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Purpose:
The association between marital status and tumor stage and grade, as well as overall mortality (OM) and cancer-specific mortality (CSM) received little attention in patients with squamous cell carcinoma of the penis (SCCP).
Methods:
We relied on the surveillance, epidemiology, and end results (SEER) 17 database to identify patients diag...
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Marriage has been reported as a beneficial factor associated with improved survival among cancer patients, but conflicting results have been observed in cervical adenocarcinoma (AC). Thus, this study is aimed to examine the relationship between the prognosis of cervical AC and marital status. Eligible patients were selected from 2004 to 2015 using...
Simple Summary
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Abstract This study aimed to investigate the association between marital status and the prognosis of patients with metastatic breast cancer (MBC). Data of patients with MBC were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were classified into married and unmarried groups. Kaplan–Meier analysis with the lo...
Citations
... Married patients often receive help from their spouse throughout the course of diagnosis and treatment. However, unpleasant and upsetting relationships generate depression, leading to divorce or separation, which could account for poor prognosis [8,9]. Satin et al. reported that depression could act as a predictor for disease progression and motility of malignant tumor by a meta-analysis [29]. ...
Aim: This population-based analysis aimed to explore the associations among marital status, prognosis and treatment of stage I non-small-cell lung cancer. Materials & methods: The propensity score matching (PSM), logistic regression and Cox proportional hazards model were used in this study. Results: A total of 13,937 patients were included. After PSM, 10579 patients were co-insured. The married were more likely to receive surgical treatment compared with the unmarried patients (OR: 1.841, p < 0.001), and patients who underwent surgery also tended to have better survival (HR: 0.293, p < 0.001). Conclusion: Compared with unmarried patients, a married group with stage I NSCLC had timely treatment and more satisfactory survival. This study highlights the importance of prompt help and care for unmarried patients.
... Proper penile hygiene has been one of the main prophylactic measures for PC, and when not performed, it favors the emergence of a favorable microenvironment for the proliferation of uropathogenic microorganisms, such as HPV [28]. In addition, it increases the chances of the onset of episodes of chronic inflammation (balanitis and lichen sclerosus), which may also contribute to PC development [29][30][31]. ...
Background:
Although penile cancer (PC) is uncommon in developed countries, it is widespread in developing countries. The state of Maranhão (Northeast, Brazil) has the highest global incidence recorded for PC, and, despite its socioeconomic vulnerability, it has been attributed to human papillomavirus (HPV) infection. This study aimed to determine the histopathological features, the prevalence of HPV infection, and the immunohistochemical profile of PC in Maranhão.
Methods:
A retrospective cohort of 200 PC cases were evaluated. HPV detection was performed using nested-PCR followed by direct sequencing for genotyping. Immunohistochemistry (IHC) was performed using monoclonal antibodies anti-p16INK4a, p53, and ki-67.
Results:
Our data revealed a delay of 17 months in diagnosis, a high rate of penile amputation (96.5%), and HPV infection (80.5%) in patients from Maranhão (Molecular detection). We demonstrated the high rate of HPV in PC also by histopathological and IHC analysis. Most patients presented koilocytosis (75.5%), which was associated with those reporting more than 10 different sexual partners during their lifetime (p = 0.001). IHC revealed frequent p16INK4a overexpression (26.0%) associated with basaloid (p < 0.001) and high-grade tumors (p = 0.008). Interestingly, p16 appears not to be a better prognostic factor in our disease-free survival analysis, as previously reported. We also demonstrated high ki-67 and p53 expression in a subset of cases, which was related to worse prognostic factors such as high-grade tumors, angiolymphatic and perineural invasion, and lymph node metastasis. We found a significant impact of high ki-67 (p = 0.002, log-rank) and p53 (p = 0.032, log-rank) expression on decreasing patients' survival, as well as grade, pT, stage, pattern, and depth of invasion (p < 0.05, log-rank).
Conclusions:
Our data reaffirmed the high incidence of HPV infection in PC cases from Maranhão and offer new insights into potential factors that may contribute to the high PC incidence in the region. We highlighted the possible association of HPV with worse clinical prognosis factors, differently from what was observed in other regions. Furthermore, our IHC analysis reinforces p16, ki-67, and p53 expression as important diagnosis and/or prognosis biomarkers, potentially used in the clinical setting in emerging countries such as Brazil.
