Association of marital status and all-cause mortality of metastatic breast cancer patients: A population-based study

Abstract

Background: Being married is positively associated with survival in patients with various types of malignancy. However, the significance of marital status on the prognosis of metastatic breast cancer (MBC) has not been explored. Methods: Data of MBC patients were extracted from the surveillance, epidemiology, and end results database from 2010 to 2015. Patients were separated into married and unmarried cohorts based on their marital status. The Kaplan–Meier analysis with log-rank test was performed to assess the difference in breast cancer-specific survival (BCSS) and overall survival (OS) between married and unmarried patients. Univariate and multivariate Cox proportional models were performed to assess whether marital status was independently associated OS. Fine-Gray subdistribution hazard method was performed to assess whether marital status was independently associated with BCSS. As potential confoundings, age, race, tumor pathologicalgrade, tumor subtype, chemotherapy, surgery, and metastasis pattern were adjusted in the multivariate model. Results: There were 16513 MBC patients identified, including 8949 married (54.19%) and 7564 unmarried patients (45.81%). When compared to the unmarried patients, married patients were younger (58.85±12.94 vs.63.41±14.75; p < 0.001), received more aggressive treatment, like chemotherapy (p < 0.001), and surgery (p< 0.001). Furthermore, the married population had higher 5‑year BCSS (42.64% vs. 33.17%, p < 0.0001) and OS (32.22% vs. 21.44%, p< 0.0001) rates. The multivariate analysis revealed that marital status was an independent prognostic factor, being married was associated with a significant reduction in the risk of breast cancer-specific (SHR: 0.845; 95% CI: 0.804–0.888; p < 0.001) and all-cause (HR: 0.810; 95% CI: 0.777–0.844; p < 0.001)mortality. In addition, BCSS as well as OS were superior in married populations than unmarried ones in most subgroups. Conclusion: Marital status was an independent prognostic indicator for survival in MBC patients. Married patients experience significant survival benefits in BCSS and OS.

Allostatic Load as a Predictor of Postoperative Complications in Patients with Breast Cancer

“…However, existing studies suggest a decreased risk of cancer-speci c and all-cause mortality amongst married women with breast cancer relative to their unpartnered counterparts. 40,41 The impact of marital status on POC development varies among other cancer types; divorced or separated patients with oropharyngeal or laryngeal cancer have twice the odds of requiring readmission for complications but no association is seen amongst patients with colorectal cancer. 42,43 Yu et al noted that patients with breast cancer with government insurance, particularly Medicare, were also more likely to develop POC even after controlling for age and comorbidities.…”

Review of the relationship between tumor receptor subtypes and preference for visceral and/or serosal metastasis in breast cancer patients

“…Metastatic disease remains the underlying cause of death in most patients who die from the disease. [6,7] Approximately 12% of patients with breast cancer develop distant metastases, reducing the 5-year survival rate from 90% to 25%. [7,8] Therefore, it is important to identify patients at high risk of tumor metastasis in advance, if possible, to ensure timely intervention.…”