Impact of marital status on survival of gastric adenocarcinoma patients: Results from the Surveillance Epidemiology and End Results (SEER) Database.

Miaozhen Qiu,Dajun Yang,Ruihua Xu

doi:10.1038/srep21098

Abstract

Marital status was found to be an independent prognostic factor for survival in various cancer types. In this study, we used the Surveillance, Epidemiology and End Results database to analyze the survival difference among different marital status in the United States. Gastric adenocarcinoma patients from 2004–2012 were enrolled for study. The 5-year cause specific survival (CSS) was our primary endpoint. Totally 29,074 eligible patients were identified. We found that more male patients were married than female. Asian patients had the highest percentages of married than the other races. More married patients were covered by the insurance. Married patients had better 5-year CSS than unmarried, 30.6% vs 25.7%, P < 0.001. The median overall CSS was 17.87 and 13.61 months for the married and unmarried patients, hazard ratio: 1.09 (95% confidence interval: 1.01–1.17), P = 0.027. The survival difference was significant in the insured but not in the uninsured patients. Widowed patients had the worst prognosis compared with other groups even though they had more stage I disease and more well / moderate differentiated tumors. These results indicated that unmarried gastric adenocarcinoma patients were at greater risk of cancer specific mortality. We recommend every patient should have access to best available gastric cancer therapy.

Highlights

Marital status was found to be an independent prognostic factor for survival in various cancer types
We found that unmarried gastric adenocarcinoma patients, were at significantly greater risk of cause-specific death than married patients
For insured patients, patients who were married had significantly better survival than those unmarried. This difference was not significant in uninsured patients. This indicated that insurance and financial status might play the key roles in the survival difference between married and unmarried patients

Summary

Introduction

Marital status was found to be an independent prognostic factor for survival in various cancer types. Sex Male Female Age < 67 > 66 Marital status Married Widowed Single Separate/Divorced Race/Ethnicity Caucasian African-American Asian Others Insurance status Uninsured Insured Location Cardia Fundus Body Antrum/Pylorus Lesser/Greater curvature Others AJCC 6th TNM stage I II III IV Lymph node removed 1–3 > 3 Histology subgroup Signet Ring cell Mucinous adenocarcinoma Adenocarcinoma Grade Well differentiated Moderately differentiated Poorly differentiated Undifferentiated Therapy (Surgery ± radiotherapy) Therapy None Unknown The median survival for patients in unmarried group was 13.61 months and the 5-year CSS was 25.7% (95% CI: 24.7%–26.7%).

Results

Conclusion