1
|
Alhadeethi A, Ibrahim AA, Atia A, Alabdallat YJ, Alkhawaldeh IM, El Din Moawad MH. Clinical Characteristics and Prognostic Factors of Endometrial Cancer Patients With Liver Metastasis: A Surveillance, Epidemiology, and End Results Database (SEER)-Based Study of 1,034 Women. Cureus 2024; 16:e54606. [PMID: 38524022 PMCID: PMC10958981 DOI: 10.7759/cureus.54606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
Background There are several patterns of metastatic spread from endometrial cancer (EC). Although studies have been conducted to study the EC population with distant metastasis in the bone and lungs, there is still a lack of studies on liver metastasis. This study aims to evaluate and assess the clinical features and prognostic factors of EC patients with liver metastasis. Methodology We conducted a retrospective cohort study adhering to the guidelines for reporting observational research. We utilized the Surveillance, Epidemiology, and End Results database to gather data on female patients diagnosed with EC and reported liver metastasis. We estimated survival curves using the Kaplan-Meier method and evaluated differences in survival using the log-rank test. We also conducted univariable and multivariable Cox proportional hazards regression analyses to determine the hazard ratios with 95% confidence intervals for overall survival (OS) and identify factors that impact survival. Results We analyzed data from 1,034 EC patients with liver metastasis. Median OS after liver metastasis was six months, and cancer-specific survival was seven months. Univariate Cox regression analysis revealed several factors associated with decreased OS in EC patients. These included age (≥60 years), non-endometrioid and sarcoma histological subtypes, absence of surgery, no chemotherapy, and the presence of distant metastasis to the lung, brain, and bone. Conversely, married marital status and white race were linked to a better prognosis. Subsequent multivariate Cox regression analysis identified age (≥60 years), non-endometrioid histological subtype, absence of surgery, no chemotherapy, and the presence of distant metastasis to lung, brain, and bone remaining as independent risk factors for decreased OS. In contrast, the white race still emerged as an independent prognostic factor for better OS. Conclusions Various risk factors, such as age, race, lung, bone, or brain metastasis, as well as chemotherapy and surgery, may influence the prognosis of individuals with primary EC liver metastases.
Collapse
Affiliation(s)
| | - Ahmed A Ibrahim
- Cardiology, Faculty of Medicine, Menofia University, Menofia, EGY
| | - Ahmed Atia
- Cardiovascular Disease, Kasr Alainy School of Medicine, Cairo University, Cairo, EGY
| | | | | | - Mostafa H El Din Moawad
- Clinical Epidemiology and Clinical Trials Management, Public Health and Community Department, Suez Canal University, Ismailia, EGY
| |
Collapse
|
2
|
Li B, Xing J, Wang Z, Gong Z, Wang Z, Xu A. Development and validation of two nomograms for predicting overall survival and Cancer-specific survival in prostate cancer patients with bone metastases: a population-based study. BMC Urol 2023; 23:200. [PMID: 38049755 PMCID: PMC10696723 DOI: 10.1186/s12894-023-01372-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 11/20/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Prostate cancer with bone metastasis has significant invasiveness and markedly poorer prognosis. The purpose of this study is to establish two nomograms for predicting the overall survival (OS) and cancer-specific survival (CSS) of prostate cancer patients with bone metastasis. METHODS From January 2000 to December 2018, a total of 2683 prostate adenocarcinoma with bone metastasis patients were identified from the Surveillance, Epidemiology, and End Results Program (SEER) database. These patients were then divided into a training cohort and a validation cohort, with OS and CSS as the study endpoints. Correlation analyses were employed to assess the relationship between variables. Univariate and multivariate Cox analyses were utilized to ascertain the independent prognostic factors. Calibration curves and the area under the time-dependent receiver operating characteristic curve (time-dependent AUC) were employed to evaluate discrimination and calibration of the nomogram. DCA was applied to examine accuracy and clinical benefits. The clinical utility of the nomogram and the AJCC Stage System was compared using net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Lastly, the risk stratifications of the nomogram and the AJCC Stage System were compared. RESULTS There was no collinearity among the variables that were screened. The results of multivariate Cox regression analysis showed that seven variables (age, surgery, brain metastasis, liver metastasis, lung metastasis, Gleason score, marital status) and six variables (age, surgery, lung metastasis, liver metastasis, Gleason score, marital status) were identified to establish the nomogram for OS and CSS, respectively. The calibration curves, time-dependent AUC curves, and DCA revealed that both nomograms had pleasant predictive power. Furthermore, NRI and IDI confirmed that the nomogram outperformed the AJCC Stage System. CONCLUSION Both nomograms had satisfactory accuracy and were validated to assist clinicians in evaluating the prognosis of PABM patients.
