. Results In the total 73 eligible patients, 54.8% were black, and 45.2% white patients. Stage distribution (per American Joint Committee on Cancer-AJCC 8th Ed) between black patients vs. white patients, Stage III (45.5% vs. 54.5%) and for Stage IV (56.5% vs. 43.5%); p=0.499. Median follow-up for the entire group was 41 months (range: 4-144 months). In the univariate analysis, variables p16 status, body mass index (BMI), alcohol history and tumor subsite were found to be significant. In the multivariate analysis, only BMI has shown to be significant. Three-year LRC for black patients was 37.8% vs.66.8% in white patients (p=0.354) and three-year OS for black patients was 51.8% vs. 80.9% for white patients (p=0.063), respectively. Five-year OS for p16 positive patients was 69.7% vs. 43% for p16 negative patients (p=0.034). Five-year OS for Stage IV black patients was 34% vs. 69.5% for Stage IV white patients (p=0.014). Conclusion Among all the co-variables examined, only BMI has shown affecting the OS outcomes; gender and BMI shown to be affecting the LRC. Racial factor appears to be significant in Stage IV patients.

Objective The purpose of this study was to identify racial disparities in treatment outcomes, if any, among patients with carcinoma of the cervix treated at a tertiary care institution in the state of Mississippi. Methods A retrospective review of patients with carcinoma of the cervix treated in the Department of Radiation Oncology at our institution between 2010 and 2018 was performed. Data regarding demographics, disease stage, treatments administered, and follow-up were collected. Patient outcomes, including median survival and overall survival, were analyzed using the Kaplan-Meier method. All analyses were performed using SPSS Statistics version 24 (IBM, Armonk, NY). Results Between January 2010 and December 2018, a total of 165 patients with carcinoma of the cervix were treated at our institution. We had a significantly higher proportion of African American (AA) compared to Caucasian American (CA) patients (59.4 vs. 36.4%; p=0.03). There was a significant difference in the disease stage at the time of presentation between AA and CA in that compared to AA women, a higher number of CA patients presented with locally advanced disease [Federation of Gynecology and Obstetrics (FIGO) stages IB2 to IVA] (78.6 vs. 86.7%; p

Introduction This study attempted to identify disparities in outcomes between African American (AA) and Caucasian American (CA) patients treated for hypopharyngeal carcinoma at a tertiary care institution over the past 25 years. Methods An institutional review board (IRB)-approved and Health Insurance Portability and Accountability Act (HIPPA)-compliant retrospective analysis was performed on patients with squamous cell carcinoma of the hypopharynx treated at our institution between January 1994 and December 2018. Data regarding demographics, stage, treatment, and follow-up were collected. Outcomes, including median survival and overall survival, were calculated using the Kaplan-Meier method. All analyses were performed using the Social Packages for the Social Sciences (SPSS) v. 24 (IBM Corp., Armonk, NY). Results We identified 144 hypopharyngeal carcinoma patients who were treated during this period. Our patient cohort consisted of 61.8% AA and 35.4% CA (P=0.538). Overall, 96% of them presented at an advanced stage (Stages III & IV) of the disease, and only 4% presented in the early stages (Stages I & II). There was no significant difference between AA and CA patients who presented with advanced disease (96.6% vs. 94.1%). In our patient cohort, 15.3% of patients did not receive any therapy; however, 51.4%, 22.9%, and 10.4% of them underwent definitive chemoradiotherapy, definitive surgery, or palliative chemotherapy, respectively. There were no significant differences in patient racial proportions within each treatment group. The median follow-up of the entire cohort was 13 months. There was no significant difference between the median survival of AA and that of CA patients (16 months vs. 15 months; p=0.917). Moreover, there was no significant difference in the overall survival between AA and CA patients at three years (27.2% vs. 36.3%; p=0.917) and five years (20.4 % vs. 16.7 %; p=0.917). Conclusions A retrospective review of patients with hypopharyngeal cancer treated at our institution over the previous 25 years did not identify significant racial disparities regarding the stage at presentation or prognosis. This study suggests that when patients have equal access to care, they appear to have a similar prognosis despite racial differences. Further studies are needed to validate this hypothesis.

