Abstract
Although the prognostic value of marital status has been implicated in many cancers, its prognostic impact on cholangiocarcinoma has not yet been determined. The aim of this study was to examine the association between marital status and cholangiocarcinoma survival. We included 8,776 extrahepatic cholangiocarcinoma cases and 1,352 intrahepatic cholangiocarcinoma cases between 1973 and 2013 from the Surveillance, Epidemiology, and End Results database. We found widowed patients were more likely to be female, aged more than 70, and from low income areas. Multivariate analysis indicated that marital status was an independent prognostic factor for extrahepatic cholangiocarcinoma patients. Subgroup analysis suggested the widowed status independently predicted poor survival at regional stage and in older patients with intrahepatic cholangiocarcinoma. To conclude, marital status is a valuable prognostic factor in cholangiocarcinoma, and widowed patients are at greater risk of death than others.
Highlights
Cholangiocarcinoma, the second most common primary hepatic cancer after hepatocellular carcinoma (HCC), accounts for approximately 3% of all gastrointestinal malignancies [1, 2]
Subgroup analysis of marital status on ECC cause-specific survival (ECSS) and ICC cause-specific survival (ICSS) according to age at diagnosis We further examined whether marital status was correlated to 5-year ECSS in patients diagnosed at different ages
We found a higher risk of death associated with being unmarried, especially widowed
Summary
Cholangiocarcinoma, the second most common primary hepatic cancer after hepatocellular carcinoma (HCC), accounts for approximately 3% of all gastrointestinal malignancies [1, 2]. The incidence of ECC/ ICC has increased substantially in the past decades, and the newly diagnosed cases have exceeded 7,000 annually [4, 5]. Both ECC and ICC are highly lethal and characterized by an aggressive behavior with early lymphatic spread and distant metastasis. In patients with colorectal neuroendocrine neoplasms, the widowed group were at greater risk of cancer specific mortality [9]. Widowed patients suffered from the poorest 5-year cancer specific survival in HCC [10]. In primary liver cancer patients, widowed patients had a survival disadvantage while married persons enjoyed survival benefits in both cancer-specific survival and overall survival [11]. A cross-sectional study conducted in wetland communities of Ubon Ratchathani in Thailand implied that married participants had a 2.61 times higher risk of cholangiocarcinoma than unmarried participants [12]
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