Marital status may predict long-term survival in early-stage gastric cancer
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Being married may increase the chances of long-term survival among patients with early-stage gastric cancer, according to research published in Journal of Investigative Medicine.
Researchers said that, based on these results, marital status should be included on the list of personal and clinical variables used to predict longevity after diagnosis.
Background
Gastric cancer is the third leading cause of cancer-related deaths globally, with incidence of the disease increasing after the age of 50 years, according to study background.
“Even for patients with early-stage gastric cancer who underwent systematic treatment, accurately predicting gastric cancer prognosis is difficult,” Lixiang Zhang of First Affiliated Hospital of Anhui Medical University in Hefei, China, and colleagues wrote. “Therefore, it is meaningful to establish a reliable predictive model in combination with post-treatment indicators.”
Marital status has been associated with prostate, cervical and rectal cancer and “has emerged as an innovative risk factor in recent years,” Zhang and colleagues noted, adding that no study to their knowledge has focused on the effect of marital status on patients with early-stage gastric cancer.
To determine whether such a relationship exists, Zhang and colleagues developed a mathematical nomogram to assess the impact of marital status on the prediction of OS among patients with early-stage gastric cancer.
Methodology
In their analysis, Zhang and colleagues included 3,647 patients (50.8% female) from the SEER database diagnosed with early-stage gastric cancer between 2010 and 2015. They reported marital status among the participants as 1,957 married, 274 divorced, 41 separated, 630 widowed, 512 single and 233 classified as “unknown.”
The investigators developed a nomogram based on multivariate analyses that integrated multiple known independent predictors of gastric cancer incidence and disease progression.
They randomly divided the study population in a 3:1 ratio into two groups, resulting in 2,719 patients as part of a training set and 928 in the testing set.
OS defined as time from diagnosis until death served as the study’s primary endpoint.
Key findings
Kaplan-Meier survival analysis showed married patients had the longest average OS (72.084 months; 95% CI, 70.847-73.321), whereas widowed patients had the shortest (60.15 months; 95% CI, 57.057-63.244).
The investigators also observed significant OS differences by sex in relation to marital status. Married women had an average OS of 76.357 months (95% CI, 74.783-77.93) compared with 69.187 months (95% CI, 67.446-70.928) among married men.
Likewise, widowed men had an average OS of 51.704 months (95% CI, 45.206-58.202) compared with 61.885 months (95% CI, 58.476-65.293) among widowed women.
Univariate and multivariate analyses showed marital status (P < .001 for both) to be an independent prognostic factor of OS, in addition to age at diagnosis, sex, tumor histology, tumor stage, surgery and tumor size.
A C-index of 0.791 for the training set and 0.685 for the testing set confirmed the validity of calibration curves used to create the predictive nomogram. Analysis of the nomogram’s predictive value showed tumor size as the most important prognosis factor, followed by age at diagnosis and surgery. Tumor stage, marital status, gender and tumor histology also showed moderate impact on patient prognosis, the investigators noted.
Clinical implications
“Our nomogram included age at diagnosis, sex, tumor stage, histology, tumor size, surgery, and marital status as risk factors [that] effectively predicted the prognosis of early-stage [gastric cancer],” Zhang and colleagues wrote. “This nomogram can help assess the prognosis and treatment of patients with gastric cancer.”
The investigation showed that marital status had a moderate influence on OS, but the researchers cautioned that the nature of this modeling study only indicates possible associations and cannot establish marital status as a causal factor for increased survival among patients with early-stage cancer.
Zhang and colleagues reasoned married patients likely have better financial resources and positive emotional encouragement that may contribute to longer OS.
“Therefore, single patients and widowed patients need more attention and social help,” they wrote.
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