The purpose of this research was to assess the existing variations in the residency training resources among radiation oncology (RO) residency programs in the United States. We queried each residency program website and Fellowship Residency Electronic Interactive Data Access System website (www.freida.ama-assn.org) to obtain information on faculty and available treatment modalities. The data were continuously updated, most recently as of April 30, 2019. A total of 94 RO residency programs were identified during the academic year 2018-2019, and data were collected. The median number of attending physicians was 13 (range, 4 -71). The median number of physicists and biologists were 9 and 3, respectively. The conventional techniques, including 3 dimensional conformal radation therapy, intensity modulated radiation therapy, electron therapy, and stereotactic body radiation therap/stereotactic radiosurgery, were available in all residency programs. In terms of specialized external beam radiation therapy machines, gamma knife, CyberKnife, and magnetic resonance imaging (MRI) linear accelerator were available in 49 (52%), 21(22%), and 7 (8%) programs, respectively. Only 19 programs (20%) had in-house proton therapy availability; however, 37 programs (39%) offered proton therapy training via resident rotation at an affiliated institution. Prostate, gynecologic, and breast brachytherapy were available in 81 (86%), 82 (87%), and 58 (62%) programs, respectively. Eighty-one (86%) programs reported to have high dose rate, and only 20 (21%) programs had low dose rate brachytherapy. Our study found that marked variations exist among RO residency programs in the United States during academic year 2018-2019 and will serve as a baseline for future intervention.

Background The survival of patients with B-acute lymphoblastic leukemia (B-ALL) is significantly lower in African American (AA) children compared with European American children (EA). Here, we present a whole exome sequencing (WES) study showing race-specific genetic variations that may play a role on the disparate outcomes among AA and EA children with B-ALL. Patients and Methods Five AA and 15 EA patients ranging in age from 1 to 18 years were enrolled. The median blast percentage was 94.8% (range, 64.5%-99.9%). Frozen bone marrow aspirate was used to extract DNA, and WES was performed, focusing on race and B-ALL-specific germline mutations. Results Most genetic variants (n = 339) were shared between AA and EA children. Some genetic aberrations were only uniquely identified in AA (n = 58) and others in EA (n = 52) In AA, the genetic aberrations clustered in canonical pathways related to telomerase signaling and cancer signaling. In EA, the unique genetic aberration clustered in pathways related to stem cell pluripotency and hereditary cancer. Conclusions Our study revealed aberrant genetic aberrations in signaling networks that may contribute to race-specific aspects of leukemogenesis. Our results suggest the value of WES as a tool for development of individual gene signatures and gene scores for AA and EA children afflicted by B-ALL. These findings may ultimately impact disease management and contribute to the elimination of disparate outcomes in AA children with B-ALL.

OBJECTIVE To identify differences in 3-year overall survival (OS) and disease-free survival (DFS) based on race in patients with tonsillar squamous cell carcinoma. METHODS We retrospectively analyzed 80 patients with squamous cell carcinoma of the tonsil treated between 2006 and 2015. Overall survival and DFS curves comparing white and black patients were generated using the Kaplan-Meier method. Cox regression was used to determine covariables associated with OS and DFS. RESULTS Forty-one percent of the patients in this cohort were black and 59% were white. Three-year OS for black patients was 45.5% versus 88.1% for white patients (P = 0.003). Three-year DFS for black patients was 41.1% versus 66.6% in white patients (P = 0.001). Black race (hazard ratio [HR] 4.81, 95% confidence interval [CI] 1.48-15.6, P = 0.009) and lack of insurance (HR 9.50, 95% CI 2.92-13.0, P

In-111 pentetreotide (Octreoscan) is a radiolabeled somatostatin analog with high binding affinity to somatostatin receptors (SSTR) used in somatostatin receptor scintigraphy (SRS). Pentetreotide labelled with In-111 is widely used due to its high affinity to SSTR 2 and 5. SSTR are expressed on neuroendocrine cells as well as several non-neural and non-endocrine cells with varying levels of density. We retrospectively reviewed articles and publications related to octreoscan accumulation in sites that classically do not have high concentrations of SSTR as well as in organs and tissues from diseases which are not usually diagnosed by octreoscan. The significance of a positive uptake as assessed by octreoscan in non-somatostatin receptor related diseases is not fully understood yet. Localization of octreotide in non-oncological disease states such as inflammation is due to presence of SSTR in activated immunological cells, over-expression by activated cells in the respective tissue and SSTR expression by blood vessels. In granulomatous diseases, over-expression of SSTR2 preferential binding sites were detected in epitheloid and giant cells. The purpose of the current study is to identify octreoscan localization in non-somatostatin receptor related disease sites to better understand the mechanism of this nonspecific accumulation which may help expand the clinical utilization of functional imaging utilizing somatostatin receptor scintigraphy in diagnosis and perhaps therapy.

