Molecular Subtypes of Head and Neck Cancer in Patients of African Ancestry


 Purpose: The purpose of this study was to better understand the complex molecular biomarkers and signatures of HNC among Black patients and identify possible molecular changes associated with HNC disparities. Experimental Design: Molecular subtypes and genomic changes in HNC samples from patients of African and European ancestry in The Cancer Genome Atlas (TCGA), Memorial Sloan Kettering Cancer Center (MSKCC), Broad Institute, MD Anderson Cancer Center, and John Hopkins University were identified. Molecular features (genomic, proteomic, transcriptomic) associated with race and genomic alterations associated with clinical outcomes were determined. An independent cohort of HNC tumor specimens was used to validate the primary findings using immunohistochemistry. Results: Black patients were found to have a younger age at diagnosis, more aggressive tumor types, higher rates of metastasis, and worse survival compared to White patients. Black patients had fewer HPV-positive tumor types and higher frequencies of laryngeal subtype tumors. Higher frequencies of TP53, MYO18B, KMT2D, and UNC13C mutations while a lower frequency of PIK3CA mutations were observed in Black patients. Tumors of Black patients showed significant enrichment of c-MYC and RET-tyrosine signaling and amplifications. A significant increase in tumor expression c-MYC in Black patients was observed and was associated with poor survival outcomes in the independent cohort. Conclusions: Novel genomic modifications and molecular signatures may be related to environmental, social, and behavioral factors associated with racial disparities in HNC. Unique tumor mutations and biological pathways have potential clinical utility in providing more targeted and individualized screening, diagnostic, and treatment modalities to improve health outcomes.