... Interestingly, the effect was higher in studies that included more unmarried patients. 2 Unmarried cancer patients are more likely to be diagnosed with an advanced stage of the disease than married patients, [3][4][5] who often have a higher socioeconomic status than unmarried ones, enabling them to have better access to healthcare. 6 They can also receive instrumental support from their spouse (e.g. ...
Background:
In recent years, authors have repeatedly reported on the significance of social support in cancer survival. Although overall the studies appear to be convincing, little is known about which types of social support promote better survival rates, and which subgroups of cancer patients are more susceptible to the benefits of it. The aim of this study was to identify, organize, and examine studies reporting on the significance of social support in cancer survival.
Methods:
The PubMed, CINAHL and EBSCO databases were searched using the keywords social support/marital status, cancer, and survival/mortality. Where possible we used a meta-analytical approach, specifically a random effect model, in order to combine the results of the hazard ratios in studies from which this information could be obtained. When interpreting clinical relevance, we used the number needed to treat (NNT).
Results:
Better survival was observed in married patients when compared to unmarried (single, never-married, divorced/separated, and widowed) in overall and cancer-specific survival. Gender group differences showed that the association was statistically significant only in cancer-specific survival when comparing divorced/separated male and female cancer patients (p < 0.001), thus confirming results from the previous meta-analysis.
Conclusions:
Being unmarried is associated with significantly worse overall and cancer-specific survival. The most vulnerable group found in our study were divorced/separated men. The results of this review can motivate physicians, oncologists, and other healthcare professionals to be aware of the importance of patients' social support, especially in the identified sub-group.
... Most contemporary large-scale epidemiological penile cancer studies exclusively focused on SCC histological subtype [4,[10][11][12][13][14]. Only one large-scale, and several case series and case reports examined outcomes of non-SCC penile cancer [15][16][17][18][19][20]. ...
Purpose
To compare Cancer-specific mortality (CSM) in patients with Squamous cell carcinoma (SCC) vs. non-SCC penile cancer, since survival outcomes may differ between histological subtypes.
Methods
Within the Surveillance, Epidemiology and End Results database (2004–2016), penile cancer patients of all stages were identified. Temporal trend analyses, cumulative incidence and Kaplan–Meier plots, multivariable Cox regression and Fine and Gray competing-risks regression analyses tested for CSM differences between non-SCC vs. SCC penile cancer patients.
Results
Of 4,120 eligible penile cancer patients, 123 (3%) harbored non-SCC vs. 4,027 (97%) SCC. Of all non-SCC patients, 51 (41%) harbored melanomas, 42 (34%) basal cell carcinomas, 10 (8%) adenocarcinomas, eight (6.5%) skin appendage malignancies, six (5%) epithelial cell neoplasms, two (1.5%) neuroendocrine tumors, two (1.5%) lymphomas, two (1.5%) sarcomas. Stage at presentation differed between non-SCC vs. SCC. In temporal trend analyses, non-SCC diagnoses neither decreased nor increased over time (p > 0.05). After stratification according to localized, locally advanced, and metastatic stage, no CSM differences were observed between non-SCC vs. SCC, with 5-year survival rates of 11 vs 11% (p = 0.9) for localized, 33 vs. 37% (p = 0.4) for locally advanced, and 1-year survival rates of 37 vs. 53% (p = 0.9) for metastatic penile cancer, respectively. After propensity score matching for patient and tumor characteristics and additional multivariable adjustment, no CSM differences between non-SCC vs. SCC were observed.
Conclusion
Non-SCC penile cancer is rare. Although exceptions exist, on average, non-SCC penile cancer has comparable CSM as SCC penile cancer patients, after stratification for localized, locally invasive, and metastatic disease.
... [12] Thuret et al. also reported that unmarried men with squamous cell carcinoma of the penis are often presented with poor disease stages. [13] Moreover, marital status is an independent prognostic factor of survival in many malignancies, including bladder cancer, [14] prostate cancer, [15] and testis cancer. [16] However, the impact of marital status on the survival of patients with UTUC remains elusive due to paucity of studies. ...
Background:
To evaluate impact of marital status on survival of patients with upper urinary tract urothelial carcinoma (UTUC).
