Gore John L, Kwan Lorna, Saigal Christopher S, Litwin Mark S
Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, 90095, USA.
Cancer. 2005 Sep 15;104(6):1188-94. doi: 10.1002/cncr.21295.
Being married confers significant benefits in survival for patients with a variety of chronic conditions including breast and prostate carcinoma. The authors attempted to determine whether marital status is associated with survival in patients undergoing radical cystectomy for bladder carcinoma.
The authors identified 7262 subjects from the Surveillance, Epidemiology, and End Results public-use database who underwent radical cystectomy for transitional cell carcinoma of the bladder. They performed survival analyses using Kaplan-Meier estimates and Cox proportional hazards models. The authors created multivariate models to evaluate the independent association between marital status and survival, controlling for pathologic stage, lymph node status, age, race/ethnicity, and gender.
Married subjects were older and more often male, white, and had earlier disease stage at diagnosis. Married subjects had significantly better survival than did single or widowed subjects (P < 0.001), and married subjects revealed a trend toward better survival than separated/divorced subjects (P = 0.20). Multivariate modeling revealed that compared with single subjects, those who were married had better survival, independent of age at the time of diagnosis, gender, race/ethnicity, disease stage, and lymph node status (P < 0.001).
Marriage was associated with improved survival in patients with bladder carcinoma, independent of other factors known to influence mortality in this population. Although the mechanisms underlying this survival advantage are unknown, possibilities include differences in cancer screening, risk behaviors, and access to medical care. The interaction between psychosocial factors and the body's immune function may further explain the differential survival in this cohort.
对于患有包括乳腺癌和前列腺癌在内的多种慢性病的患者而言，已婚能带来显著的生存益处。作者试图确定婚姻状况是否与接受膀胱癌根治性膀胱切除术患者的生存率相关。
作者从监测、流行病学和最终结果公共使用数据库中识别出7262名因膀胱移行细胞癌接受根治性膀胱切除术的受试者。他们使用Kaplan-Meier估计法和Cox比例风险模型进行生存分析。作者创建多变量模型以评估婚姻状况与生存率之间的独立关联，同时控制病理分期、淋巴结状态、年龄、种族/民族和性别。
已婚受试者年龄更大，男性、白人比例更高，诊断时疾病分期更早。已婚受试者的生存率显著高于单身或丧偶受试者（P < 0.001），且已婚受试者的生存率有高于分居/离婚受试者的趋势（P = 0.20）。多变量建模显示，与单身受试者相比，已婚者生存率更高，且独立于诊断时的年龄、性别、种族/民族、疾病分期和淋巴结状态（P < 0.001）。
婚姻与膀胱癌患者生存率提高相关，独立于已知影响该人群死亡率的其他因素。尽管这种生存优势背后的机制尚不清楚，但可能包括癌症筛查、风险行为和获得医疗护理方面的差异。心理社会因素与身体免疫功能之间的相互作用可能进一步解释该队列中的生存差异。
