Brusselaers Nele, Mattsson Fredrik, Johar Asif, Wikman Anna, Lagergren Pernilla, Lagergren Jesper, Ljung Rickard
Unit of Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
BMJ Open. 2014 Jun 6;4(6):e005418. doi: 10.1136/bmjopen-2014-005418.
A beneficial effect of being married on survival has been shown for several cancer types, but is unclear for oesophageal cancer. The objective of this study was to clarify the potential influence of the marital status on the overall and disease-specific survival after curatively intended treatment of oesophageal cancer using a nationwide population-based design, taking into account the known major prognostic variables.
Prospective, population-based cohort.
All Swedish hospitals performing surgery for oesophageal cancer during 2001-2005.
This study included 90% of all patients with oesophageal or junctional cancer who underwent surgical resection in Sweden in 2001-2005, with follow-up until death or the end of the study period (2012).
Cox regression was used to estimate associations between the marital status and the 5-year overall and disease-specific mortality, expressed as HRs with 95% CIs, with adjustment for sex, age, tumour stage, histological type, complications, comorbidities and annual surgeon volume.
Of all 606 included patients (80.4% men), 55.1% were married, 9.2% were remarried, 22.6% were previously married and 13% were never married. Compared with the married patients, the never married (HR 1.02, 95% CI 0.77 to 1.35), previously married (HR 0.90, 95% CI 0.71 to 1.15) and remarried patients (HR 0.79, 95% CI 0.55 to 1.13) had no increased overall 5-year mortality. The corresponding HRs for disease-specific survival, and after excluding the initial 90 days of surgery, were similar to the HRs for the overall survival.
This study showed no evidence of a better 5-year survival in married patients compared with non-married patients undergoing surgery for oesophageal cancer.
已表明婚姻状况对几种癌症类型的生存具有有益影响，但食管癌的情况尚不清楚。本研究的目的是利用全国性的基于人群的设计，在考虑已知主要预后变量的情况下，阐明婚姻状况对食管癌根治性治疗后总体生存和疾病特异性生存的潜在影响。
前瞻性、基于人群的队列研究。
2001年至2005年期间在瑞典所有进行食管癌手术的医院。
本研究纳入了2001年至2005年在瑞典接受手术切除的所有食管或交界性癌患者的90%，随访至死亡或研究期结束（2012年）。
采用Cox回归估计婚姻状况与5年总体死亡率和疾病特异性死亡率之间的关联，以风险比（HR）及95%置信区间（CI）表示，并对性别、年龄、肿瘤分期、组织学类型、并发症、合并症和外科医生年手术量进行调整。
在纳入的所有606例患者中（80.4%为男性），55.1%已婚，9.2%再婚，22.6%曾婚，13%未婚。与已婚患者相比，未婚患者（HR 1.02，95%CI 0.77至1.35）、曾婚患者（HR 0.90，95%CI 0.71至1.15）和再婚患者（HR 0.79，95%CI 0.55至1.13）的5年总体死亡率均未升高。疾病特异性生存的相应HR以及排除手术最初90天后的HR与总体生存的HR相似。
本研究表明，与接受食管癌手术的未婚患者相比，已婚患者并无5年生存率更高的证据。