Methods:
Data of patients diagnosed with UTUC from 2010 to 2015 were identified and retrieved from the Surveillance, Epidemiology, and End Results database. The impact of marital status on overall survival (OS) and cancer-specific survival (CSS) was analyzed using Kaplan-Meier survival curve method and compared with the log-rank test. Multivariate survival analysis of OS and CSS was conducted using the Cox proportional hazards regression model.
Results:
A total of 4520 eligible patients with UTUC were included in this study. The 5-year OS rates of married patients, never-married patients, and separated, divorced, or widowed (SDW) patients were 47.3%, 43.7%, and 39.2%, respectively (P < 0.001), and the corresponding 5-year CSS rates were 57.7%, 55.2%, and 51.5%, respectively (P = 0.005). In multivariate analyses, marital status was an independent prognostic factor for OS (P < 0.001) and CSS (P = 0.002) of patients with UTUC. Compared to married patients, never married (hazard ratio [HR], 1.187; 95% confidence interval [CI], 1.016-1.386 for OS; HR, 1.102; 95% CI, 0.877-1.385 for CSS) and SDW (HR, 1.205; 95% CI, 1.094-1.327 for OS; HR, 1.309; 95% CI, 1.131-1.514 for CSS) patients showed poor OS and unfavorable CSS.
Conclusions:
Marital status was an independent prognostic factor for OS and CSS in patients with UTUC. Married patients with UTUC experienced longer OS and a more favorable CSS than their never married and SDW counterparts.
... Unmarried patients with cancer have a higher risk of being diagnosed with cancer at an advanced stage of the disease than married patients. 3,7,[10][11][12][13] Moreover, studies have revealed that unmarried patients are less likely to receive appropriate treatment than married patients. 3,7,13,14 The association between being married and better CSS has been speculated to be secondary to the benefits of early diagnosis and treatment. ...
Importance
Married patients with cancer have better cancer-specific survival than unmarried patients. Increasing the early diagnosis and definitive treatment of cancer among unmarried patients may reduce the survival gap.
Objectives
To evaluate the extent to which marriage is associated with cancer-specific survival, stage at diagnosis, and treatment among patients with 9 common solid cancers and to recommend methods for reducing the survival gap.
Design, Setting, and Participants
This retrospective, population-based cohort study included patients older than 18 years who were diagnosed with 1 of 9 common cancers between January 1, 2007, and December 31, 2016. Patient data were retrieved from the Surveillance, Epidemiology, and End Results Program. Statistical analyses were performed from August 1 to October 1, 2020.
Exposures
Marital status, classified as married and unmarried (including single, separated, divorced, widowed, and unmarried patients or domestic partners).
Main Outcomes and Measures
The primary outcome was the time ratio (TR) of cancer-specific survival (married vs unmarried). Mediation analyses were conducted to determine the extent to which the association of marriage with cancer-specific survival was mediated by stage at diagnosis and treatment.
Results
This study included 1 733 906 patients (894 379 [51.6%] women; 1 067 726 [61.6%] married; mean [SD] age, 63.76 [12.60] years). Multivariate analyses found that those who were married were associated with better cancer-specific survival than unmarried patients (TR, 1.36; 95% CI, 1.35-1.37). Early diagnosis in breast cancer, colorectal cancer, endometrial cancer, and melanoma mediated the association between marital status and cancer-specific survival (breast cancer: proportion mediated [PM], 11.4%; 95% CI, 11.2%-11.6%; colorectal cancer: PM, 10.9%; 95% CI, 10.7%-11.2%; endometrial cancer: PM, 12.9%; 95% CI, 12.5%-13.3%; melanoma: PM, 12.0%; 95% CI, 11.7-12.4%). Surgery mediated the association between marital status and cancer-specific survival in lung (PM, 52.2%; 95% CI, 51.9%-52.4%), pancreatic (PM, 28.9%; 95% CI, 28.6%-29.3%), and prostate (PM, 39.3%; 95% CI, 39.0%-39.6%) cancers. Chemotherapy mediated the association of marital status with cancer-specific survival in lung (PM, 37.7%; 95% CI, 37.6%-37.9%) and pancreatic (PM, 28.6%; 95% CI, 28.4%-28.9%) cancers. Improved cancer-specific survival associated with marriage was greater among men than women (men: TR, 1.27; 95% CI, 1.25-1.28; women: TR, 1.20; 95% CI, 1.19-1.21). The contribution of receiving an early diagnosis and treatment with surgery or chemotherapy to the association between marital status and cancer-specific survival was greater among men than women (early diagnosis: PM, 21.7% [95% CI, 21.5%-21.9%] vs PM, 20.3% [95% CI, 20.2%-20.4%]; surgery: PM, 26.6% [95% CI, 26.4%-26.7%] vs PM, 11.1% [95% CI, 11.0%-11.2%]; chemotherapy: PM, 6.8% [95% CI, 6.7%-6.8%] vs PM, 5.1% [95% CI, 5.0%-5.2%]).