Collapse
Affiliation(s)
- Baochao Li
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Street, Nanjing, 210029, Jiangsu Province, China
| | - Jiajun Xing
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Street, Nanjing, 210029, Jiangsu Province, China
| | - Zhongyuan Wang
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Street, Nanjing, 210029, Jiangsu Province, China
| | - Zixuan Gong
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Street, Nanjing, 210029, Jiangsu Province, China
| | - Zengjun Wang
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Street, Nanjing, 210029, Jiangsu Province, China.
| | - Aiming Xu
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Street, Nanjing, 210029, Jiangsu Province, China.
| |
Collapse
|
3
|
Sun D, Lin A, Sun Z, Yang S, Sun Y, Chen A, Qian G, Ji Z, Wang L. Nomograms predict survival benefits of radical prostatectomy and chemotherapy for prostate cancer with bone metastases: A SEER-based study. Front Oncol 2022; 12:1020898. [PMID: 36561516 PMCID: PMC9764338 DOI: 10.3389/fonc.2022.1020898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose This study aimed to identify independent prognosis-associated factors of bone-metastatic prostate cancer. The nomograms were further developed to obtain indicators for the prognostic evaluation. Methods A total of 7315 bone-metastatic prostate cancer (PCa) patients from 2010 to 2016 were retrospectively collected from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were randomly divided into the training cohort (n=5,120) and test cohort (n=2,195) in a ratio of 7:3. Univariate and multivariate Cox regression models were applied to evaluate potential risk factors. A 1:1 propensity score matching (PSM) was further performed to decrease the confounding effect and re-evaluate the influence of radical prostatectomy and chemotherapy on prognosis. Combining these potential prognosis factors, the nomograms of cancer-specific survival (CSS) and overall survival (OS) at different times were established. C-indexes, calibration curves, and decision curves were developed to evaluate the discrimination, calibration, and clinical benefit of the nomograms. Results Eleven independent prognosis factors for CSS and twelve for OS were utilized to conduct the nomograms respectively. The C-indexes of nomograms for CSS and OS were 0.712 and 0.702, respectively. A favorable consistency between the predicted and actual survival probabilities was demonstrated by adopting calibration curves. Decision curves also exhibited a positive clinical benefit of the nomograms. Conclusions Nomograms were formulated successfully to predict 3-year and 5-year CSS and OS for bone-metastatic PCa patients. Radical prostatectomy and chemotherapy were strongly associated with the bone-metastatic PCa prognosis.
Collapse
Affiliation(s)
- Donglin Sun
- Center for Cancer and Immunology Research, State Key Laboratory of Respiratory Disease, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
| | - Ao Lin
- The State Key Lab of Respiratory Disease, Institute of Public Health, Guangzhou Medical University, Xinzao, Guangzhou, China
| | - Zhun Sun
- Center for Cancer and Immunology Research, State Key Laboratory of Respiratory Disease, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
| | - Shuqi Yang
- Department of Clinical Medicine, The Second Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Yuexin Sun
- Department of Clinical Medicine, The Second Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Anning Chen
- Center for Cancer and Immunology Research, State Key Laboratory of Respiratory Disease, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
| | - Guojun Qian
- Center for Cancer and Immunology Research, State Key Laboratory of Respiratory Disease, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China,*Correspondence: Li Wang, ; Zhonghua Ji, ; Guojun Qian,
| | - Zhonghua Ji
- Department of Anesthesia, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China,*Correspondence: Li Wang, ; Zhonghua Ji, ; Guojun Qian,
| | - Li Wang
- Nephrology Department, Southern Medical University Affiliated Longhua People’s Hospital, Shenzhen, China,*Correspondence: Li Wang, ; Zhonghua Ji, ; Guojun Qian,
| |
Collapse
|
4
|
Husaini DC, Harris-Thurton L, Brown NT, Enriquez LS, Novelo JC, Pot SV, Humes A. Prostate cancer awareness, knowledge, and perception of screening among men aged 40–70 in the Belize district. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-021-01527-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|
5
|
Huang L, Peng S, Sun C, Chen L, Chu Q, Thapa S, Chummun V, Zhang L, Zhang P, Chen EL, Cheng C, Chen Y. Impact of marital status on survival in patients with stage 1A NSCLC. Aging (Albany NY) 2022; 14:770-779. [PMID: 35045398 PMCID: PMC8833113 DOI: 10.18632/aging.203838] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 09/18/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To study how marital status influences overall survival (OS) in patients with stage IA non-small cell lung cancer (NSCLC). And whether the result is valid in different time periods. MATERIALS AND METHODS We retrospectively analyzed 55,207 cases of stage IA NSCLC from 1995 to 2015 in the Surveillance, Epidemiology, and End Results (SEER) database. Marital status was classified as follows: married or with unmarried/domestic partner (MR/W.P), divorced or separated (DV/SP), widowed (WD), and single (never married). Patients diagnosed in 1995-2005 and 2006-2015 were analyzed separately as groups 1 and 2, respectively, to validate the results. Within each group, age-stratified demographic, clinicopathologic features, and OS were compared among different marital statuses. RESULTS AND CONCLUSIONS A total of 55,207 cases were included (group 1 n=20,223, group 2 n=34,984). From 1995-2005 to 2006-2015, median OS was prolonged significantly in all patients besides the DV/SP subgroup. In general, being MR/W.P was associated with the lowest relative risk of death in the study population (Group 1, HR= 0.854, 95%CI: 0.816-0.893; Group 2, HR = 0.799, 95%CI: 0.758-0.842). Meanwhile, OS of DV/SP and widowed patients was similar. In group 2, being single was associated with lower risk of death beyond 60-year-old.
