Nelles Jason L, Joseph Sue A, Konety Badrinath R
Department of Urology, School of Medicine, University of California-San Francisco, San Francisco, CA 94143, USA.
Urol Oncol. 2009 May-Jun;27(3):263-7. doi: 10.1016/j.urolonc.2008.04.016. Epub 2008 Jul 14.
Marital status has been found to influence survival in a number of malignancies. We examined data from the Surveillance, Epidemiology, and End Results (SEER) cancer survival database to see if married patients with bladder cancer had a survival advantage vs. nonmarried patients.
The SEER database contains data on 127,015 patients diagnosed with bladder cancer between 1973 and 2002. Using multivariate Cox proportional hazard regression analyses, we examined the impact of marital status (single, married, separated, divorced, or widowed) on survival after diagnosis with bladder cancer. Age, race, AJCC stage, radiation and chemotherapy, and cystectomy were other variables analyzed.
Marital status did not appear to have a significant survival effect for women. However, men who were widowed had a risk of death of 1.74 relative to married men (95% CI 1.15, 2.26, P = 0.008). For widowed men over 70, this effect was even more pronounced, with a risk of death of 2.1 (95% CI 1.33, 3.31, P = 0.001).
While we did not see any definite survival advantage to being married vs. not being married for patients who are diagnosed with bladder cancer, there is a significant risk to widowed men, particularly older widowed men. This risk is independent of age, race, stage, and may reflect the patient's willingness to seek medical treatment in addition to psychoneuroimmune factors.
已发现婚姻状况会影响多种恶性肿瘤患者的生存率。我们研究了监测、流行病学和最终结果（SEER）癌症生存数据库中的数据，以确定膀胱癌已婚患者与未婚患者相比是否具有生存优势。
SEER数据库包含1973年至2002年间被诊断为膀胱癌的127,015名患者的数据。我们使用多变量Cox比例风险回归分析，研究了婚姻状况（单身、已婚、分居、离婚或丧偶）对膀胱癌诊断后生存的影响。年龄、种族、美国癌症联合委员会（AJCC）分期、放疗和化疗以及膀胱切除术是其他分析的变量。
婚姻状况对女性的生存似乎没有显著影响。然而，丧偶男性相对于已婚男性的死亡风险为1.74（95%置信区间1.15, 2.26，P = 0.008）。对于70岁以上的丧偶男性，这种影响更为明显，死亡风险为2.1（95%置信区间1.33, 3.31，P = 0.001）。
虽然我们没有看到膀胱癌患者已婚与未婚在生存方面有任何明确的优势，但丧偶男性，尤其是老年丧偶男性存在显著风险。这种风险与年龄、种族、分期无关，可能除了心理神经免疫因素外，还反映了患者寻求医疗治疗的意愿。