Background The purpose of this study was to present the outcomes of oropharyngeal cancers treated with intensity‐modulated radiotherapy (IMRT) especially the differences between tonsillar and base of tongue (BOT) primaries. Methods Retrospective analysis of 124 patients with biopsy proven squamous cell carcinomas of the oropharynx, treated with IMRT. Results Human papillomavirus (HPV) association correlated with improvement in survivals in both tonsillar and BOT primaries. At the 2‐year median follow‐up, the cumulative incidences of locoregional recurrences were 8% in both the tonsil and BOT groups (P = .76) but the distant metastases were 8% in the tonsil group versus 26% in the BOT group (P = .009). Thirty percent of tonsil primaries has ≥N2c neck disease as compared to 54% of BOT. Incidence of distant metastases increases with advanced nodal classification, especially >N2c. Conclusion Even though the locoregional controls are excellent with IMRT and chemotherapy, these patients continue to fail distantly, particularly significant for the BOT group and for nodal stage >N2c.

Introduction Due to conflicting data in the literature, there is a continuing debate on whether advanced hypopharyngeal carcinoma patients should be treated with definitive surgery or chemoradiotherapy. The purpose of this study is to evaluate the management and outcomes of advanced hypopharyngeal carcinoma in a tertiary care institution over the last 25 years. Methods An Institutional Review Board (IRB)-approved and HIPPA-compliant retrospective analysis was performed of patients with advanced-stage squamous cell carcinoma of the hypopharynx treated at our institution between January 1994 and December 2018. Data regarding demographics, stage, treatment, and follow-up were collected. Outcomes including median survival and overall survival were calculated using the Kaplan Meier method. All analyses were performed using SPSS v. 24. Results This study included a total of 103 advanced stage hypopharyngeal cancer patients. The median age for this cohort is 61 years (range: 41-88, SD 9.3). Of the total 103 eligible patients treated, 92 (89.3%) were male and 11 (10.7%) female; 61 (59.2%) were African Americans, 39 (37.9%) were Caucasians and three (2.9%) were other races. Seventeen patients (16.5%) had stage III disease, whereas 86 (83.5%) patients were diagnosed with Stage IV A or B disease. Seventy-two patients (69.9%) were treated with definitive chemoradiotherapy (ChemoRT group), and 31 patients (30.1%) underwent primary surgery with or without adjuvant treatments (Surgery group). The two treatment groups were similar in terms of age, gender, ethnicity, alcohol status, N staging, and subsites but were significantly different for smoking status (p = 0.035) and T staging (p = 0.024). The median follow-up was 17 months. The median survival of the overall cohort was 26 months, and five-year overall survival was 25.5%. The median survival was found to be significantly better for the surgery group as compared to the definitive chemoradiotherapy group (43 months vs 16 months, p = 0.049). The five-year overall survival (OS; 41.5% vs 18.5%, p = 0.049) and disease-free survival (DFS; 75.3% vs 56%; p = 0.029) were significantly better for patients in the surgery group compared to the chemoradiotherapy group. On multivariate Cox-regression analysis, lymph nodal status (HR = 1.27, CI: 1.00-1.62, p = 0.047) and chemoradiation treatment (HR = 1.82, CI: 1.00-3.29, p = 0.048) were associated with higher risk of mortality. Conclusion In our single institutional experience of advanced hypopharyngeal carcinoma management, the five-year overall survival rate was found to be 25.5 % and was the poorest among head and neck cancers. The patients with advanced hypopharyngeal cancer treated with surgery followed by adjuvant radiation or chemoradiation have significantly improved overall survival compared to those treated with definitive chemoradiotherapy. Further research warranted for early detection and better treatment to improve the cure rate in hypopharyngeal carcinoma patients.

