title: The influence of marital status on the stage at diagnosis, treatment, and survival of adult patients with gastric cancer: a population-based study.
abstract: OBJECTIVE
  Marital status was reported as a prognostic factor in many cancers. However, its role in gastric cancer (GC) hasn't been thoroughly explored. In this study, we aimed to investigate the effect of marital status on survival, stage, treatment, and survival in subgroups.
  
  
  METHODS
  We used the Surveillance, Epidemiology and End Results (SEER) database and identified 16910 GC patients. These patients were categorized into married (58.44%) and unmarred (41.56%) groups. Pearson chi-square, Wilcoxon-Mann-Whitney, Log-rank, multivariate Cox regression, univariate and multivariate binomial or multinomial logistic regression analysis were used in our analysis. Subgroup analyses of married versus unmarried patients were summarized in a forest plot.
  
  
  RESULTS
  Married patients had better 5-year overall survival (OS) (32.09% VS 24.61%, P<0.001) and 5-year cancer-caused special survival (CSS) (37.74% VS 32.79%, P<0.001) than unmarried ones. Then we studied several underlying mechanisms. Firstly, married patients weren't in earlier stage at diagnosis (P=0.159). Secondly, married patients were more likely to receive surgery (P < 0.001) or radiotherapy (P < 0.001) compared with the unmarried. Thirdly, in subgroup analyses, married patients still had survival advantage in subgroups with stage II-IV and no radiotherapy.
  
  
  CONCLUSIONS
  These results showed that marital status was an independently prognostic factor for both OS and CSS in GC patients. Undertreatment and lack of social support in unmarried patients were potential explanations. With the knowledge of heterogeneous effects of marriage in subgroups, we can target unmarried patients with better social support, especially who are diagnosed at late stage and undergo no treatment.
authors.affiliation: Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China.
authors.forename: Jieyun
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China.
authors.forename: Lu
authors.initials: L
authors.lastname: Gan
authors.affiliation: Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China.
authors.forename: Zhenhua
authors.initials: Z
authors.lastname: Wu
authors.affiliation: Department of Surgery, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China.
authors.forename: Shican
authors.initials: S
authors.lastname: Yan
authors.affiliation: Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China.
authors.forename: Xiyu
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China.
authors.forename: Weijian
authors.initials: W
authors.lastname: Guo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China / Q000453:epidemiology; D016208:Databases, Factual; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D009367:Neoplasm Staging; D044382:Population Groups; D011379:Prognosis; D016016:Proportional Hazards Models; D018426:SEER Program; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D016019:Survival Analysis; D055815:Young Adult
keywords: SEER; gastric cancer; marital status; subgroup analysis; survival analysis