Wang Hua, Zhao Yong, Feng Shifeng, Wei Guo
Department of General Surgery, Public Health Clinical Center of Chengdu, No. 18, Jingjusi Road, Jinjiang District, Chengdu, 610000, China.
Sci Rep. 2025 May 2;15(1):15443. doi: 10.1038/s41598-025-00479-4.
The protective role of marriage has been identified in various cancers, but its effect on the overall urological system remains unclear. Patients diagnosed with bladder cancer (BCa), renal cell carcinoma (RCC), and upper tract urothelial carcinoma (UTUC) were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were divided into married and unmarried groups based on their marital status. A binary multivariable logistic regression was used to explore the effect of marriage on the diagnosis of urological cancers. One-to-one propensity score matching (PSM) was employed to reduce baseline differences between the two groups. Multivariable Cox regression analysis and subgroup analysis were conducted to investigate the impact of marriage on cancer-specific survival (CSS). A total of 162,544 patients were included in the study, with a median follow-up period of 6.2 years (IQR 2.3-9.8 years). Among them, 104,706 (64.4%) were married, and 57,838 (35.6%) were unmarried. Married patients had a lower risk of being diagnosed with stage III/IV disease compared to unmarried patients (OR 0.94, 95% CI 0.92-0.96, p < 0.001), but this trend was only significant in BCa (OR 0.88, 95% CI 0.84-0.91, p < 0.001), but not in RCC (OR 0.98, 95% CI 0.94-1.01, p = 0.172) or UTUC (OR 1.03, 95% CI 0.95-1.12, p = 0.523). After PSM, 47,975 patients were included in each group, and marriage was found to be an independent protective prognostic factor for CSS (HR 0.81, 95% CI 0.79-0.83, p < 0.001), but this was not significant in UTUC (HR 0.95, 95% CI 0.88-1.03, p = 0.244). Across the entire urological system, marriage is an independent protective predictor for both diagnosis and survival, but the effect varies among different types of cancers.
婚姻的保护作用已在多种癌症中得到证实，但其对整个泌尿系统的影响仍不明确。从监测、流行病学和最终结果（SEER）数据库中确定了被诊断为膀胱癌（BCa）、肾细胞癌（RCC）和上尿路尿路上皮癌（UTUC）的患者。根据婚姻状况将患者分为已婚和未婚两组。采用二元多变量逻辑回归分析来探讨婚姻对泌尿系统癌症诊断的影响。采用一对一倾向评分匹配（PSM）来减少两组之间的基线差异。进行多变量Cox回归分析和亚组分析以研究婚姻对癌症特异性生存（CSS）的影响。本研究共纳入162,544例患者，中位随访期为6.2年（四分位间距2.3 - 9.8年）。其中，104,706例（64.4%）已婚，57,838例（35.6%）未婚。与未婚患者相比，已婚患者被诊断为III/IV期疾病的风险较低（比值比[OR] 0.94，95%置信区间[CI] 0.92 - 0.96，p < 0.001），但这种趋势仅在膀胱癌中显著（OR 0.88，95% CI 0.84 - 0.91，p < 0.001），在肾细胞癌中不显著（OR 0.98，95% CI 0.94 - 1.01，p = 0.172）或在上尿路尿路上皮癌中不显著（OR 1.03，95% CI 0.95 - 1.12，p = 0.523）。PSM后，每组纳入47,975例患者，发现婚姻是CSS的独立保护性预后因素（风险比[HR] 0.81，95% CI 0.79 - 0.83，p < 0.001），但在上尿路尿路上皮癌中不显著（HR 0.95，95% CI 0.88 - 1.03，p = 0.244）。在整个泌尿系统中，婚姻是诊断和生存的独立保护性预测因素，但不同类型癌症的影响有所不同。
