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Effects of marital status on survival of hepatocellular carcinoma by race/ethnicity and gender

Authors Wu W, Fang D, Shi D, Bian X, Li L

Received 18 May 2017

Accepted for publication 7 November 2017

Published 3 January 2018 Volume 2018:10 Pages 23—32

DOI https://doi.org/10.2147/CMAR.S142019

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Akshita Wason

Peer reviewer comments 2

Editor who approved publication: Professor Nakshatri


Wenrui Wu,1,2 Daiqiong Fang,1,2 Ding Shi,1,2 Xiaoyuan Bian,1,2 Lanjuan Li1,2

1State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, 2Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, People’s Republic of China

Purpose: It is well demonstrated that being married is associated with a better prognosis in multiple types of cancer. However, whether the protective effect of marital status varied across race/ethnicity and gender in patients with hepatocellular carcinoma remains unclear. Therefore, we aimed to evaluate the roles of race/ethnicity and gender in this relationship.
Patients and methods: We identified eligible patients from Surveillance, Epidemiology and End Results (SEER) database during 2004–2012. Overall and cancer-specific survival differences across marital status were compared by Kaplan–Meier curves. We also estimated crude hazard ratios (CHRs) and adjusted hazard ratios (AHRs) with 95% confidence intervals (CIs) for marital status associated with survival by race/ethnicity and gender in Cox proportional hazard models.
Results: A total of 12,168 eligible patients diagnosed with hepatocellular carcinoma were included. We observed that married status was an independent protective prognostic factor for overall and cancer-specific survival. In stratified analyses by race/ethnicity, the AHR of overall mortality (unmarried vs married) was highest for Hispanic (AHR =1.25, 95% CI, 1.13–1.39; P<0.001) and lowest for Asian or Pacific Islander (AHR =1.13; 95% CI, 1.00–1.28; P=0.042). Stratified by gender, the AHR was higher in males (AHR =1.27; 95% CI, 1.20–1.33; P<0.001).
Conclusion: We demonstrated that married patients obtained better survival advantages. Race/ethnicity and gender could influence the magnitude of associations between marital status and risk of mortality.

Keywords: primary hepatocellular carcinoma, SEER, being married, race, gender, prognosis

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