Collapse
Affiliation(s)
- Liu Huang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, P.R. China
| | - Shu Peng
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, P.R. China
| | - Chenyu Sun
- AMITA Health Saint Joseph Hospital Chicago, Chicago, IL 60657, USA
| | - Lian Chen
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, P.R. China
| | - Qian Chu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, P.R. China
| | - Sudip Thapa
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, P.R. China
| | - Vanisha Chummun
- Department of Radiotherapy and Oncology, Victoria Hospital, Candos, Quatre Bornes 72259, Mauritius
| | - Lu Zhang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, P.R. China
| | - Peng Zhang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, P.R. China
| | - Eric L Chen
- AMITA Health Saint Joseph Hospital Chicago, Chicago, IL 60657, USA
| | - Ce Cheng
- The University of Arizona College of Medicine at South Campus, Tucson, AZ 85713, USA
| | - Yuan Chen
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, P.R. China
| |
Collapse
|
6
|
Montiel Ishino FA, Odame EA, Villalobos K, Rowan C, Whiteside M, Mamudu H, Williams F. Sociodemographic and Geographic Disparities of Prostate Cancer Treatment Delay in Tennessee: A Population-Based Study. Am J Mens Health 2021; 15:15579883211057990. [PMID: 34836465 PMCID: PMC8646205 DOI: 10.1177/15579883211057990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The relationship of social determinants of health, Appalachian residence, and prostate cancer treatment delay among Tennessee adults is relatively unknown. We used multivariate logistic regression on 2005–2015 Tennessee Cancer Registry data of adults aged ≥18 diagnosed with prostate cancer. The outcome of treatment delay was more than 90 days without surgical or nonsurgical intervention from date of diagnosis. Social determinants in the population-based registry were race (White, Black, Other) and marital status (single, married, divorced/separated, widow/widower). Tennessee residence was classified as Appalachian versus non-Appalachian (urban/rural). Covariates include age at diagnosis (18–54, 54–69, ≥70), health insurance type (none, public, private), derived staging of cancer (localized, regional, distant), and treatment type (non-surgical/surgical). We found that Black and divorced/separated patients had 32% (95% confidence interval [CI]: 1.22–1.42) and 15% (95% CI: 1.01–1.31) increased odds to delay prostate cancer treatment. Patients were at decreased odds of treatment delay when living in an Appalachian county, both urban (odds ratio [OR] = 0.89, 95% CI: 0.82–0.95) and rural (OR = 0.83, 95% CI: 0.78–0.89), diagnosed at ≥70 (OR = 0.59, 95% CI: 0.53–0.66), and received surgical intervention (OR = 0.72, 95% CI: 0.68–0.76). Our study was among the first to comprehensively examine prostate cancer treatment delay in Tennessee, and while we do not make clinical recommendations, there is a critical need to further explore the unique factors that may propagate disparities. Prostate cancer treatment delay in Black patients may be indicative of ongoing health and access disparities in Tennessee, which may further affect quality of life and survivorship among this racial group. Divorced/separated patients may need tailored interventions to improve social support.
