Marital status and survival in patients with soft tissue sarcoma: A population-based, propensity-matched study

Shi-Long Zhang; Wen-Rong Wang; Ze-Juan Liu; Zhi-Ming Wang

doi:10.1002/cam4.1802

Marital status and survival in patients with soft tissue sarcoma: A population-based, propensity-matched study

Cancer Med. 2019 Feb;8(2):465-479. doi: 10.1002/cam4.1802. Epub 2019 Jan 9.

Authors

Shi-Long Zhang¹, Wen-Rong Wang², Ze-Juan Liu³, Zhi-Ming Wang⁴

Affiliations

¹ Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China.
² Faculty of Physical Education, Shandong Normal University, Jinan, China.
³ Department of Pharmacy, Maternal and Child, Health Care Hospital of Zaozhuang, Zaozhuang, China.
⁴ Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.

Abstract

Background: Marital status serves as an independent prognostic factor for survival in a variety of cancers. However, its prognostic impact on soft tissue sarcoma (STS) has not yet been established.

Objective: To investigate the impact of marital status on survival outcomes among STS patients.

Methods: A total of 18 013 STS patients diagnosed between 2004 and 2015 were extracted from Surveillance, Epidemiology, and End Results (SEER) database. The marital status was classified into married, divorced, widowed, and single. Kaplan-Meier analysis and multivariate Cox proportional hazards regression analysis were conducted to establish the impact of marital status on the overall survival (OS) and cancer-specific survival (CSS). Subgroup analyses were conducted based on age, SEER historic stage and surgery condition. Propensity score matching (PSM) was used to perform a 1:1 matched-pair analysis to minimize the group differences caused by covariates.

Results: Married patients enjoyed better 5-year overall survival (OS) and 5-year cancer-specific survival (CSS), compared with patients who were divorced, widowed, and single, respectively. Multivariate Cox proportional hazards regression analysis revealed that marital status was an independent prognostic and protective factor for survival among STS patients, and unmarried status was associated with higher mortality hazards for both OS and CSS. Additionally, widowed individuals had the highest risks of overall and cancer-specific mortality compared to other unmarried groups. In the subgroup analyses, similar associations were also found. Furthermore, marital status still remained an independent prognostic and protective factor for both OS and CSS even in 1:1 matched-pair analysis.

Conclusions: Marital status was an independent prognostic and protective factor for survival for STS patients. Widowed patients suffered the highest death risks among the unmarried groups.

Keywords: and end results; epidemiology; marital status; soft tissue sarcoma; surveillance; survival analysis.

MeSH terms

Female
Humans
Kaplan-Meier Estimate
Male
Marital Status*
Middle Aged
Prognosis
Propensity Score
Proportional Hazards Models
Soft Tissue Neoplasms / mortality*