Conclusions and Relevance
In this study, survival disparities associated with marital status were attributable to early diagnosis in breast, colorectal, and endometrial cancers as well as melanoma and to treatment-related variables in lung, pancreatic, and prostate cancers. The findings also suggest that marriage may play a greater protective role in the cancer-specific survival of men than of women.
... However, other confounding factors, such as dietary habits, socioeconomic status, educational attainment, and marital status were rarely evaluated. Several previous studies had reported the relationship between marital status and SCC of the head and neck and penis [9][10][11]. They all indicated that marital status was an independent prognostic factor among these cancers and married patients showed a signi cantly better prognosis. ...
Background: Marital status has been proved as an independent prognostic factor in many cancer types. However, no detailed investigation of marital status on squamous cell carcinoma (SCC) has been evaluated. The aim of this essay is to explore the relationship between marital status and SCC in 7 tumor sites.
Methods: All patients diagnosed with SCC were collected from the SEER database (1975-2016). We analyzed the survival of all included SCC patients in four marital status. We utilized propensity-score matching analysis to balance baseline characteristics between married and unmarried SCC patients in 7 tumor sites. The influence of marital status on overall survival (OS) in each site was performed by Cox regression analysis.
Results: A total of 180009 SCC patients were involved in this study. After propensity-score matching, patients in the married group were 1:1 matched with patients in the unmarried group for each sites. Married group exhibited higher 5- year OS rate than unmarried group (27.3% vs 19.8%). More precisely, being divorced and widowed were observed to be related to have worse survival than single patients in most sites. Furthermore, patients with clinical stage IV were more common in the unmarried group which having a lower proportion of receiving treatment.
Conclusions: This study indicated that marital status was a significant factor for OS of SCC in 7 tumor sites. Married patients always behaved more favorable than unmarried including single, divorced, and widowed patients.
... Most contemporary large-scale epidemiological penile cancer studies exclusively focused on SCC histological subtype [4,[10][11][12][13][14]. Only one large-scale, and several case series and case reports examined outcomes of non-SCC penile cancer [15][16][17][18][19][20]. ...
Purpose:
To test the effect of variant histology (non-SCC) cancer-specific mortality (CSM), relative to squamous cell carcinoma (SCC) in penile cancer patients.
Methods:
Within the Surveillance, Epidemiology and End Results database (2004–2016), penile cancer patients of all stages were identified. Temporal trend analyses, cumulative incidence and Kaplan-Meier plots and multivariable competing-risks regression analyses tested for CSM differences between non-SCC vs. SCC penile cancer patients.
Results:
Of 4,120 eligible penile cancer patients, 123 (3%) harbored non-SCC vs. 4,027 (97%) SCC. Of all non-SCC patients, 51 (41%) harbored melanomas vs. 42 (34%) basal cell carcinomas vs. 10 (8%) adenocarcinomas vs. eight (6.5%) skin appendage malignancies vs. six (5%) epithelial cell neoplasms vs. two (1.5%) neuroendocrine tumors vs. two (1.5%) lymphomas, vs. two (1.5%) sarcomas. In temporal trend analyses, non-SCC diagnoses neither decreased nor increased over time (p>0.05). After stratification according to localized, locally advanced, and metastatic stage, no CSM differences were observed between non-SCC vs. SCC, with 5-year survival rates of 11 vs 11% (p=0.9) for localized, 33 vs 37% (p=0.4) for locally advanced, and 1-year survival rates of 37 vs 53% (p=0.9) for metastatic penile cancer, respectively. After propensity score matching for patient and tumor characteristics and additional multivariable adjustment, no CSM differences between non-SCC vs. SCC were observed.
