The impact of marital status at diagnosis on cancer survival in patients with differentiated thyroid cancer

Abstract

Previous studies have revealed that marital status influences the prognosis of patients with various types of cancer. We evaluated the influence of marriage on the survival outcomes in differentiated thyroid cancer (DTC). The Surveillance, Epidemiology and End Results (SEER) database between 2002 and 2012 was used to compare cancer-specific mortality in different marital status, and in each sex, age, and stage stratification by multivariate Cox regression model. In total, 61,077 eligible patients were identified. The widowed group had the highest proportion of women, elderly patients (≥45 years), and advanced stage III/IV tumor (P = 0.001), but the total thyroidectomy (TT) performed and radioisotopes therapy rates were lower than those in the married group. Married patients had a better cancer-specific survival (CSS) than the unmarried (P < 0.05). Further analysis showed that widowed patients always presented the lowest CSS compared with other groups. Widowed patients had a significant increased risk for CSS compared with married patients in males [hazard ratio (HR) 2.72, 95% confidence interval (CI): 1.59–4.65, P = 0.001], females (HR 2.02, 95% CI: 2.24–4.06, P = 0.001), young patients (<45, HR 28.12, 95% CI: 3.48–227.25, P = 0.002), elderly patients (≥45, HR 28.12, 95% CI: 2.97, 95% CI: 2.30–3.83, P = 0.001), stage I (HR 8.44, 95% CI: 4.05–17.59, P = 0.001), stage II (HR 3.64, 95% CI: 1.30–10.20, P = 0.014), stage III (HR 2.27, 95% CI: 1.08–4.78, P = 0.031), and stage IV (HR 2.63, 95% CI: 1.94–3.57, P = 0.001). These results showed that unmarried status, especially for widowhood, increased the risk of cancer mortality in DTC patients.

Our results confirmed that the unmarried status has an independent impact on cancer-specific mortality with a varied risk compared to marriage. Moreover, we indicated that the unmarried patients groups were heterogeneous, and the widowed patients were always at the highest risk of death of cancer than those in other groups.

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