Marital status independently predicts testis cancer survival-an analysis of the SEER database
Marital status independently predicts testis cancer survival-an analysis of the SEER database
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DOI：
10.1016/j.urolonc.2010.03.005
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发表时间：
2012-07-01
影响因子：
2.7
通讯作者：
Coogan, Christopher L.
中科院分区：
文献类型：
--
作者：
Abern, Michael R.;Dude, Annie M.;Coogan, Christopher L.
目的：以前的报告表明，已婚男性恶性肿瘤患者的10年生存率高于未婚男性。我们试图调查婚姻状况对10年生存率的影响，在美国人口为基础的队列的男性睾丸cancer.Materials和方法：我们检查了30,789例睾丸癌报告的监测，流行病学，和最终结果（SEER 17）数据库在1973年和2005年之间。所有分期均转换为1997年AJCC TNM系统。排除诊断时年龄小于18岁的患者。对I期或II期非恶性生殖细胞肿瘤（NSGCT）患者进行亚组分析。采用t检验和卡方检验的单变量分析比较了按婚姻状况分开的患者的特征。使用考克斯比例风险模型进行多变量分析，生成Kaplan-Meier生存曲线，以全因死亡率和癌症特异性死亡率为主要终点。结果：20，245例病例符合纳入标准。已婚男性更可能年龄较大（38.9 vs. 31.4岁），白人（94.4% vs. 92.1%），I期（73.1% vs. 61.4%），肿瘤组织学类型为乳腺癌（57.3% vs. 43.4%）。多变量分析显示，（HR 0.58，P < 0.001）和高加索人种（HR 0.66，P < 0.001）独立预测总生存期改善，而年龄增加（HR 1.05，P < 0.001）、分期增加（HR 1.53-6.59，P < 0.001）、淋巴样（HR 4.05，P < 0.001）或NSGCT（HR 1.89，P < 0.001）组织学独立预测死亡。同样，在多变量分析中，（HR 0.60，P < 0.001）和高加索人种（HR 0.57，P < 0.001）独立预测睾丸癌特异性生存率提高，而年龄增加（HR 1.03，P < 0.001）、分期增加（HR 2.51-15.67，P < 0.001）和NSGCT（HR 2.54，P < 0.001）组织学独立预测睾丸癌特异性死亡。对I期或II期NSGCT男性患者的亚组分析显示，全因生存率的预测因子与总体队列相似，腹膜后淋巴结清扫术（RPLND）是总体生存率的额外独立预测因子（HR 0.59，P = 0.001），尽管已婚和未婚男性之间的治疗率相同结论：婚姻状况是男性睾丸癌患者总生存率和肿瘤特异性生存率提高的独立预测因子。在I期或II期NSGCT患者中，RPLND是改善总生存率的另一个预测因素。婚姻状况似乎并不影响男性是否患有RPLND。(C)2012 Elsevier Inc. All rights reserved.
Objectives: Previous reports have shown that married men with malignancies have improved 10-year survival over unmarried men. We sought to investigate the effect of marital status on 10-year survival in a U.S. population-based cohort of men with testis cancer.Materials and methods: We examined 30,789 cases of testis cancer reported to the Surveillance, Epidemiology, and End Results (SEER 17) database between 1973 and 2005. All staging were converted to the 1997 AJCC TNM system. Patients less than 18 years of age at time of diagnosis were excluded. A subgroup analysis of patients with stages I or II non-seminotnatous germ cell tumors (NSGCT) was performed. Univariate analysis using t-tests and chi(2) tests compared characteristics of patients separated by marital status. Multivariate analysis was performed using a Cox proportional hazard model to generate Kaplan-Meier survival curves, with all-cause and cancer-specific mortality as the primary endpoints.Results: 20,245 cases met the inclusion criteria. Married men were more likely to be older (38.9 vs. 31.4 years), Caucasian (94.4% vs. 92.1%), stage I (73.1% vs. 61.4%), and have seminoma as the tumor histology (57.3% vs. 43.4%). On multivariate analysis, married status (HR 0.58, P < 0.001) and Caucasian race (HR 0.66, P < 0.001) independently predicted improved overall survival, while increased age (HR 1.05, P < 0.001), increased stage (HR 1.53-6.59, P < 0.001), and lymphoid (HR 4.05, P < 0.001), or NSGCT (HR 1.89, P < 0.001) histology independently predicted death. Similarly, on multivariate analysis, married status (HR 0.60, P < 0.001) and Caucasian race (HR 0.57, P < 0.001) independently predicted improved testis cancer-specific survival, while increased age (HR 1.03, P < 0.001), increased stage (HR 2.51-15.67, P < 0.001), and NSGCT (HR 2.54, P < 0.001) histology independently predicted testis cancer-specific death. A subgroup analysis of men with stages I or II NSGCT revealed similar predictors of all-cause survival as the overall cohort, with retroperitoneal lymph node dissection (RPLND) as an additional independent predictor of overall survival (HR 0.59, P = 0.001), despite equal rates of the treatment between married and unmarried men (44.8% vs. 43.4%, P = 0.33).Conclusions: Marital status is an independent predictor of improved overall and cancer-specific survival in men with testis cancer. In men with stages I or II NSGCT, RPLND is an additional predictor of improved overall survival. Marital status does not appear to influence whether men undergo RPLND. (C) 2012 Elsevier Inc. All rights reserved.