Marital status as an independent prognostic factor for patients of malignant pleural mesothelioma

Our plain-English summary of Marital status as an independent prognostic factor for patients of malignant pleural mesothelioma, by S. Pan, N. Yan, Y. Zhao, et al (Frontiers in Medicine, 2022).

The study

• Authors: S. Pan, N. Yan, Y. Zhao, Z. Li
• Journal: Frontiers in Medicine
• Published: 2022;9:955619
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: The prognostic impact of marital status on malignant pleural mesothelioma (MPM) is not investigated. This paper probes into the relationship between the prognosis of MPM and marital status.

Materials And Methods: The Surveillance, Epidemiology, and End Results (SEER) database of American had been applied to choose eligible patients over the 2004-2015 periods. Moreover, cancer-specific survival (CSS) and overall survival (OS) of unmarried and married groups were compared.

Results: A total of 3,997 patients in total had been identified, including 2,735 (68.43%) married patients. In comparison to unmarried patients, married ones tended to be younger, male, white, and received active treatment (surgery, chemotherapy, or radiotherapy). In addition, the 1, 3, and 5-year CSS rates were 44.40, 12.09, and 6.88% in married patients, while 35.75, 12.12, and 6.37% in unmarried group (p = 0.0014). At the same time, the 1, 3, and 5-year OS rates were 41.84, 10.56, and 5.91% in married patients, while 33.67, 10.44, and 4.93%, respectively, in the unmarried group (p < 0.0001). As revealed by the multivariate analysis results, the marital status was an independent favorable prognostic factor, in which the married groups showed better CSS [hazard ratio (HR): 0.870; 95% confidence interval (CI): 0.808-0.938; p < 0.001] as well as OS (HR: 0.871; 95% CI: 0.810-0.936; p < 0.001). According to the results of subgroup analysis, the CSS and OS survival of married groups were better than the unmarried groups in almost all the subgroups.

Conclusion: Marital status is an independent favorable prognostic indicator of MPM. Poor prognosis in unmarried patients is likely to be related to insufficient treatments and socioeconomic and psychosocial factors.

Copyright © 2022 Pan, Yan, Zhao and Li.

In plain English

Using the US SEER cancer registry database, the authors examined whether marital status was linked to survival in malignant pleural mesothelioma. Of 8,673 patients diagnosed from 2004 to 2015, 3,997 met the study criteria: 2,735 married and 1,262 unmarried (never married, divorced, separated or widowed). Asbestos exposure was not studied. Married patients were more often younger, male and white, and more often received surgery, chemotherapy or radiotherapy. One-year cancer-specific survival was 44.40% in married and 35.75% in unmarried patients. At five years it was 6.88% and 6.37%. After adjusting for factors including age, gender, tumor type, stage and treatment, married patients had a lower risk of death than unmarried patients. The hazard ratio was 0.870 (95% confidence interval 0.808 to 0.938) for cancer-specific survival and 0.871 (0.810 to 0.936) for overall survival. The authors concluded that marital status is an independent prognostic factor, and that poorer outcomes in unmarried patients may relate to less treatment and socioeconomic and psychosocial factors. They noted that marital status was recorded only at diagnosis, that the quality of marriage was not recorded, and that more detailed data on education, insurance and income were lacking.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective analysis of a US population-based cancer registry database (SEER), comparing survival of married and unmarried patients using Kaplan–Meier and multivariate Cox regression analysis
• Who was studied: 3,997 patients with primary, pathology-confirmed malignant pleural mesothelioma in 18 SEER registry areas in the United States, diagnosed 2004 to 2015, selected from 8,673 patients after exclusions. 2,735 (68.43%) were married and 1,262 (31.57%) were unmarried.
• Exposure: Marital status at diagnosis: married versus unmarried (never married single, divorced, separated, and widowed). Asbestos or other fiber exposure was not measured or analysed. The patient factors examined were age, gender, histology, marital status, race, grade, tumor size, AJCC stage, surgery, chemotherapy and radiotherapy.
• Main results:
  • Compared with unmarried patients, married patients were more often younger, male and white, and more often received surgery, chemotherapy and radiotherapy.
  • Median survival for all 3,997 patients was 9.0 months (range 0 to 152 months).
  • The 1, 3 and 5-year cancer-specific survival rates were 44.40%, 12.09% and 6.88% in married patients, and 35.75%, 12.12% and 6.37% in unmarried patients (p = 0.0014).
  • The 1, 3 and 5-year overall survival rates were 41.84%, 10.56% and 5.91% in married patients, and 33.67%, 10.44% and 4.93% in unmarried patients (p less than 0.0001).
  • In multivariate analysis, married patients had better cancer-specific survival than unmarried patients: hazard ratio 0.870 (95% CI 0.808 to 0.938; p less than 0.001).
  • In multivariate analysis, marital status remained an independent prognostic factor for overall survival, with married patients compared with unmarried patients: hazard ratio 0.871 (95% CI 0.810 to 0.936; p less than 0.001).
  • In subgroup analyses, married patients had better cancer-specific and overall survival than unmarried patients in nearly all subgroups. The difference was statistically significant in patients aged 70 or over, with tumor size 3 to 7 cm, with AJCC stage IV disease, and in those who received no surgery or radiotherapy.
• The authors' conclusion: The authors concluded that marital status is an independent favorable prognostic indicator in malignant pleural mesothelioma. They suggested that poorer prognosis in unmarried patients is likely related to insufficient treatment and to socioeconomic and psychosocial factors, and said further study is needed to confirm the finding.
• Limitations the authors state:
  • Marital status was recorded only at diagnosis, so later changes in marital status were unknown.
  • The SEER database did not provide information on the quality of marriage, which could affect survival.
  • More detailed data on education, insurance and income were lacking, which may have affected interpretation of the results. A basic insured-status variable was available and reported in Tables 1 and 2.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Prognosis, Epidemiology, SEER, Overall Survival, Chemotherapy, Multivariate Analysis, Hazard Ratio.

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