Collapse
Affiliation(s)
- Francisco A Montiel Ishino
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
| | - Emmanuel A Odame
- Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kevin Villalobos
- Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Claire Rowan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Martin Whiteside
- Tennessee Cancer Registry, Tennessee Department of Health, Nashville, TN, USA
| | - Hadii Mamudu
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
| |
Collapse
|
7
|
Ilie G, White J, Mason R, Rendon R, Bailly G, Lawen J, Bowes D, Patil N, Wilke D, MacDonald C, Rutledge R, Bell D. Current Mental Distress Among Men With a History of Radical Prostatectomy and Related Adverse Correlates. Am J Mens Health 2021; 14:1557988320957535. [PMID: 32938266 PMCID: PMC7503014 DOI: 10.1177/1557988320957535] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Recent reviews and observational studies have reported that patients with prostate cancer (PCa) are at increased risk of mental health issues, which in turn negatively affects oncological outcomes. Here, we examine possible explanatory variables of mental distress in a population-based cohort of men who have undergone radical prostatectomy (RP). Data were derived from a Maritimes-Canada online survey assessing patient-reported quality of life outcomes between 2017 and 2019 administered to 136 men (47–88 years old, currently in a relationship) who have undergone RP for their PCa diagnosis. The primary outcome was a validated assessment of mental distress, the Kessler Psychological Distress Scale (K10). Urinary function was assessed using the International Prostate Symptom Score, and relationship satisfaction was assessed using the Dyadic Assessment Scale. A multivariate logistic regression assessed the contribution of urinary function, relationship satisfaction, age, multimorbidity, additional treatments, medication for depression and/or anxiety, and survivorship time. A total of 16.2% men in this sample screened positive for mental distress. The severity of urinary problems was positively associated with increased mental distress (OR = 4.79, 95% CI [1.04, 22.03]), while increased age (OR = 0.87, 95% CI [0.78, 0.97]), relationship satisfaction (OR = 0.14, 95% CI [0.3, .077]), and current medication for anxiety, depression, or both (OR = 0.09, 95% CI [0.02, 0.62]) were protective factors. Survivorship time, the presence of additional comorbidities, or PCa treatments were not identified to be statistically significant contributions to the fitted model. Here, we report that RP survivors are prone to presenting with increased mental distress long after treatment. Screening for mental distress during RP survivorship is recommended.
Collapse
Affiliation(s)
- Gabriela Ilie
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.,Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.,Department of Radiation Oncology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Joshua White
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ross Mason
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ricardo Rendon
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Greg Bailly
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Joseph Lawen
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - David Bowes
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Nikhilesh Patil
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Derek Wilke
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Cody MacDonald
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Robert Rutledge
- Department of Radiation Oncology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - David Bell
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
8
|
Qiu J, Cai D, Wang Z, Zhou J, Gong Y, Cai L, Gong K. Prognostic Models for Patients With Gleason Score 9 Prostate Cancer: A Population-Based Study. Front Oncol 2021; 11:633312. [PMID: 33981602 PMCID: PMC8107690 DOI: 10.3389/fonc.2021.633312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/15/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Gleason score (GS) system is one of the most widely used histological grading methods for prostate cancer (PCa) all over the world. GS can be obtained by adding the primary Gleason pattern (GP) and secondary GP. Different proportions of GP 4 and GP 5 in prostate specimens can both lead to GS 9. In this study, we explored whether GP 5 + 4 or GP 4 + 5 was associated with different prognoses among patients with GS 9 PCa. Materials and methods: A retrospective population-based study was conducted on 10,124 subjects diagnosed with GS 9 PCa between 2004 and 2009 from the Surveillance, Epidemiology, and End Results program. A 1:1 propensity-score matching (PSM) was performed to balance the baseline characteristics between the GP 4 + 5 and 5 + 4 groups and to compare the prognoses between the two groups. Cox regression analysis and Fine-Gray competing risk regression models were adopted to screen the covariates significantly associated with all-cause mortality (ACM) and cancer-specific mortality (CAM). Results: GP 5 + 4 was associated with higher risks of ACM and CSM before or after PSM than GP 4 + 5. In the original cohort, there were eight independent predictors for ACM, which were age at diagnosis, race, AJCC NM stage, PSA levels, treatments, GP, and marital status, confirmed by the Cox analysis; and nine independent predictors for CSM, which were age at diagnosis, race, AJCC TNM stage, PSA levels, treatments, GP, and marital status, confirmed by the competing-risk model. Conclusion: GP 5 + 4 was associated with a poorer overall survival and cancer-specific survival compared with GP 4 + 5.
