Marital status independently predicts non-small cell lung cancer survival: a propensity-adjusted SEER database analysis
Marital status has been demonstrated as an independent prognostic factor in many cancer types. The impact of marital status on non-small cell lung cancer (NSCLC) survival has not been assessed at the population level. Here, we used the surveillance, epidemiology and end results (SEER) database, a US national cancer registry, to address this issue.
All patients diagnosed with NSCLC from 2004 to 2009 were identified in the SEER database (version 8.3.2, updated at April 14, 2016). Those with incomplete clinicopathological information were excluded. The tumor, node, metastasis (TNM) staging was based on the criteria of the American Joint Committee on Cancer (AJCC) 6th edition. We used propensity-score matching analysis to balance baseline characteristics between the patients who were married and those who were not married. The impact of marital status on cancer-specific survival was analyzed with Cox proportional-hazards regression.
A total of 72, 984 NSCLC patients (41, 095 married patients, 56.3%) were enrolled in this study. After propensity-score matching, 25, 617 patients in the married group were 1:1 matched with patients in the unmarried group. Being unmarried was found to be associated with significantly decreased cancer-specific survival (hazard ratio (HR): 1.142, 95% CI: 1.119–1.166, p < 0.001). Among the unmarried group, patients who were single had worse cancer-specific survival (median survival 12 months, 95% CI: 11.37–12.63 months) than those who were divorced (median survival 15 months, 95% CI: 14.24–15.76 months, p < 0.001) or widowed (median survival 15 months, 95% CI: 14.25–15.76 months, p < 0.001).
This study shows that marital status is an independent prognostic factor for cancer-specific survival in NSCLC patients. Patients who were married had better cancer-specific survival compared to the unmarried ones.
KeywordsNon-small cell lung cancer Marital status Prognosis
Dr Haiquan Chen is the guarantor of the manuscript. Dr Zongwei Chen: contributed to conception and study design, acquisition and analysis of data, and writing and revision of the manuscript. Dr Kanhua Yin: contributed to conception and study design, acquisition and analysis of data, and writing and revision of the manuscript. Dr Difan Zheng: contributed to conception and study design, acquisition and analysis of data, and writing and revision of the manuscript. Dr Jie Gu: contributed to acquisition of data and writing and revision of the manuscript. Dr Jizhuang Luo: contributed to acquisition of data and writing and revision of the manuscript. Dr Shuai Wang: contributed to acquisition of data and writing and revision of the manuscript. Dr Haiquan Chen: contributed to conception and study design, analysis of data, and review and revision of the manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Research involving human participants and/or animals
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent is waived as SEER is a de-identified, publicly available cancer database.
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