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Cancer Manag Res. 2018 Jan 3;10:23-32. doi: 10.2147/CMAR.S142019. eCollection 2018.

Effects of marital status on survival of hepatocellular carcinoma by race/ethnicity and gender.

Wu W1,2, Fang D1,2, Shi D1,2, Bian X1,2, Li L1,2.

Author information

State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University.
Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, People's Republic of China.



It is well demonstrated that being married is associated with a better prognosis in multiple types of cancer. However, whether the protective effect of marital status varied across race/ethnicity and gender in patients with hepatocellular carcinoma remains unclear. Therefore, we aimed to evaluate the roles of race/ethnicity and gender in this relationship.

Patients and methods:

We identified eligible patients from Surveillance, Epidemiology and End Results (SEER) database during 2004-2012. Overall and cancer-specific survival differences across marital status were compared by Kaplan-Meier curves. We also estimated crude hazard ratios (CHRs) and adjusted hazard ratios (AHRs) with 95% confidence intervals (CIs) for marital status associated with survival by race/ethnicity and gender in Cox proportional hazard models.


A total of 12,168 eligible patients diagnosed with hepatocellular carcinoma were included. We observed that married status was an independent protective prognostic factor for overall and cancer-specific survival. In stratified analyses by race/ethnicity, the AHR of overall mortality (unmarried vs married) was highest for Hispanic (AHR =1.25, 95% CI, 1.13-1.39; P<0.001) and lowest for Asian or Pacific Islander (AHR =1.13; 95% CI, 1.00-1.28; P=0.042). Stratified by gender, the AHR was higher in males (AHR =1.27; 95% CI, 1.20-1.33; P<0.001). Conclusion: We demonstrated that married patients obtained better survival advantages. Race/ethnicity and gender could influence the magnitude of associations between marital status and risk of mortality.


SEER; being married; gender; primary hepatocellular carcinoma; prognosis; race

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

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