Marriage is a dependent risk factor for mortality of colon adenocarcinoma without a time-varying effect
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Minling Liu1,*, Lixian Li2,*, Wei Yu1, Jie Chen3, Weibin Xiong1, Shuang Chen1, Li Yu1
1Department of Pathology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
2Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
3Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
*These authors have contributed equally to this work
Li Yu, email: [email protected]
Keywords: marriage, colon adenocarcinoma, time-varying effect, all-cause mortality, surveilance
Received: November 14, 2016 Accepted: January 11, 2017 Published: February 16, 2017
Background: It has been well recognized that the effects of many prognostic factors could change during long-term follow-up. Although marriage has been proven to be a significant prognostic factor for the survival of colon cancer, whether the effect of marriage is constant with time remain unknown. This study analyzed the impact of marital status on the mortality of colon cancer patients with an extended Cox model that allowed for time-varying effects.
Methods: We identified 71,955 patients who underwent colectomy between 2004 and 2009 to treat colon adenocarcinoma from the Surveilance, Epidemiology and End Results Database. The multivariate extended Cox model was used to evaluate the effect of marital status on all-cause mortality, while the Fine-Gray competing risks model was used for colon cancer-specific mortality, with death from other causes as the competing risk.
Results: The unmarried patients carried a 1.37-fold increased risk of all-cause mortality compared with the married patients (95%CI: 1.33-1.40; p<0.001), and the hazard ratio remained constant over time. Being unmarried was at a higher risk of death from colon adenocarcinoma as well as death from other causes. Four variables including tumor site, tumor grade, sex and TNM stage were proved to have time-varying effects on survival.
Conclusions: Marriage is a dependent prognosis factor for survival of surgically treated colon adenocarcinoma patients. Psychological interventions are suggested to improve receipt of treatment among unmarried patients, as their poor survival may be due to the inefficient treatment.
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