The influence of marital status on the stage at diagnosis, treatment, and survival of adult patients with gastric cancer: a population-based study.
The influence of marital status on the stage at diagnosis, treatment, and survival of adult patients with gastric cancer: a population-based study.
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DOI：
10.18632/oncotarget.7399
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发表时间：
2017-04-04
期刊：
影响因子：
--
通讯作者：
Guo W
中科院分区：
文献类型：
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作者：
Zhang J;Gan L;Wu Z;Yan S;Liu X;Guo W
据报道，婚姻状况是许多癌症的预后因素。然而，其在胃癌（GC）中的作用尚未得到彻底探索。在本研究中，我们旨在调查婚姻状况对亚组生存、分期、治疗和生存的影响。我们使用监测、流行病学和最终结果 (SEER) 数据库并确定了 16910 名 GC 患者。这些患者分为已婚组（58.44%）和未婚组（41.56%）。我们的分析中使用了 Pearson 卡方、Wilcoxon-Mann-Whitney、Log-rank、多元 Cox 回归、单变量和多元二项式或多项 Logistic 回归分析。已婚患者与未婚患者的亚组分析总结在森林图中。已婚患者的5年总生存率（OS）（32.09% VS 24.61%，P<0.001）和5年癌因特殊生存率（CSS）（37.74% VS 32.79%，P<0.001）优于未婚患者。然后我们研究了几个潜在的机制。首先，已婚患者诊断时并非处于早期阶段（P=0.159）。其次，与未婚患者相比，已婚患者更有可能接受手术（P < 0.001）或放射治疗（P < 0.001）。第三，在亚组分析中，已婚患者在II-IV期且未接受放疗的亚组中仍具有生存优势。这些结果表明，婚姻状况是 GC 患者 OS 和 CSS 的独立预后因素。未婚患者治疗不足和缺乏社会支持是可能的解释。了解婚姻对亚组的异质性影响后，我们可以针对未婚患者提供更好的社会支持，特别是那些在晚期诊断且未接受治疗的患者。
Marital status was reported as a prognostic factor in many cancers. However, its role in gastric cancer (GC) hasn't been thoroughly explored. In this study, we aimed to investigate the effect of marital status on survival, stage, treatment, and survival in subgroups. We used the Surveillance, Epidemiology and End Results (SEER) database and identified 16910 GC patients. These patients were categorized into married (58.44%) and unmarred (41.56%) groups. Pearson chi-square, Wilcoxon-Mann-Whitney, Log-rank, multivariate Cox regression, univariate and multivariate binomial or multinomial logistic regression analysis were used in our analysis. Subgroup analyses of married versus unmarried patients were summarized in a forest plot. Married patients had better 5-year overall survival (OS) (32.09% VS 24.61%, P<0.001) and 5-year cancer-caused special survival (CSS) (37.74% VS 32.79%, P<0.001) than unmarried ones. Then we studied several underlying mechanisms. Firstly, married patients weren't in earlier stage at diagnosis (P=0.159). Secondly, married patients were more likely to receive surgery (P < 0.001) or radiotherapy (P < 0.001) compared with the unmarried. Thirdly, in subgroup analyses, married patients still had survival advantage in subgroups with stage II-IV and no radiotherapy. These results showed that marital status was an independently prognostic factor for both OS and CSS in GC patients. Undertreatment and lack of social support in unmarried patients were potential explanations. With the knowledge of heterogeneous effects of marriage in subgroups, we can target unmarried patients with better social support, especially who are diagnosed at late stage and undergo no treatment.