Wen Yixin, Zhang Hui, Zhi Kaining, Li Minghui
Department of Orthopaedics, Fifth Hospital in Wuhan, Wuhan, China.
Department of Blood Transfusion, Wuhan Hankou Hospital, Wuhan, China.
Front Med (Lausanne). 2022 Oct 18;9:1001522. doi: 10.3389/fmed.2022.1001522. eCollection 2022.
The role of spousal support has been recognized to benefit patients with many chronic diseases and cancers. However, the impact of marital status on the survival of middle-aged and elderly patients with primary bone tumors remains elusive.
The data of patients aged ≥ 45 years with primary bone tumors diagnosed between 2000 and 2018 were extracted from the Surveillance, Epidemiology, and End Results Database. Kaplan-Meier analysis was used to assess the overall survival and tumor-specific survival of patients. The Cox proportional hazards and Fine-and-Gray models were used to calculate the hazard ratios (HRs) and sub-distribution HRs (sHR) and the corresponding 95% confidence interval (CI) of all-cause mortality and tumor-specific mortality, respectively.
A total of 5,640 primary bone tumors were included in the study. In 45-59 years cohort, married, unmarried, divorced and widowed accounted for 66.0, 21.0, 11.2, and 1.8%, respectively; while 64.3, 10.1, 8.8, and 16.8% in 60+ years cohort, respectively. The widowed patients had a lower proportion of early-stage tumors at diagnosis than that married, unmarried, and divorced patients (31.0% vs. 36% vs. 37.1% vs. 39.4%; = 0.008), and had a higher proportion of patients who did not undergo surgery than that of married, unmarried, and divorced patients (38.6% vs. 21.3% vs. 24.6% vs. 24.4%; < 0.001). The widowed population had an increased risk of all-cause mortality (HR, 1.68; 95% CI, 1.50-1.88; < 0.001) and disease-related mortality (HR, 1.33; 95% CI, 1.09-1.61; = 0.005) compared with the married population.
The marital status of middle-aged and elderly people can affect the tumor stage at diagnosis, treatment, and survival prognosis of patients with primary bone cancer. Widowed patients are more inclined to choose non-surgical treatment and have the worst prognosis.
配偶支持的作用已被认为对许多慢性病和癌症患者有益。然而，婚姻状况对中老年原发性骨肿瘤患者生存的影响仍不明确。
从监测、流行病学和最终结果数据库中提取2000年至2018年间诊断为原发性骨肿瘤的年龄≥45岁患者的数据。采用Kaplan-Meier分析评估患者的总生存率和肿瘤特异性生存率。分别使用Cox比例风险模型和Fine-and-Gray模型计算全因死亡率和肿瘤特异性死亡率的风险比（HR）和亚分布风险比（sHR）以及相应的95%置信区间（CI）。
本研究共纳入5640例原发性骨肿瘤患者。在45 - 59岁队列中，已婚、未婚、离异和丧偶者分别占66.0%、21.0%、11.2%和1.8%；而在60岁及以上队列中分别占64.3%、10.1%、8.8%和16.8%。丧偶患者在诊断时早期肿瘤的比例低于已婚、未婚和离异患者（31.0%对36%对37.1%对39.4%；P = 0.008），未接受手术治疗的患者比例高于已婚、未婚和离异患者（38.6%对21.3%对24.6%对24.4%；P < 0.001）。与已婚人群相比，丧偶人群全因死亡风险增加（HR，1.68；95% CI，1.50 - 1.88；P < 0.001），疾病相关死亡风险增加（HR，1.33；95% CI，1.09 - 1.61；P = 0.005）。
中老年人的婚姻状况会影响原发性骨癌患者的诊断时肿瘤分期、治疗及生存预后。丧偶患者更倾向于选择非手术治疗，预后最差。
