Marital status: a gender-independent risk factor for poorer survival after radical cystectomy
Marital status: a gender-independent risk factor for poorer survival after radical cystectomy
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DOI：
10.1111/j.1464-410x.2012.10993.x
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发表时间：
2012-11-01
影响因子：
4.5
通讯作者：
Karakiewicz, Pierre I.
中科院分区：
文献类型：
--
作者：
Sammon, Jesse D.;Morgan, Monica;Karakiewicz, Pierre I.
目的研究婚姻状况（MS）对根治性膀胱切除术（RC）时非器官局限性疾病（NOCD）发生率的影响。目的评价MS对膀胱尿路上皮癌（UCUB）RC后膀胱癌特异性死亡率（BCSM）和全因死亡率（ACM）的影响。在1988年至2006年的监测、流行病学和最终结果数据库中收集了100例非吸烟性CD患者，采用Logistic回归分析评估非吸烟性CD的发生率（T3-4/NI-3/M-0），采用考克斯回归分析，对BCSM和ACM进行评估。协变量包括社会经济地位、肿瘤分期、年龄、种族、肿瘤分级和手术年份。（比值比= 1.22，P = 0.004），在从未结过婚的女性中没有发现这种影响。分居、离婚或丧偶（SDW）男性（风险比[HR] = 1.18，P = 0.005）和女性（HR = 1.16，P = 0.002）的BCSM患病率高于已婚男性，SDW和未婚男性ACM患病率高于已婚男性（HR = 1.22，P < 0.001和HR = 1.26，P < 0.001）。SDW和未婚女性的ACM发生率也高于已婚女性（HR = 1.24，P < 0.001和HR = 1.22，P = 0.01）。结果表明，在RC后，处于SDW状态的男性患BCSM的风险增加，SDW和未婚对ACM有不利影响，RC时处于不利阶段的男性也多见于未婚男性。
OBJECTIVESTo examine the effect of marital status (MS) on the rate of non-organ-confined disease (NOCD) at radical cystectomy (RC)To assess the effect of MS on the rate of bladder-cancer-specific mortality (BCSM) and all-cause mortality (ACM) after RC for urothelial carcinoma of the urinary bladder (UCUB).MATERIALS AND METHODSA total of 14 859 patients, who underwent RC for UCUB, were captured within the Surveillance, Epidemiology, and End Results database, between 1988 and 2006.Logistic regression analysis was used to assess the rate of NOCD (T3-4/NI-3/M-0) at RC and Cox regression analyses were used to assess BCSM and ACM.Analyses were stratified according to gender; covariates included socio-economic status, tumour stage, age, race, tumour grade and year of surgery.RESULTSNever-married males had a higher rate of NOCD at RC (odds ratio = 1.22, P = 0.004), an effect not found in never-married females.Separated, divorced or widowed (SDW) males (hazard ratio [HR] = 1.18, P = 0.005) and females (HR = 1.16, P = 0.002) had higher rates of BCSM than their married counterparts.SDW and never-married males had higher rates of ACM than their married counterparts (HR = 1.22, P < 0.001 and HR = 1.26, P < 0.001, respectively).SDW and never-married females also had higher rates of ACM than married females (HR = 1.24, P < 0.001 and HR = 1.22, P = 0.01, respectively).CONCLUSIONSFor both men and women, being SDW conveyed an increased risk of BCSM after RC.SDW and never marrying had a deleterious effect on ACM.Unfavourable stage at RC was also seen more commonly in never-married males.