Collapse
Affiliation(s)
- Jianhui Qiu
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Desheng Cai
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Zixin Wang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Jingcheng Zhou
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Yanqing Gong
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Lin Cai
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Kan Gong
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| |
Collapse
|
9
|
Timsina LR, Zarzaur B, Haggstrom DA, Jenkins PC, Lustberg M, Obeng-Gyasi S. Dissemination of cancer survivorship care plans: who is being left out? Support Care Cancer 2021; 29:4295-4302. [PMID: 33415363 DOI: 10.1007/s00520-020-05915-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 11/25/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The Institute of Medicine (IOM) and the American College of Surgeons Commission on Cancer (CoC) recommend a clear and effectively explained comprehensive survivorship care plan (SCP) be given to all cancer survivors. The objective of this study is to understand the relationship between social determinants of health (SDOH) and self-reported receipt of SCP by cancer survivors in the USA. METHODS We analyzed an adult population of cancer survivors in the 2016 Behavioral Risk Factor Surveillance System's (BRFSS) Survivorship modules. Weighted multivariable logistic regression was used to analyze the association of SDOH and reported receipt of SCP. RESULTS There were 7061 cancer patients eligible for an SCP. The probability of reporting receipt of SCP decreased with lower educational achievement (high school/some college: AOR = 0.82, 95% CI: 0.70-0.97, p = 0.02; < high school: AOR = 0.68, 95% CI: 0.47-0.97, p = 0.03) compared to those with at least one college degree. Additionally, being widowed/divorced/separated (widowed/divorced/separated: AOR = 0.72, 95% CI: 0.61-0.86, p < 0.01 vs. married/cohabiting) and uninsured (uninsured: AOR = 0.52, 95% CI: 0.0.34-0.80, p < 0.01 vs. insured) increased the odds of not receiving an SCP. Younger patients were more likely to receive an SCP than those over 65 (18-24 years: AOR = 6.62, 95% CI: 1.87-24.49, p < 0.01 vs. 65+ years). CONCLUSION Among cancer survivors, SDOH such as low educational achievement, widowed/divorced/separated marital status, and being uninsured were associated with a lower likelihood of receiving an SCP. Future studies should evaluate how omission of SCP in these patients influences the quality of care during the transition from oncologists to primary care.
Collapse
Affiliation(s)
- Lava R Timsina
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ben Zarzaur
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - David A Haggstrom
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, Indianapolis, IN, USA
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
| | - Peter C Jenkins
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Maryam Lustberg
- Department of Internal Medicine, Division of Medical Oncology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Department of Surgery, Division of Surgical Oncology, The Ohio State University, N924 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA.
| |
Collapse
|
10
|
Tao L, Pan X, Zhang L, Wang J, Zhang Z, Zhang L, Liang C. Marital Status and Prognostic Nomogram for Bladder Cancer With Distant Metastasis: A SEER-Based Study. Front Oncol 2020; 10:586458. [PMID: 33194738 PMCID: PMC7654226 DOI: 10.3389/fonc.2020.586458] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/05/2020] [Indexed: 12/31/2022] Open
Abstract
Background To investigate the impact of marital status on overall survival (OS) and create a prognostic nomogram predicting OS in distant-metastatic bladder cancer (DMBC) patients. Methods The Surveillance, Epidemiology, and End Results (SEER) database was explored to recruit DMBC patients from 2010 to 2015. Kaplan–Meier survival analysis was used to compare survival differences among different marital status. Univariate and multivariate analyses were used to screen for prognostic factors and then constructed the nomogram based on Cox proportional hazard regression models. Calibration plot diagrams and concordance index (C-index) were used to verify the prognostic nomogram. Results Kaplan–Meier curves suggested the significant differences of OS among different marital status existed in total (P < 0.001), female (P = 0.011) and male (P = 0.001) DMBC patients, respectively. Multivariate analysis indicated marital status was an independent prognostic factor for OS of DMBC patients. Nomogram showed the contribution of marital status to predicting OS was small. Other independent prognostic factors included age, grade, histology type, surgery of primary site, chemotherapy, and metastasis pattern. By combining seven factors, we constructed a prognostic nomogram for DMBC patients. The C-index of this nomogram for OS prediction was 0.722 (95% CI 0.712–0.732). The calibration curves showed perfect consistency between observed and predictive survival. Conclusions Marital status was an independent prognostic factor for OS of DMBC patients, but its contribution to predicting OS was small. The prognostic nomogram will provide an individualized evaluation of OS and guidance for suitable treatments in DMBC patients.