Purpose: To assess the prognostic significance of tumor HPV/p16 status among oropharyngeal squamous-cell carcinoma (SCC) patients. Methods: A retrospective analysis of 80 patients diagnosed with oropharyngeal SCC between 2008 and 2018 at an academic medical center with known HPV/p16 status was performed. Pearson’s Chi-squared test was used to compare the proportional differences between the known tumor HPV status among positive and negative p16 staining groups. Kaplan- Meier analysis was used to estimate overall survival [OS] and local control [LC] between the HPV groups stratified by risk and compared using the log-rank test. Uni and multi-variable Cox hazard regression analyses were used to compare the risk of death among patients with HPV- positive and HPV- negative cancer. The SPSS v.24.0 was used for all statistical analyses. Results: Our patient cohort included 37.5% HPV- positive and 62.5% HPV-negative (median age, 61 y; range 45-86 y) patients. Patient groups were classified on the basis of risk factors: HPV/p16 status, pack-years [py] of tobacco smoking, and tumor stage into low (p16+, ≤ 10 py), intermediate (p16+, > 10 py/p16-, < 10 py), and high risk (p16-, > 10 py/ any T4), accounting for 36.7%, 36.7% and 26.7% of HPV-positive and 0%, 20% and 40% of HPV-negative patients, respectively (p=0.000). The median follow-up duration for this cohort was 34 months (range 0 to 154 months). The low risk HPV-positive group had better 5-year OS rates (87.5%, vs. 59.5% and 27.2%) compared to intermediate and high risk groups (p=0.003 by the log-rank test). After adjustment for gender, age, race, income level, distance travelled, tobacco exposure, alcohol history, tumor stage, and treatment modality, this group had a 63% reduction in the risk of death (hazard ratio, 0.37; 95% CI, 0.18-0.77; p= 0.008). Insurance and BMI was associated with a 71% reduction (hazard ratio, 0.29; 95% CI, 0.97-0.89; p=0.032), and a 49% reduction in the risk of death (hazard ratio, 0.51; 95% CI, 0.37-0.71; p=0.000), respectively. In terms of LC, the low risk HPV-positive patients had better 3-year rates 70.1%, vs. 55.7% and 39.9% compared to the intermediate and, high risk groups (p=0.379). Conclusion: Tumor HPV/p16 status may be an independent prognostic factor along with insurance status and BMI for overall survival among oropharyngeal SCC patients. Citation Format: Mary R. Nittala, Eswar K. Mundra, Ashley Albert, William C. Woods, Maria L. Smith, Robert D. Hamilton, Lana Jackson, Gina Jefferson, Satyaseelan Packianathan, Eldrin Bhanat, Varsha Manucha, Srinivasan Vijayakumar. Univariate and multivariate prognostic factors for overall survival among oropharyngeal cancer patients with known HPV/p16 status [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-232.

