Association between Marital Status and Prognosis in Patients with Prostate Cancer: A Meta-Analysis of Observational Studies
1 January 2020
Purpose: The impact of marital status on the prognosis amongst patients diagnosed with prostate cancer remains controversial. Thus, a meta-analysis was performed to determine whether marital status can influence the prognosis in patients with prostate cancer.
Materials and Methods: Literature search of the MEDLINE, PsycINFO, Embase and Cochrane Library databases was conducted to identify eligible studies published before April 2020. Multivariate adjusted risk estimates and corresponding 95% confidence intervals (CIs) were extracted and calculated using the random effects model.
Results: A total of 11 observational studies comprising 1,457,799 patients diagnosed with prostate cancer were identified. Results indicated that unmarried status (separated, divorced, widowed or never married) was associated with an increased risk of all-cause mortality (hazard ratio, HR = 1.39, 95% CI: 1.30–1.50; P < .001; I2 = 92.2%) compared with married status, especially for divorced and never-married patients. Similarly, being unmarried had an elevated risk of cancer-specific mortality (HR = 1.29, 95% CI: 1.17–1.41; P < .001; I2 = 82.5%) in patients with prostate cancer. A significant difference was also observed between unmarried status and shorter overall survival (HR = 1.37, 95% CI: 1.20–1.56; P < .001; I2 = 94.5%).
Conclusion: Results demonstrated that unmarried status is associated with a worse prognosis regarding mortality and survival in patients diagnosed with prostate cancer, particularly in divorced and never-married patients. Hence, further research should explore the potential mechanisms which can benefit the development of novel, more personalised management methods for unmarried patients with prostate cancer.
- Marital status
- Prostate cancer
How to Cite
Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127:2893–917.
Buja A, Lange JH, Perissinotto E, et al. Cancer incidence among male military and civil pilots and flight attendants: an analysis on published data. Toxicol Ind Health. 2005;21:273–82.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68:7–30.
Eeles RA, Olama AA, Benlloch S, et al. Identification of 23 new prostate cancer susceptibility loci using the iCOGS custom genotyping array. Nat Genet. 2013;45:385–91, 391e1–2.
Culp SH, Schellhammer PF, Williams MB. Might men diagnosed with metastatic prostate cancer benefit from definitive treatment of the primary tumor? A SEER-based study. Eur Urol. 2014;65:1058–66.
Chang SM, Barker FG. Marital status, treatment, and survival in patients with glioblastoma multiforme: a population based study. Cancer. 2005;104(9):1975–84.
Datta GD, Neville BA, Kawachi I, et al. Marital status and survival following bladder cancer. J Epidemiol Community Health. 2009;63:807–13.
Hellenthal NJ, Chamie K, Ramirez ML, et al. Sociodemographic factors associated with nephrectomy in patients with metastatic renal cell carcinoma. J Urol. 2009;181:1013–8; discussion 1018–9.
Kravdal O. The impact of marital status on cancer survival. Soc Sci Med. 2001;52:357–68.
Nelles JL, Joseph SA, Konety BR. The impact of marriage on bladder cancer mortality. Urol Oncol. 2009;27:263–7.
Gomez SL, Hurley S, Canchola AJ, et al. Effects of marital status and economic resources on survival after cancer: A population-based study. Cancer. 2016;122:1618–25.
Khan S, Nepple KG, Kibel AS, et al. The association of marital status and mortality among men with early-stage prostate cancer treated with radical prostatectomy: insight into post-prostatectomy survival strategies. Cancer Causes Control. 2019;30:871–876.
Nepple KG, Kibel AS, Sandhu GS, et al. Impact of marital status on prostate cancer-specific mortality and overall mortality after radical prostatectomy. Journal of Clinical Oncology. 2012;30.
Schiffmann J, Beyer B, Tennstedt P, et al. Oncological outcome after radical prostatectomy: Marital status does not make a difference. Int J Urol. 2015;22:484–9.
Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration. 2011.
Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1.
Wells GA , Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analysis. Ottawa Hospital Research Institute website. http:// www.ohri.ca/programs/clinical_epidemiology/oxford.asp. 2014.
Greenland S. Quantitative methods in the review of epidemiologic literature. Epidemiol Rev. 1987;9:1–30.
Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088–101.
Abdollah F, Sun M, Thuret R, et al. The effect of marital status on stage and survival of prostate cancer patients treated with radical prostatectomy: a population-based study. Cancer Causes Control. 2011;22:1085–95.
Aizer AA, Chen MH, McCarthy EP, et al. Marital status and survival in patients with cancer. J Clin Oncol. 2013;31:3869–76.
Du KL, Bae K, Movsas B, et al. Impact of marital status and race on outcomes of patients enrolled in Radiation Therapy Oncology Group prostate cancer trials. Support Care Cancer. 2012;20:1317–25.
Huang TB, Zhou GC, Dong CP, et al. Marital status independently predicts prostate cancer survival in men who underwent radical prostatectomy: An analysis of 95,846 individuals. Oncol Lett. 2018;15(4):4737–44.
Knipper S, Preisser F, Mazzone E, et al. Contemporary analysis of the effect of marital status on survival of prostate cancer patients across all stages: A population-based study. Urol Oncol. 2019;37:702–10.
Lai H, Lai S, Krongrad A, Trapido E, et al. The effect of marital status on survival in late-stage cancer patients: an analysis based on surveillance, epidemiology, and end results (SEER) data, in the United States. Int J Behav Med. 1999;6:150–76.
Tyson MD, Andrews PE, Etzioni DA, et al. Marital status and prostate cancer outcomes. Can J Urol. 2013;20:6702–6.
Buja A, Lago L, Lago S, et al. Marital status and stage of cancer at diagnosis: A systematic review. Eur J Cancer Care (Engl). 2018;27:e12755.
Denberg TD, Beaty BL, Kim FJ, et al. Marriage and ethnicity predict treatment in localized prostate carcinoma. Cancer. 2005;103:1819–25.
Denberg TD, Glodé LM, Steiner JF, et al. Trends and predictors of aggressive therapy for clinical locally advanced prostate carcinoma. BJU Int. 2006;98:335–40.
Rosengren A, Wedel H, Wilhelmsen L. Marital status and mortality in middle-aged Swedish men. Am J Epidemiol. 1989;129:54–64.
Umberson D. Gender, marital status and the social control of health behavior. Soc Sci Med. 1992;34:907–17.
Watt RG, Heilmann A, Sabbah W, et al. Social relationships and health related behaviors among older US adults. BMC Public Health. 2014;14:533.
O'Shaughnessy PK, Laws TA, Esterman AJ. The prostate cancer journey: results of an online survey of men and their partners. Cancer Nurs. 2015;38:E1–E12.
Bellardita L, Rancati T, Alvisi MF, et al. Predictors of health-related quality of life and adjustment to prostate cancer during active surveillance. Eur Urol. 2013;64:30–6.
Chamie K, Kwan L, Connor SE, et al. The impact of social networks and partnership status on treatment choice in men with localized prostate cancer. BJU Int. 2012;109:1006–12.
Forsythe LP, Alfano CM, Kent EE, et al. Social support, self-efficacy for decision-making, and follow-up care use in long-term cancer survivors. Psycho-oncology. 2014;23:788–96.
Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010;7:e1000316.
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