Collapse
Affiliation(s)
- Liangjun Tao
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Institute of Urology and Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Xinyuan Pan
- Department of Ophthalmology, The Second People's Hospital of Wuhu, Wuhu, China
| | - Lixiang Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jiawei Wang
- Department of Urology, The Second People's Hospital of Wuhu, Wuhu, China
| | - Zican Zhang
- Clinical College of Bengbu Medical University, Bengbu, China
| | - Li Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Institute of Urology and Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Chaozhao Liang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Institute of Urology and Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| |
Collapse
|
11
|
Wang K, Mao W, Shi H, Wang G, Yin L, Xie J, Ian LH, Zhang H, Peng B. Marital status impacts survival in patients with upper tract urothelial carcinoma: a population-based, propensity-matched study. Transl Androl Urol 2020; 9:1611-1629. [PMID: 32944523 PMCID: PMC7475671 DOI: 10.21037/tau-20-605] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Marital status has been considered as an independent prognostic factor for various types of cancer survival. The objectives of our study were to investigate the function of marital status on the survival of upper tract urothelial carcinoma (UTUC) patients. Methods The patients diagnosed with UTUC between 1988 and 2015 were captured within the Surveillance, Epidemiology, and End Results (SEER) database. Patients were classified into married, divorced/separated, widowed and single cohorts. Kaplan-Meier and Cox regression analysis was conducted to assess the effects of marital status on overall survival (OS) and cancer-specific survival (CSS). A 1:1 matched‐pair analysis was performed to optimize the final statistical results by propensity score matching (PSM). Results Among the 10,852 eligible patients, the percentage of married, divorced/separated, widowed and single patients accounted for 58.2% (6,321), 9.0% (980), 23.3% (2,526) and 9.4% (1,025) respectively. The widowed patients had the worst OS and CSS. Marital status was a predictive factor for OS and CSS of UTUC patients. The results of multivariate Cox regression showed that the worst OS [hazard ratio (HR): 1.41; 95% confidence interval (CI): 1.33–1.49, P<0.001] and the poorer CSS (HR: 1.32; 95% CI: 1.22–1.43, P<0.001) were existed in the widowed patients, compared with married patients. The results of the stratified analysis by primary site also indicated the same conclusion. Furthermore, the results were confirmed in the 1:1 matched group. Conclusions Marital status acted as an independent prognostic and protective factor for survival in UTUC patients. Additionally, being widowed was related with a high risk of death in UTUC compared with married, divorced, or single patients.
Collapse
Affiliation(s)
- Keyi Wang
- Department of Urology, People's Hospital of Putuo District, School of Medicine, Tongji University, Shanghai, China.,Department of Urology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Weipu Mao
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Heng Shi
- Department of Urology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Guangchun Wang
- Department of Urology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lei Yin
- Department of Urology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jinbo Xie
- Department of Urology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lap Hong Ian
- Department of Urology, Centro Hospitalar Conde de São Januário (CHCSJ) Hospital, Macau, China
| | - Hui Zhang
- Department of Anesthesiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Bo Peng
- Department of Urology, People's Hospital of Putuo District, School of Medicine, Tongji University, Shanghai, China.,Department of Urology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| |
Collapse
|
12
|
Shi Y, Chen W, Li C, Qi S, Zhou X, Zhang Y, Li Y, Li G. Clinicopathological characteristics and prediction of cancer-specific survival in large cell lung cancer: a population-based study. J Thorac Dis 2020; 12:2261-2269. [PMID: 32642131 PMCID: PMC7330367 DOI: 10.21037/jtd.2020.04.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background To describe the demographic and clinical characteristics of large cell lung cancer (LCLC) with a population-based database and to find the prognosis factors of cancer-specific survival (CSS) for these patients; also, to develop a nomogram to independently validate and predict the CSS for LCLC based on the identified prognosis factors. Methods We extracted the LCLC patient’s information from the Surveillance, Epidemiology, and End Results (SEER) database [2005–2014] and summarized the characteristics of the extracted factors. We used Cox proportional hazards regression to find the prognosis factors for LCLC patients and to develop the nomogram based on these in a split train cohort from the extracted data. The validation of the developed nomograms was performed in an independent validation cohort from the extracted data, in which the C-index and the average of the time-dependent area under the receiver operating characteristic curve (time-dependent AUC) for CSS in 1-year, 3-year, and 5-year CSS was calculated. The calibration curves were drawn to visualize the performance of the established nomogram. Results As a result, 4,936 patients with LCLC were identified from the SEER database. Nearly half of LCLC patients were diagnosed with stage IV; only approximately 20% of patients underwent surgery. The prognosis factors that influenced the LCLC patients included age, sex, American Joint Committee on Cancer (AJCC) stage, race, surgery, tumor size, and marital status. The calculated C-index was 0.701±0.01, and the mean time-dependent AUC for in 1-year, 3-year, and 5-year CSS was 0.88. The calibrated curve showed that the gap between the predicted and observed values for 1-year, 3-year, and 5-year CSS was small. Conclusions Sex, age, race, marital status, AJCC stage, surgery, and tumor size were shown to all be the independent prognostic factors of CSS in LCLC. The established nomogram can provide more precise evaluation for the survival of LCLC patients and help the clinicians in the individual management of patients.