Objective: To study factors affecting outcomes such as overall survival (OS) and locoregional control (LRC), in patients with squamous cell carcinomas of oropharynx treated with definitive radiation therapy (RT), with or without concurrent chemotherapy. Method: Retrospective analysis of 83 patients with squamous cell carcinoma of oropharynx treated with definitive radiation therapy at University of Mississippi Medical Center. All patients were treated to 70 Gy utilizing intensity-modulated radiation treatment. Stage III and IV patients also received concurrent chemotherapy with weekly cisplatin. Chi-square test was used to test the goodness of fit, OS and LRC comparing races were generated by using log rank test and Kaplan-Meier method. The covariables associated with the OS and LRC were determined by multivariate Cox regression model. Hazards ratio (HR) was used to estimate time to event outcome with associated 95% confidence intervals (CIs) and P values. Median follow-up for the entire group was 39 months. Results: Of the total 83 eligible patients 51.8% were black, 48.5% were white, and 2.4% wee other. Stage distribution (per American Joint Committee on Cancer-AJCC 7th Ed) between blacks vs. whites for Stage I and II was 50% vs. 50%; for Stage III, 41.6% vs. 58.3%; and for Stage IV, 55.2% vs. 41.8%. In the univariate analysis, insurance, HPV/p16, body mass index (BMI), and race are the variables that affected the outcomes. In the multivariate analysis, HPV/p16, BMI, race, and tonsil subsite are shown to be significant. Age, gender, income level, employment, distance from facility, smoking, alcohol, and marital status are not shown to be significant. LRC for black patients was 49% vs. 72% in white patients (P = 0.022). Three-year OS for black patients was 49.2% vs. 66% for white patients (P = 0.010). HR for black patients was 0.13 with 95% CI 0.03- 0.61 (P= 0.009); HR for white patients was 0.24 with 95% CI 0.56- 1.06 (P= 0.061). OS for Stage IV black patients was 28% vs. 82% for white patients (P=0.006). In this cohort, HPV/p16 black positive patients were 75%, black negative 33%, white positive 87%, and white negative 50%, respectively. HR for HPV/p16 positive was 0.23 with 95% CI 0.07-0.71(P = 0.01). HR for tonsil subsite was 0.37 with 95% CI 0.15-0.91 (P=0.031). HR for BMI was 5.27 with 95% CI 1.79-15.5 (P = 0.003). The race, HPV/p16, BMI, and tonsil subsite were all independently associated with worse OS on multivariate analysis. HR for black patients was 0.16 with 95% CI 0.03-0.73 (P= 0.019), HR for HPV/p16 positive was 0.24 with 95% CI 0.07-0.73 (P = 0.013), HR for tonsil subsite was 0.41 with 95% CI 0.17-0.99 (P = 0.048), and HR for BMI was 5.59 with 95% CI 1.90-16.39 (P= 0.002). Race, HPV/p16, BMI, and tonsil subsite were all independently associated with worse locoregional failure on multivariate analysis. Conclusion: Among all the covariables examined, race, HPV/p16 status, BMI, and tonsil subsite were shown to be affecting the locoregional and overall survival outcomes. Racial factor appears to be more significant in patients with Stage IV disease. Citation Format: Mary R. Nittala, Eldrin Bhanat, Srinivasn Vijayakumar, Madhava R. Kanakamedala. Factors affecting outcomes in patients with squamous cell carcinoma of oropharynx [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr B21.

Introduction: The purpose of this study is to evaluate the incidence, management, and prognosis of hypopharyngeal carcinoma in a tertiary care institution over the past 25 years. Methods: We retrospectively analyzed patients from 1995 to 2019 from the head and neck cancer data base of our institution. The data regarding the demographics, stage, treatment, and follow-up were collected. Outcomes including median survival and overall survival were evaluated using the Kaplan Meier method. All analyses were performed using SPSS version 24. Results: We identified 144 hypopharyngeal carcinoma patients, and the incidence was almost 4% of all head and neck cancers. All patients had squamous cell carcinoma. Sixty-one percent of patients were African Americans and 36% were Caucasians. Ninety percent of the patients were males, and 10% were females. Pyriform sinus was the subsite most commonly affected (67%), followed by posterior pharyngeal wall (10%) and postcricoid area (5%). Ninety-six percent of patients presented with advanced-stage disease (stages III and IV), with only 4% of patients presenting with early-stage disease (Stages I and II). Fifty-one percent of patients underwent definitive chemoradiotherapy with or without induction chemotherapy and 23% of patients underwent surgical management, followed by adjuvant radiation or chemoradiation, depending on risk factors. Ten percent of patients received only palliative chemotherapy and 15% did not receive any treatments. Induction chemotherapy was used in 31% of patients prior to initiation of definitive chemoradiation treatment. The median overall survival of early-stage patients and of advanced-stage patients was 56 months and 15 months, respectively. The median survival of the patients with advanced-stage patients who received definitive treatment was 26 months. The patients who underwent definitive operative management followed by adjuvant treatments had an improved median survival as compared to those undergoing definitive chemoradiation treatment (38 months vs. 16 months, p=0.05). Similarly, the overall survival at 3 years (30% vs. 54%, p=0.05) and 5 years (13% vs. 34%, p=0.05) was also better for surgery patients. The patients who received induction chemotherapy had clinically worse median survival as compared to those who did not, but this was not statistically significant (14 months vs. 21 months, p=0.2). Conclusions: Our results agree with the published literature regarding the low incidence of hypopharyngeal cancer, presentation in advanced stages, and poor long-term outcomes. Selection of patients for laryngeal preservation should be done very carefully. Our results suggest that trimodality treatment may be more efficacious than definitive chemoradiotherapy for locally advanced disease. Future studies are warranted to evaluate if neoadjuvant chemoradiotherapy followed by surgery might be able to improve the current poor outcomes for advanced hypopharyngeal cancer patients who are not eligible for laryngeal preservation. Citation Format: Toms Vengaloor Thomas, Mary R. Nittala, Divyang Mehta, Madhava Rao Kanakamedala, Anu Abraham, Lacey Weatherall, Eldrin Bhanat, Ashley A. Albert, Srinivasan Vijayakumar. Hypopharyngeal carcinoma management: 25-year experience from a tertiary care medical center in United States [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr B20.

