Zhou Yu, Feng Yi, Zhang Min
Department of Ophthalmology, The Affiliated Chengdu 363 Hospital of Southwest Medical University, Chengdu, China.
Department of Electrocardiogram, The Affiliated Chengdu 363 Hospital of Southwest Medical University, Chengdu, China.
Medicine (Baltimore). 2025 Aug 29;104(35):e44162. doi: 10.1097/MD.0000000000044162.
Marital status may influence cancer management by affecting factors such as emotional support, health-related decision-making, and access to medical care. Its impact has been reported across various cancer types. However, the role of marital status in the diagnosis and survival of ocular cancer remains underexplored. Patients diagnosed with ocular cancer between 2000 and 2019 were identified from the Surveillance, Epidemiology, and End Results database, a population-based cancer registry in the United States. Multivariable ordinal logistic regression was used to evaluate the association between marital status and stage at diagnosis. Propensity score matching was used to match baseline characteristics between married and unmarried patients, and overall survival (OS) and cancer-specific survival (CSS) were estimated using Kaplan-Meier curves. A total of 7556 patients were included. Unmarried patients were more likely to be present with advanced disease at diagnosis than married patients (OR = 1.31, 95% CI, 1.11-1.55; P = .001). After propensity score matching, 2625 married and 2625 unmarried patients were included. Unmarried patients showed significantly worse OS (HR = 1.40, 95% CI, 1.29-1.52, P < .001) and CSS (HR = 1.13, 95% CI, 1.02-1.26, P = .022) compared with married patients. Subgroup analysis suggests that females (female vs male; OS: HR 1.45 vs 1.33; CSS: HR 1.18 vs 1.07), older individuals (>60 vs 18-60; OS: HR 1.51 vs 1.17; CSS: HR 1.36 vs 1.23), and low-risk populations (localized [localized vs regional vs distant; OS: HR 1.47 vs 1.20 vs 1.30; CSS: HR 1.21 vs 1.15 vs 1.18], low grade [Grade I-II vs Grade III-IV; OS: HR 1.87 vs 1.14; CSS: HR 1.70 vs 1.08], nonmelanoma [nonmelanoma vs melanoma; OS: HR 1.50 vs 1.34; CSS: HR 1.22 vs 1.11]) appear to derive greater survival benefits from marriage. Additionally, the survival disparity attributable to marriage has increased over time (2010-2019 vs 2000-2009: OS, HR 1.45 vs 1.36; CSS, HR 1.22 vs 1.11). In the multivariable Cox regression analysis, unmarried status was identified as an independent predictor of poor OS (HR = 1.37, 95% CI, 1.27-1.49, P < .001) and CSS (HR = 1.12, 95% CI, 1.02-1.22, P = .031). In ocular cancer patients, unmarried individuals are typically diagnosed at later disease stages and have poorer survival outcomes.
婚姻状况可能通过影响情感支持、与健康相关的决策以及获得医疗护理等因素来影响癌症治疗。其影响已在各种癌症类型中得到报道。然而，婚姻状况在眼癌诊断和生存中的作用仍未得到充分探索。从美国基于人群的癌症登记处监测、流行病学和最终结果数据库中识别出2000年至2019年间被诊断为眼癌的患者。使用多变量有序逻辑回归来评估婚姻状况与诊断时分期之间的关联。倾向评分匹配用于匹配已婚和未婚患者的基线特征，并使用Kaplan-Meier曲线估计总生存期（OS）和癌症特异性生存期（CSS）。共纳入7556例患者。未婚患者在诊断时比已婚患者更有可能出现晚期疾病（OR = 1.31，95%CI，1.11 - 1.55；P = 0.001）。倾向评分匹配后，纳入2625例已婚患者和2625例未婚患者。与已婚患者相比，未婚患者的OS（HR = 1.40，95%CI，1.29 - 1.52，P < 0.001）和CSS（HR = 1.13，95%CI，1.02 - 1.26，P = 0.022）明显更差。亚组分析表明，女性（女性与男性；OS：HR 1.45对1.33；CSS：HR 1.18对1.07）、老年人（>60岁与18 - 60岁；OS：HR 1.51对1.17；CSS：HR 1.36对1.23）以及低风险人群（局限性[局限性对区域性对远处；OS：HR 1.47对1.20对1.30；CSS：HR 1.21对1.15对1.18]、低级别[I-II级对III-IV级；OS：HR 1.87对1.14；CSS：HR 1.70对1.08]、非黑色素瘤[非黑色素瘤对黑色素瘤；OS：HR 1.50对1.34；CSS：HR 1.22对1.11]）似乎从婚姻中获得更大的生存益处。此外，婚姻导致的生存差距随时间增加（2010 - 2019年对2000 - 2009年：OS，HR 1.45对1.36；CSS，HR 1.22对1.11）。在多变量Cox回归分析中确定未婚状态是OS差（HR = 1.37，95%CI，1.27 - 1.49，P < 0.001）和CSS差（HR = 1.12，95%CI，1.02 - 1.22，P = 0.031）的独立预测因素。在眼癌患者中，未婚个体通常在疾病晚期被诊断出来，生存结果较差。
