Analysis of association between marital status at diagnosis and prognosis in 142 007 patients with breast cancer based on SEER database

Abstract:

Objective：To investigate the association between marital status at diagnosis and breast cancer specific survival（BCSS）. Methods：Data of patients who were diagnosed with breast cancer between 2010 and 2014 were extracted from the Surveillance，Epi－demiology，and End Results（SEER） database. Association between marital status（married，single，divorced，separated and widowed） and BCSS was retrospectively analyzed by univariate and multivariate Cox proportional hazards models. Results：A total of 142 007 patients were enrolled，with a median follow-up of 28 months（IQR：2-59 months），and 6685 patients were died with specific breast cancer. There were significant imbalances in clinicopathologic characteristics[age，tumor stage，histological grade，estrogen receptor（ER），progesterone receptor（PR），human epidermal growth factor 2（HER2），molecular type，chemotherapy and radiation therapy] between patients with different marital status（all P<0.001）. Multivariate Cox proportional hazards model analyses showed that the single（HR=1.26，95%CI=1.18 to 1.35，P<0.001），the divorced（HR=1.11，95%CI=1.07 to 1.16，P＜0.001），the widowed（HR=1.10，95%CI=1.03 to 1.18，P<0.001） and the separated（HR=1.18，95%CI=1.16 to 1.20，P＜0.001） were bad prognostic factors for breast cancer patients when compared with married patients. Subgroup analysis showed that separation had no influences on patients with a subtype of HR-/HER2+，HR+/HER2+ or HR-/HER2-，and divorce was not associated with the BCSS in HR-/HER2- subtype patients（P>0.05）. After the correction of age，single was a poor prognostic factor for breast cancer patients of all ages. Divorce was a poor prognostic factor for patients aged 60 to 69 years old（HR=1.18，95%CI=1.10 to 1.27，P<0.001）. Separation influenced the prognosis of patients aged less than 49 years old and 60 to 69 years old（P<0.05）. Widowhood was a poor prognostic factor for patients aged 70 years old or older（HR=1.10，95%CI=1.07 to 1.13，P<0.001）. Conclusion：Marital status at diagnosis is significantly correlated with prognosis of breast cancer and has different influences on the prognosis of patients with different age groups and molecular subtypes.