Introduction: The purpose of this study is to determine the likelihood of racial disparities between African American and Caucasian patients treated with hypopharyngeal carcinoma at a tertiary care institution over the last 25 years. Methods: HIPPA-compliant, IRB-approved retrospective analysis of patients with squamous cell carcinoma of the hypopharynx treated at our institution between January 1994 and December 2018 was performed. The data regarding the demographics, stage, treatment and follow up were collected. Outcomes including median survival and overall survival were evaluated using the Kaplan Meier method. All analyses were performed using SPSS version 24. Results: We evaluated 144 hypopharyngeal carcinoma patients who were treated during the time period. Our patient cohort consisted of 61.8% African Americans and 35.4% Caucasians (P= 0.538). Overall, 96% of patients presented with advanced stage disease (stages III & IV), and only 4% of patients presented with early stage disease (Stages I & II). There was no significant difference between African American and Caucasians who presented with advanced disease (96.6 % vs 94.1%). Among our patient cohort, 15.3% of patients didn’t receive any treatments, 51.4%, 22.9% and 10.4% of patients underwent definitive chemoradiotherapy, definitive surgery, and palliative chemotherapy respectively. There were no significant differences in each treatment group between the two races. The median follow up of the entire cohort was 13 months. There was no significant difference in the median survival of African American and Caucasian patients (16 months vs 15 months, p=0.917). In addition, there was no significant difference in the overall survival between African American and Caucasian patients at 3 years (27.2% vs 36.3%, p=0.917) or at 5 years (20.4% vs 16.7 %, p= 0.917). Conclusions: Retrospective review of the patients with hypopharyngeal cancer treated at our institution over the last 25 years did not reveal a significant racial disparity in regards to stage at presentation or prognosis. This study demonstrates that if patients have equal access to the care, they are likely to have similar prognosis despite racial differences. Further studies are warranted to validate this hypothesis. At the meantime, efforts should be focused on improving the access to medical care for the underserved population. Citation Format: Toms Vengaloor Thomas, Mary R Nittala, Teessa Perekattu Kuruvilla, Anu Abraham, Eldrin Bhanat, Satyaseelan Packianathan, Madhava Kanakamedala, Srinivasan Vijayakumar. Is there a racial disparity in the prognosis of hypopharyngeal carcinoma? 25-year experience from a tertiary care medical center in the United States [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D127.

Introduction: The purpose of this study was to evaluate the racial disparities among patients with carcinoma of cervix treated at a tertiary care institution. Methods: An IRB-approved and HIPPA-compliant retrospective analysis of patients with carcinoma of cervix was performed. All patients were treated in the department of Radiation Oncology at our institution between 2010 and 2018. Data regarding demographics, stage, treatment administered, and follow up were collected. Patient outcomes including median survival and overall survival were evaluated using the Kaplan Meier method. All analyses were performed using SPSS v. 24. Results: One hundred sixty-five patients with carcinoma of the cervix were treated between January 2010 and December 2018. We had significantly higher proportion of African American (AA) as compared to Caucasian Americans (CA) patients (59.4 % vs 36.4 %; p=0.03). There was a significant difference in stage at the time of presentation between African Americans and Caucasian Americans in that a higher number of CA patients presented with locally advanced disease, (FIGO Stages IB2 to IVA) as compared to AA (86.7 vs 78.6 %; p=0.000). Unfortunately, a higher number of African Americans presented with metastatic disease at diagnosis 13.3 % vs 8.3 % (p=0.000), as compared to Caucasian Americans. In regard to treatment, 157 (95.2 %) underwent definitive chemoradiotherapy while 3 (1.8 %) had definitive surgery, followed by adjuvant radiation or chemoradiation depending on the risk factors. The treatment details of 5 patients were not available. The median follow up and the median survival of the entire cohort was 16 months and 79 months, respectively. In our cohort, there was no significant difference in overall survival between AA and CA patients at 3 years (80 % vs 68 %; p=0.883) or at 5 years (77 % vs 68 %; p=0.883). As expected, patients with locally advanced disease showed a significantly improved median survival of 79 months as compared to 11 months for those with metastatic disease at their presentation (p=0.000). Conclusions: Retrospective review of the patients with carcinoma of the cervix treated at our institution over the last 8 years revealed a significant racial disparity in that more AA women presented with metastatic disease. However, our analysis did not identify any racial disparity in the prognosis of the whole cohort. Citation Format: Toms Vengaloor Thomas, Eldrin Bhanat, Shivanthidevi Gandhi, Teessa Perekattu Kuruvilla, Anu Abraham, Mildred Ridgway, Satyaseelan Packianathan, Srinivasan Vijayakumar. Racial disparities among patients with carcinoma of the cervix [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D126.

