Effect of marital status on the survival of patients with hepatocellular carcinoma treated with surgical resection: an analysis of 13,408 patients in the surveillance, epidemiology, and end results (SEER) database
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Chao Wu1, Ping Chen2, Jian-Jun Qian2, Sheng-Jie Jin2, Jie Yao2, Xiao-Dong Wang2, Dou-Sheng Bai2, Guo-Qing Jiang2
1Department of General Surgery, Wuxi 9th People's Hospital, Wuxi, China
2Department of Hepatobiliary and Pancreatic Surgery, Clinical Medical College of Yangzhou University, Yangzhou, China
Dou-Sheng Bai, email: firstname.lastname@example.org
Guo-Qing Jiang, email: email@example.com
Keywords: hepatocellular carcinoma, marital status, SEER, survival analysis, surgery
Received: September 01, 2016 Accepted: October 07, 2016 Published: October 18, 2016
Marital status has been reported as an independent prognostic factor for survival in various cancers, but it has been rarely studied in hepatocellular carcinoma (HCC) treated by surgical resection. We retrospectively investigated Surveillance, Epidemiology, and End Results (SEER) population-based data and identified 13,408 cases of HCC with surgical treatment between 1998 and 2013. The patients were categorized according to marital status, as “married,” “never married,” “widowed,” or “divorced/separated.” The 5-year HCC cause-specific survival (HCSS) data were obtained, and Kaplan–Meier methods and multivariate Cox regression models were used to ascertain whether marital status is also an independent prognostic factor for survival in HCC. Patients in the widowed group had the higher proportion of women, a greater proportion of older (>60 years) patients, more frequency in latest year of diagnosis (2008-2013), a greater number of tumors at TNM stage I/II, and more prevalence at localized SEER Stage, all of which were statistically significant within-group comparisons (P < 0.001). Marital status was demonstrated to be an independent prognostic factor by multivariate survival analysis (P < 0.001). Married patients had better 5-year HCSS than did unmarried patients (46.7% vs 37.8%) (P < 0.001); conversely, widowed patients had lowest HCSS compared with all other patients, overall, at each SEER stage, and for different tumor sizes. Marital status is an important prognostic factor for survival in patients with HCC treated with surgical resection. Widowed patients have the highest risk of death compared with other groups.
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