Michele Marchioni1,2, Tristan Martel3,4, Marco Bandini3,5, Raisa S Pompe3,6, Zhe Tian3, Anil Kapoor7, Luca Cindolo8, Riccardo Autorino9, Alberto Briganti5, Shahrokh F Shariat10, Luigi Schips8, Pierre I Karakiewicz3,4. 1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada. mic.marchioni@gmail.com. 2. Department of Urology, SS Annunziata Hospital, "G.D'Annunzio" University of Chieti, Chieti, Italy. mic.marchioni@gmail.com. 3. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada. 4. Department of Urology, University of Montreal Health Centre, Montreal, QC, Canada. 5. Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy. 6. Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 7. Division of Urology, McMaster University, Hamilton, ON, Canada. 8. Department of Urology, ASL Abruzzo 2, Chieti, Italy. 9. Division of Urology, Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA. 10. Department of Urology, Medical University of Vienna, Vienna, Austria.
Abstract
PURPOSE: To examine the effect of marital status and gender on stage at diagnosis, tumor grade, treatment type and cancer specific mortality (CSM) in patients with localized renal cell carcinoma (RCC). METHODS: Within Surveillance, Epidemiology, and End Results registry (2001-2013), we identified 57,700 patients with T1-2 N0 M0 RCC. Logistic regression and competing-risks regression models tested the effect of marital status and gender on stage, tumor grade, treatment type and cancer specific mortality (CSM). RESULTS: Of all patients, 8.8, 10.6 and 14.8% were, respectively, widowed, separated/divorced and never married. The three categories accounted for 3.9, 9.0 and 14.9% of males (35,641) and for 16.7, 13.1 and 14.7% of females (22,059). Widowed (OR 1.13, p = 0.04), separated/divorced (OR 1.16, p = 0.02) and never married status (OR 1.38, p < 0.001) predisposed to higher rate of no surgical treatment. Widowed (HR 1.32, p < 0.001) and separated/divorced (HR 1.32, p < 0.001) status predisposed to higher CSM. Male gender predisposed to higher T-stage (OR 1.12, p < 0.001), higher tumor grade (OR 1.35, p < 0.001), no surgical treatment (OR 1.23, p < 0.001) and higher CSM (1.13, p = 0.01). Interaction tests between gender and marital status failed to reach independent predictor status in all analyses. CONCLUSIONS: Male patients are at higher risk of less favorable baseline characteristics. Additionally, male, widowed and separated/divorced patients exhibit worse cancer control outcomes after treatment for T1-2 N0 M0 RCC. These observations indicate the need of more focused attention to those patients prior to, as well as after treatment for localized RCC.
PURPOSE: To examine the effect of marital status and gender on stage at diagnosis, tumor grade, treatment type and cancer specific mortality (CSM) in patients with localized renal cell carcinoma (RCC). METHODS: Within Surveillance, Epidemiology, and End Results registry (2001-2013), we identified 57,700 patients with T1-2 N0 M0 RCC. Logistic regression and competing-risks regression models tested the effect of marital status and gender on stage, tumor grade, treatment type and cancer specific mortality (CSM). RESULTS: Of all patients, 8.8, 10.6 and 14.8% were, respectively, widowed, separated/divorced and never married. The three categories accounted for 3.9, 9.0 and 14.9% of males (35,641) and for 16.7, 13.1 and 14.7% of females (22,059). Widowed (OR 1.13, p = 0.04), separated/divorced (OR 1.16, p = 0.02) and never married status (OR 1.38, p < 0.001) predisposed to higher rate of no surgical treatment. Widowed (HR 1.32, p < 0.001) and separated/divorced (HR 1.32, p < 0.001) status predisposed to higher CSM. Male gender predisposed to higher T-stage (OR 1.12, p < 0.001), higher tumor grade (OR 1.35, p < 0.001), no surgical treatment (OR 1.23, p < 0.001) and higher CSM (1.13, p = 0.01). Interaction tests between gender and marital status failed to reach independent predictor status in all analyses. CONCLUSIONS: Male patients are at higher risk of less favorable baseline characteristics. Additionally, male, widowed and separated/divorced patients exhibit worse cancer control outcomes after treatment for T1-2 N0 M0 RCC. These observations indicate the need of more focused attention to those patients prior to, as well as after treatment for localized RCC.
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