Background: A diagnosis of hypertension (HTN) has been reported to be associated with an increased risk of total and aggressive prostate cancer (PCa) in some studies. In this study, we evaluated the association between HTN and total and lethal PCa in African-American (AA) and Caucasian-American (CA) men. Given that AA men are disproportionately burdened by both HTN and PCa, especially aggressive disease, we hypothesized that the positive association between HTN and total and lethal PCa is stronger in AA than CA men. We alternatively hypothesized that the positive association between HTN and PCa is the same in AA and CA men, but the higher HTN prevalence in AA men results in a greater PCa burden in AA men. Methods: We studied 1,590 AA men and 5,094 CA men from the Atherosclerosis Risk in Communities (ARIC) study without a history of cancer at the first study visit (1987-1989) and who were followed through 2012. HTN was defined based on clinic-measured systolic and diastolic blood pressure and self-reported use of antihypertensive drugs at Visit 1. First primary total PCa (N=266 in AA men, 565 in CA men) and lethal PCa (metastatic at baseline or progressed to death from prostate cancer, N=39 in AA men, 59 in CA men) were ascertained by cancer registry linkage, medical records, and death certificates. We used Cox proportional hazards regression to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of total and lethal PCa comparing CA men with HTN, AA men without HTN, and AA men with HTN to CA men without HTN. We adjusted for age, education, and purported risk factors including body mass index, waist to hip ratio, smoking, physical activity, diabetes, cholesterol-lowering medication use, and aspirin use. Results: AA men had a higher prevalence of HTN (54.6%) than CA men (28.6%) at baseline. Compared with CA men without HTN, CA men with HTN had a higher risk of total PCa (HR=1.23, 95% CI=1.01-1.49, p=0.040), and as expected, AA men without HTN had an elevated PCa risk (HR=2.41, 95% CI=1.94-3.01, p Conclusions: Our prospective findings support some prior studies that HTN is associated with an increased risk of total and possibly lethal PCa in CA men. Counter to our hypothesis, HTN was not associated with total or lethal PCa in AA men. Support: NHLBI, NCI, NPCR, UMMC Office of Research. Citation Format: Wanmei Wang, Eldrin Bhanat, Kenneth R. Butler, Corinne E. Joshu, Thomas H. Mosley, Elizabeth A. Platz, Christian R. Gomez. Association between hypertension and prostate cancer risk in black and white men in the Atherosclerosis Risk in Communities (ARIC) study [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C090.

