Abstract
Multiple studies have shown that marital status is associated with the survival of various types of cancer patients. Majority of the findings support high survival rate for married patients is closely related to well social support and family care. However, another conclusion that there is no correlation between marital status and the length of cancer survival makes it controversial when talking about the survival benefit of cancer patients. To better explain the issue, here we did further investigation to study the effect of marital status on survival of lung cancer patients. In this study, we retrospectively extracted 136535 eligible lung cancer patients from the Surveillance, Epidemiology, and End Results (SEER) database in the period from 2010 to 2014. Marital status was categorized as married, divorced/separated, widowed, and Single/Partner. The latter three are classified as unmarried. Meanwhile, 1:1 propensity scores for marital status, which were calculated for each patient using a multivariable logistic regression model, were used to match 64749 unmarried patients with 71786 married patients. With accurate matching, the fault tolerance rate is set to 0. Chi-square tests were used to investigate the association between marital status and other variables. The Kaplan-Meier test was adopted to compare survival curves of different groups. Multivariate Cox regression analyses were conducted to estimate the effect of marital status on OS and CSS. We exactly matched 37105 unmarried patients with 37105 married patients. Married patients had higher OS than unmarried patients before matching (OS: HR: 0.903(0.891-0.916), P<0.001; CSS: HR: 0.917(0.904-0.931), P<0.001). But after matching, the OS is undifferentiated between married patients and unmarried patients (OS: HR: 0.985(0.967-1.003), P=0.1; CSS: HR: 1.004(0.985-1.024), P =0.695). Then we carried out subgroup COX analyses stratified by AJCC stage for OS and CSS. Result hints that the prognosis of married patients is better than that of unmarried patients in Stage III and IV, there is no significant difference between the stage I and II patients in lung cancer. Marital status affects the prognosis of patients with advanced lung cancer. the prognosis of married patients is better than that of unmarried patients.
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