Abstract
Marital status has been reported as an independent prognostic factor for survival in various cancers, but it has been rarely studied in hepatocellular carcinoma (HCC) treated by surgical resection. We retrospectively investigated Surveillance, Epidemiology, and End Results (SEER) population-based data and identified 13,408 cases of HCC with surgical treatment between 1998 and 2013. The patients were categorized according to marital status, as “married,” “never married,” “widowed,” or “divorced/separated.” The 5-year HCC cause-specific survival (HCSS) data were obtained, and Kaplan–Meier methods and multivariate Cox regression models were used to ascertain whether marital status is also an independent prognostic factor for survival in HCC. Patients in the widowed group had the higher proportion of women, a greater proportion of older (>60 years) patients, more frequency in latest year of diagnosis (2008-2013), a greater number of tumors at TNM stage I/II, and more prevalence at localized SEER Stage, all of which were statistically significant within-group comparisons (P < 0.001). Marital status was demonstrated to be an independent prognostic factor by multivariate survival analysis (P < 0.001). Married patients had better 5-year HCSS than did unmarried patients (46.7% vs 37.8%) (P < 0.001); conversely, widowed patients had lowest HCSS compared with all other patients, overall, at each SEER stage, and for different tumor sizes. Marital status is an important prognostic factor for survival in patients with HCC treated with surgical resection. Widowed patients have the highest risk of death compared with other groups.
Highlights
Worldwide, primary liver cancer (LC), which consists of primary hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), and combined HCC and ICC, is the fifth most common cancer and the third leading cause of cancer-associated mortality [1]
Marital status has been reported as an independent prognostic factor for survival in various cancers, but it has been rarely studied in hepatocellular carcinoma (HCC) treated by surgical resection
We extracted data from the Surveillance, Epidemiology, and End Results (SEER) cancer registry to investigate the effect of marital status on HCC cause-specific survival (HCSS) in patients with HCC treated by surgical resection
Summary
Primary liver cancer (LC), which consists of primary hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), and combined HCC and ICC, is the fifth most common cancer and the third leading cause of cancer-associated mortality [1]. Extensive research has demonstrated that marital status is an independent prognostic factor of survival in several cancers [4,5,6,7]. Wang et al showed that marital status was an important prognostic factor in pancreatic cancer and that widowed www.impactjournals.com/oncotarget patients were at the greatest risk for death [7]. A study reported, in primary liver cancer patients, married patients enjoyed survival benefits while widowed persons suffered survival disadvantages in both overall survival and cancerspecific survival [8]. The effect of marital status on HCC survival with surgical resection has not been rigorously studied. We extracted data from the Surveillance, Epidemiology, and End Results (SEER) cancer registry to investigate the effect of marital status on HCC cause-specific survival (HCSS) in patients with HCC treated by surgical resection
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