Prostate cancer (PCa) is the second most common cancer in American men, with higher incidence and death rates in African Americans (AA) relative to Caucasian Americans (CA); nevertheless, these disparities are still poorly understood. MHC class I polypeptide related sequence A (MICA) is a cell surface protein able to promote activation of natural killer cells. Cleavage of MICA and generation of its soluble form (sMICA) has been described as an immunoevasion mechanism presented by different types of aggressive tumors. In agreement with the role of MICA on tumor immunoevasion, recent studies correlated better prognosis for patients expressing higher levels of MICA in different types of cancer. We speculated that MICA expression would be different between AA and CA PCa tumors. To access MICA expression in PCa patients, we stained a TMA containing 30 AA and 27 CA tumor cores. Our results showed that CA PCa tumor cores had higher expression of MICA than the AA (p=0.0019). In order to establish an in vitro system to study the biologic effects of MICA in the context of disparity in PCa, we assessed the expression of surface MICA and release rate of sMICA in different PCa cell lines: MDA-PCa-2b and E006AA-hT, derived from AA, and DU-145 and LNCaP, derived from CA. Flow cytometry analysis showed baseline cell fraction expression positive for surface MICA of 3% in MDA-PCa-2b, 18% in E006AA-hT, 54% in DU-145, and 67% in LNCaP, with significant difference between each cell line (p Citation Format: Charles R. Pound, Marcelo J. Sakiyama, Amit Reddy, Ingrid Espinoza, Eldrin Bhanat, Krista Syrigos, Roya Gordji, Deepak Kumar, Jack Lewin, Xinchun Zhou, Jesus Monico, Christian Gomez. MHC class I polypeptide related sequence A (MICA) race-related differential expression in prostate cancer [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C038.

To identify differences in 3-year overall survival (OS) and disease-free survival (DFS) based on race in patients with tonsillar squamous cell carcinoma.We retrospectively analyzed 80 patients with squamous cell carcinoma of the tonsil treated between 2006 and 2015. Overall survival and DFS curves comparing white and black patients were generated using the Kaplan-Meier method. Cox regression was used to determine covariables associated with OS and DFS.Forty-one percent of the patients in this cohort were black and 59% were white. Three-year OS for black patients was 45.5% versus 88.1% for white patients (P = 0.003). Three-year DFS for black patients was 41.1% versus 66.6% in white patients (P = 0.001). Black race (hazard ratio [HR] 4.81, 95% confidence interval [CI] 1.48-15.6, P = 0.009) and lack of insurance (HR 9.50, 95% CI 2.92-13.0, P 0.009) were independently associated with worse OS on multivariable analysis. Black patients were more likely to have high-risk tumor features. Black patients with stage IV disease (American Joint Committee on Cancer, 7th edition) had decreased OS as compared to white patients, 41.4% versus 82.1% (P = 0.005). There was a trend toward worse OS in human papillomavirus (HPV)-negative black patients compared to HPV-negative white patients. Uninsured black patient experienced worse OS than white patients without insurance, 22.2% versus 68.1%, respectively (P 0.001).Significant racial disparities were found in presentation, tumor, and nodal characteristics, as well as in outcomes in this group of patients with tonsillar cancer. The difference in HPV-associated tonsillar cancer is likely the primary cause of these disparities, but other factors may also contribute to inferior outcomes in black patients.3 Laryngoscope, 129:643-654, 2019.

MHC class I polypeptide related sequence A (MICA) is a cell surface protein associated to tumor immunosurveillance activity, due to its ability to activate natural killer (NK) cells. Cleavage of MICA and generation of its soluble form (sMICA) has been described as an immunoevasion mechanism presented by aggressive tumors. In agreement with the role of MICA on tumor immunoevasion, recent studies correlated better prognosis for patients with higher levels of MICA expression in different types of cancer. Chemotherapeutic drugs are used to treat a great variety of malignant diseases. However, a fraction of patients under chemotherapy regimen stop responding to the treatment and develop recurrent tumors. We postulate that MICA can be a factor contributing to chemotherapy-induced resistance. To test our hypothesis, we tested the expression of MICA in prostate cancer-derived LNCaP and E006AA-hT cell lines were treated with bortezomib, a chemotherapeutic drug that inhibits proteasome activity. MTT cell viability assays showed that both cells had similar sensitivity to bortezomib, with IC50 of 10 nM and 8 nM for LNCaP and E006AA-hT, respectively. Flow cytometry analysis showed baseline difference in the cell fraction expressing surface MICA with 67% in LNCaP cells against 18% in E006AA-hT (p Citation Format: Marcelo Jun Sakiyama, Ingrid Espinoza, Deepak Kumar, Amit Reddy, Eldrin Bhanat, Krista Syrigos, Roya Gordji, Christian Gomez. MHC class I polypeptide related sequence A as contributing factor to chemotherapy-induced resistance [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 66.