title: Prognostic impact of marital status on survival of women with epithelial ovarian cancer.
abstract: OBJECTIVE
  The objective of this study is to examine the impact of marital status on survival of patients with epithelial ovarian cancer (EOC).
  
  
  METHODS
  Patients with a diagnosis of EOC were identified from the Surveillance, Epidemiology, and End Results Program for the period 1988-2006 and divided into married and unmarried groups. Statistical analysis using Student's t-test, Kaplan-Meier, and Cox regression proportional hazards was performed.
  
  
  RESULTS
  In 49,777 patients with EOC, 51.2% were married and 48.8% were unmarried. White women were likely to be married compared with African Americans (52.0% vs 32.4%, p < 0.05). Younger age (63.9% vs 43.4%, p < 0.001) and early stage disease (37.5% vs 33.8%, p < 0.001) were more prominent in married patients compared with unmarried patients. Staging lymphadenectomy was performed more frequently in married than unmarried patients (39.9% vs 29.8%, p < 0.001). Overall 5-year survival was 45.0% for married patients and 33.1% for unmarried patients, p < 0.001. Married patients had a better survival compared with unmarried patients within each racial subgroup: 44.5% vs 33.3% for White women (p < 0.001), 36.9% vs 24.9% for African Americans (p < 0.001), and 53.7% vs 42.7% for others (p < 0.001), respectively. In a model that controlled for age, race, histology, stage, grade, and surgical treatment, married patients had a significantly improved survival compared with unmarried patients (HR 0.8, 95% CI 0.78-0.83, p < 0.001).
  
  
  CONCLUSIONS
  In this epidemiologic study, the social institution of marriage is associated with improved survival in women with ovarian cancer.
authors.affiliation: Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA. mahdih@uw.edu
authors.forename: Haider
authors.initials: H
authors.lastname: Mahdi
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Kumar
authors.forename: Adnan R
authors.initials: AR
authors.lastname: Munkarah
authors.forename: Moshrik
authors.initials: M
authors.lastname: Abdalamir
authors.forename: Mark
authors.initials: M
authors.lastname: Doherty
authors.forename: Ron
authors.initials: R
authors.lastname: Swensen
mesh_terms: D000368:Aged; D000077216:Carcinoma, Ovarian Epithelial; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D053208:Kaplan-Meier Estimate; D017533:Marital Status / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000175:diagnosis / Q000401:mortality* / Q000523:psychology*; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000523:psychology*; D011159:Population Surveillance; D011379:Prognosis; D016016:Proportional Hazards Models; D011788:Quality of Life; D018426:SEER Program; D012737:Sex Factors; D012944:Social Support; D017741:Survivors / Q000523:psychology*; D014481:United States / Q000453:epidemiology