Collapse
Affiliation(s)
- Yafei Shi
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wei Chen
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Chunyu Li
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shuya Qi
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiaowei Zhou
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yujun Zhang
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ying Li
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Guohui Li
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| |
Collapse
|
13
|
Luo P, Zhou JG, Jin SH, Qing MS, Ma H. Influence of marital status on overall survival in patients with ovarian serous carcinoma: finding from the surveillance epidemiology and end results (SEER) database. J Ovarian Res 2019; 12:126. [PMID: 31888704 PMCID: PMC6937688 DOI: 10.1186/s13048-019-0600-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 12/10/2019] [Indexed: 12/14/2022] Open
Abstract
Objective This study is to investigate the relationship between marital status and prognosis of patients with ovarian serous carcinoma. Results We performed data analysis from 19,276 patients identified from the SEER database of the National Cancer Center of the United States. 57.8% of the patients were married, 13.0% unmarried, and 29.2% separated/ divorced/widowed (SDW). The median overall survival time ofthe unmarried group and the married group are 48 months and 52 months respectively. Univariate Cox regression analysis showed that the patients with serous ovarian cancer in the unmarried group resulted in a hazard ratio (HR) of 1.14 (95% CI: 1.08–1.19%; P < 0.001), comparing to SDW group with a HR of 1.02 (95% CI: 0.98–1.19%; P = 0.26). However, the SDW group was not statistically significantly different from the married group. (median 32 vs 52 months). Multivariate Cox regression analysis presented the unmarried group leading to a HR of 1.05 (95% CI: 1.00–1.11%; P = 0.05), and the SDW group was not significant with a HR of 0.99 (95% CI: 0.95–1.03%; P = 0.57). Conclusion Unmarried patients with ovarian serous carcinoma have higherHRof overall survival. After controlling age, race, grade, radiation and year of diagnosis, unmarried patients were found to have a significantly higher risk of OS. Consequently, these patients are suggested to obtain more focused healthcare for the management of ovarian serous carcinoma.
Collapse
Affiliation(s)
- Pei Luo
- Department of Oncology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
| | - Jian-Guo Zhou
- Department of Oncology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China. .,Department of Radiation Oncology, Universitätsklinikum Erlangen, Erlangen, 91054, Germany.
| | - Su-Han Jin
- Department of Orthodontics, Affiliated Stomatology Hospital of Zunyi Medical University, Zunyi, 563000, China
| | - Ming-Song Qing
- Department of Orthopedics, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
| | - Hu Ma
- Department of Oncology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China.
| |
Collapse
|
14
|
Zhu X, Gou X, Zhou M. Nomograms Predict Survival Advantages of Gleason Score 3+4 Over 4+3 for Prostate Cancer: A SEER-Based Study. Front Oncol 2019; 9:646. [PMID: 31380282 PMCID: PMC6646708 DOI: 10.3389/fonc.2019.00646] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 07/02/2019] [Indexed: 12/24/2022] Open
Abstract
Background: Different proportions of Gleason pattern 3 and Gleason pattern 4 lead to various prognosis of prostate cancer with Gleason score 7. The objective of this study was to compare the survival outcomes of Gleason score 3+4 and 4+3 based on data from the Surveillance, Epidemiology, and End Results cancer registry database, and to investigate independent prognosis-associated factors and develop nomograms for predicting survival in Gleason score 7 prostate cancer patients. Methods: A retrospective study was conducted on 69,116 cases diagnosed as prostate adenocarcinoma with Gleason score 7 between 2004 and 2009. Prognosis-associated factors were evaluated using univariate and multivariate Cox regression analysis, and a 1:1 ratio paired cohort by propensity score matching with the statistical software IBM SPSS, to evaluate prognostic differences between Gleason score 3+4 and 4+3. The primary cohort was randomly divided into training set (n = 48,384) and validation set (n = 20,732). Based on the independent factors of prognosis, nomograms for prognosis were established by the training group and validated by the validation group using R version 3.5.0. Results: After propensity score matching, Cox regression analysis showed that Gleason 4+3 had an increased mortality risk both for overall survival (HR: 1.235, 95% CI: 1.179–1.294, P < 0.001) and cancer-specific survival (HR: 1.606, 95% CI: 1.468–1.762, P < 0.001). Nomograms for overall survival and cancer-specific survival were established with C-index 0.786 and 0.842, respectively. The calibration plot indicated an optimal agreement between the actual observation and nomogram prediction for overall survival and cancer-specific survival probability at 5 or 10 year. Conclusions: Prostate cancer with Gleason score 4+3 had worse overall survival and cancer-specific survival than Gleason score 3+4. Nomograms were formulated to predict 5-year and 10-year OS and CSS in patients with prostate cancer of Gleason score 7.