Conclusion:
Non-SCC penile cancer is rare. Although exceptions exist, on average, non-SCC penile cancer has comparable CSM as SCC penile cancer patients, after stratification for localized, locally invasive, and metastatic disease.
... Studies in breast, colorectal and bladder cancer have demonstrated cohabitation as an independent prognostic factor [5][6][7]. This has also been indicated in previous studies on penile cancer [8][9][10], though findings are not equivocal. ...
... At the current cohort size, we could not establish a significant association between living arrangements and cancer-specific survival. Our finding of cohabiting as a predictor of survival in penile cancer is in line with previous studies on marital status [5][6][7][8][9][10] . These studies have examined cohabitation as a prognostic factor, Mao et al. had their cohabiting patients stratified even further into married, divorced, single and widowed and found the lowest cancer-specific survival (CSS) in the widowed patient group [15]. ...
Background
Cohabitation and social conditions predict prognosis in several cancers; recent data suggest this might also be the case in penile cancer.
Objective
To assess the prognostic significance of cohabitation, living arrangements and socio-economic conditions for cancer-specific survival (CSS) in patients with penile squamous cell carcinoma (pSCC)
Methods
We retrospectively evaluated CSS in 429 pSCC patients from a 10-year period. We assessed cohabitation, living arrangements and socio-economic conditions(SEC) as prognostic predictors. Kaplan–Meier estimates and Cox hazard rates (HR) with 95% confidence intervals were used for analysis.
Results
Out of 429 pSCC patients, 137 (32%) were living alone and 292 (68%) were cohabiting. With a Cox HR at 1.91 (95% CI 1.3–2.98) patients living alone had a significantly lower median five-year survival rate at 69% (95% CI 60-77%) compared to cohabiting patients at 83% (95% CI 78–87%), p = 0.002. Comparing 60 (14%) from higher to 202 (47%) from medium and 95 (22%) patients from lower socio-economic groups we found Cox HRs at 1, 2.4 (95% CI 1.0-5.7, p = 0.04) and 3.4 (95% CI 1.4-8.1, p < 0.01) respectively. When comparing living arrangements, the trend that patients living in apartments and institutions had poorer outcomes than patients living in a house did not reach statistical significance.
Conclusions
Living alone and in poor socio-economic conditions predict poor prognosis in penile cancer in this national study. We make the case for further research in efforts to minimize cancer inequality pSCC patients.
... 27,28 Many studies have shown that marital status was an independent prognostic factor for the survival of a variety of cancers, including breast cancer, penis cancer, gastric cancer and colorectal cancer, and unmarried patients have a higher risk of death. [29][30][31][32] Our study found that marital status was an influential factor in surgical compliance, and married patients were more likely to receive surgical treatment. We speculate that the better prognosis of married patients may be partly due to good surgical compliance. ...
Introduction
Our aim was to determine the relationship between surgical compliance and survival outcomes in patients with stage T1-2 non-small-cell lung cancer (NSCLC).
Methods
Patients with T1-2 NSCLC who were diagnosed between 2004 and 2015 were identified from the SEER database. Multivariate logistic regression was used to analyse factors associated with surgical compliance. Kaplan–Meier curves and Cox regression were used to analyse the effects of surgical compliance on overall survival (OS) and cancer-specific survival (CSS).
Results
Of the 221,704 eligible T1-2 NSCLC patients, 106,668 patients recommended surgery. Among them, 99,672 (93.4%) patients were surgical compliance group, and 6996 (6.6%) were surgical noncompliance group. Poor surgical compliance was associated with earlier diagnosis time, old age, male, black race, unmarried status, main bronchus site, poor grade/stage, and lower household income. Patients’ compliance was an independent prognostic factor for OS and CSS of T1-2 NSCLC patients. Multivariate Cox regression showed that surgical noncompliance individuals showed lower OS (hazard ratio [HR] 2.494; 95% confidence interval [CI] 2.423–2.566, p < 0.001) and lower CSS (HR 2.877; 95% CI 2.782–2.974, p < 0.001) compared with surgical compliance patients. In addition, results in the non-surgical group were observed to be similar to those of the surgical noncompliance group.
Conclusion
We found that patients’ compliance was an independent prognostic factor for survival in T1-2 NSCLC patients. Poor surgical compliance was associated with earlier diagnosis time, old age, male, black race, unmarried status, main bronchus site, poor grade/stage, and lower household income.
