Early-stage gastric cancer patients who are married have a better chance of surviving the disease, according to a study published online in the Journal of Investigative Medicine.
Researchers think this factor should be included with other clinical and personal characteristics when evaluating a patient’s survival time following a diagnosis.
With approximately 1 million new cases and 780,000 fatalities in 2018, gastric cancer is the third most common cancer worldwide and the fifth most common cancer kind. The condition is uncommon in those under the age of 50 and is roughly twice as common in men than in women.
Early detection increases survival odds. But even though people’s marital status is a good predictor of survival for liver and lung cancer, it’s not on the list of things that predict survival for early-stage gastric cancer.
So, the researchers wanted to find out if the marital status of people with early-stage gastric cancer could also be a good way to predict how they would do in the long run.
They drew on clinical data from 3647 patients who were diagnosed between 2010 and 2015 with early-stage gastric cancer—which hadn’t progressed outside of the stomach to other regions of the body—and had been recorded in the Surveillance, Epidemiology and End Results (SEER) database.
Randomly, the participants were split into two groups: a “training” group of 2719 people was asked to make a nomogram, which is a mathematical model that shows how different variables relate to each other, and a “test” group of 928 people was asked to check the model.
Age at diagnosis (in 10-year increments ranging from under 40 to 90-100); race; gender; tumor site; molecular findings (histology); grade (appearance of cancerous cells); spread to lymph nodes (stage); surgery; lymph node removal; chemotherapy; radiotherapy; tumor size; insurance; and marital status were all considered.
The objective was to identify the variables that accurately predicted the interval between a diagnosis and mortality from any cause.
Men made up 1793 (49%) of the participants, while women made up 1854 (51%). Most were white (2231). There were 1957 married people overall, 274 divorced people, 41 separated people, 630 widowed people, 512 single people, and 233 people whose marital status was unknown.
In general, women’s chances of survival were better than those of men and married individuals.
Married individuals in the training group had the greatest prognosis (an average 72 percent chance), whereas widows had the worst (average 60 percent chance).
Similarly, when gender was considered, the likelihood of survival was best for married males (average 69%); and married women (average 76%), while it was lowest for widowers (average 51%) and widows (average 61 percent ).
Divorced women fared substantially better in terms of survival than divorced males.
Age at diagnosis, gender, molecular results, stage, surgery, tumour size, and marital status were all independent predictive factors, according to further research.
Based on these findings, the researchers constructed a nomogram to predict 3 and 5-year survivals, in which each variable received a score between 0 and 100 based on how much of a contribution it made to survival. The nomogram also classified individuals as having a high or low risk of recurrence or death.
The nonogram accurately identified patients who were at high and low risks of recurrence or mortality. The C-index, a statistical measure of agreement between the actual result and the outcome predicted, was 0.791. A value above 0.7 is thought to be favorable.
The most contributing factor to the likelihood of mortality or recurrence was the size of the tumor. According to the experts, this is not surprising because a larger tumor is more aggressive whereas a smaller tumor grows more slowly.
Additionally, marriage status had a minor impact on survival. The prognosis for married people was the best, then for single people, and the prognosis for those who were separated was the worst.
The researchers hypothesize that this may be because married persons are more likely to have better financial situations and to experience emotional support from their spouse. They go on to say that the observed gender differences might potentially be the result of genetic and/or lifestyle variations.
As this is a modeling study, it cannot determine cause. Additionally, the study excluded some established risk factors for stomach cancer, such as family history, alcohol consumption, and Helicobacter pylori infection.
Nevertheless, the researchers said: “All patients diagnosed with early-stage [gastric cancer] can use our nomogram to assess their prognostic risk after receiving corresponding treatment.
“For high-risk patients, review frequency and follow-up times should be increased. Patients themselves should pay more attention to symptom fluctuation and improvements in lifestyle.”
They also say that people who are single or widowed and have this disease should get more social help and care.
Image Credit: Getty
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