Collapse
Affiliation(s)
- Xin Zhu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xin Gou
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mi Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
15
|
Xie Y, Shen G. Association of neck dissection with survival for early stage N0 tongue cancer: A SEER population-based study. Medicine (Baltimore) 2018; 97:e13633. [PMID: 30572477 PMCID: PMC6320122 DOI: 10.1097/md.0000000000013633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The management of the node negative neck in patients with tongue cancer remains a complex and controversial issue, especially in those with early stage tumors. Patients with negative cervical lymph nodes generally have a good prognosis. However, in patients without neck dissection, neck recurrences may occur after excision of the primary tumor due to occult cervical metastases. It often results in poor salvage therapy options and short survival. We used Surveillance, Epidemiology, and End Results data from 2004 to 2013 to investigate the association of neck dissection with survival among early stage tongue cancer patients with negative lymph node metastasis. A total of 4274 eligible patients were subdivided into 2 groups according to their neck management strategies: neck dissection and observation. Univariate and multivariate Cox proportional hazards regression models were used to determine the independent factors of survival. The Kaplan-Meier method was employed for survival analysis. In the overall cohort, patients who underwent neck dissection had better survival than those who were managed with observation in both tongue cancer specific survival and overall survival. After adjusting for confounding variables, neck dissection strategy remains an independent prognostic factor for better survival. When stratifying the patients according to age, gender, race, marital status, histologic grade, stage and radiotherapy, patients in the neck dissection group had significantly better survival than those in the observation group. Neck dissection may improve survival for early stage tongue cancer patients with negative lymph node metastasis. These results may assist clinicians in selecting the most appropriate neck management strategy for individual patients.
Collapse
Affiliation(s)
- Yufei Xie
- Shanghai Xuhui District Dental Disease Prevention and Control Institute
| | - Gang Shen
- Department of Orthodontics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; National Clinical Research Center of Stomatology, China
| |
Collapse
|
16
|
Liu L, Chi YY, Wang AA, Luo Y. Marital Status and Survival of Patients with Hormone Receptor-Positive Male Breast Cancer: A Surveillance, Epidemiology, and End Results (SEER) Population-Based Study. Med Sci Monit 2018; 24:3425-3441. [PMID: 29795054 PMCID: PMC5994964 DOI: 10.12659/msm.910811] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Although marital status has been reported as a prognostic factor in different cancer types, its prognostic effect on hormone receptor (HR) positive male breast cancer (MBC) is unclear. The objective of the present analysis was to assess the effects of marital status on survival in patients with HR positive MBC. Material/Methods Patients diagnosed with HR positive MBC from 1990 to 2014 in the Surveillance, Epidemiology, and End Results (SEER) database were included. Kaplan-Meier survival analysis and Cox proportional hazard regression were used to identify the effects of marital status on cancer-specific survival (CSS) and overall survival (OS). Results A total of 3612 cases were identified in this study. Married patients had better 5-year CSS and 5-year OS than unmarried men. In multivariate Cox regression models, unmarried patients also showed higher mortality risk for both CSS and OS, independent of age, race, grade, stage, PR status, HER2 status, and surgery. Subgroup survival analysis according to different ER/PR status showed that married patients had beneficial CSS results only in ER+/PR+ subtype, and CSS in the married and unmarried groups did not significantly differ by TNM stage. The results were further confirmed in the 1: 1 matched group. Conclusions Marital status was an important prognostic factor for survival in patients with HR positive MBC. Unmarried patients are at greater risk of death compared with married groups. The survival benefit for married patients remained even after adjustment, which indicates the importance of spousal support in MBC.
Collapse
Affiliation(s)
- Lei Liu
- Department of Breast Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland).,Department of Breast Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Ya-Yun Chi
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China (mainland).,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai, China (mainland)
| | - An-An Wang
- Department of Breast Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Yonghui Luo
- Department of Breast Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| |
Collapse
|