Abstract
Background and aimsMultiple studies have shown that marital status is associated with the survival of various types of cancer patients. However, there has not been adequate evidence of the association between marital status and the survival of patients with esophageal cancer (EC). We aimed to investigate the effect of marital status on survival of EC patients.MethodsWe identified 15,598 EC patients from the Surveillance, Epidemiology, and End Results (SEER) database. Meanwhile, propensity scores for marital status, which were calculated for each patient using a nonparsimonious multivariable logistic regression model, were used to match 6,319 unmarried patients with 9,279 married patients. We performed Kaplan–Meier analysis and multivariate Cox regression to analyze the association between marital status and the overall survival (OS) and EC cause-specific survival (CSS) of EC patients before matching and after matching.ResultsWe matched 2,986 unmarried patients with 2,986 married patients. Unmarried patients had poorer OS than married patients before matching (hazard ratio [HR]: 1.22; 95% confidence interval [CI]: 1.18–1.27; P < 0.0001) and after matching (HR: 1.20; 95% CI: 1.13–1.27; P < 0.0001) and poorer CSS than married patients before matching (HR: 1.21; 95% CI: 1.16–1.26; P < 0.0001) and after matching (HR: 1.17; 95% CI: 1.10–1.24; P < 0.0001). Further analysis showed that among different unmarried patients, widowed patients had the poorest OS (HR: 1.46; 95% CI: 1.38–1.55; P < 0.0001) and CSS (HR: 1.43; 95% CI: 1.34–1.52; P < 0.0001) compared with married patients.ConclusionsUnmarried EC patients had poorer survival rates than married EC patients. Meanwhile, widowed patients with EC had the highest risk of death compared with single, married, and divorced patients.
Highlights
Esophageal cancer (EC) is one of ten leading causes of cancer-related deaths, with 16,940 new cases and 15,690 deaths in the US [1]
Unmarried patients had poorer overall survival (OS) than married patients before matching and after matching (HR: 1.20; 95% confidence level (CI): 1.13–1.27; P < 0.0001) and poorer cause-specific survival (CSS) than married patients before matching (HR: 1.21; 95% CI: 1.16–1.26; P < 0.0001) and after matching (HR: 1.17; 95% CI: 1.10–1.24; P < 0.0001)
Further analysis showed that among different unmarried patients, widowed patients had the poorest OS (HR: 1.46; 95% CI: 1.38–1.55; P < 0.0001) and CSS (HR: 1.43; 95% CI: 1.34–1.52; P < 0.0001) compared with married patients
Summary
Esophageal cancer (EC) is one of ten leading causes of cancer-related deaths, with 16,940 new cases and 15,690 deaths in the US [1]. One population-based nationwide Swedish cohort study that included patients with gastric cancer or EC found that unmarried patients had poorer survival rates than married patients [9]. A prospective populationbased cohort that included postsurgery EC patients from all Swedish hospitals investigated the role of marital status in EC survival but found that unmarried patients did not have poorer survival rates than married patients [10]. In a large population-based study that used data from the Surveillance, Epidemiology, and End Results (SEER) database, the authors used the Cox proportional hazards multivariable regression while adjusting for age, sex, race, income, residence, nodal stage, tumor stage, educational level, metastatic status, and use of definitive therapy to analyze the role of marital status in the ten leading cancers that cause cancer-related deaths, including EC, concluding that unmarried patients had a higher risk death from these cancers [3]. We aimed to investigate the effect of marital status on survival of EC patients
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