Propensity-score Matching Analysis for Marital Status and Survival of Oral and Oropharyngeal Squamous Cell Carcinoma Based on SEER Database

ObjectMarital status plays different roles as a risk factor on survival in various cancers . The study is aimed to analyze the impact of marital status on survival of oral and oropharyngeal squamous cell carcinoma(OPSCC) at population level based on SEER database using propensity-score matching method(PSM).Methods37,023 eligible patients were extracted from the Surveillance, Epidemiology, and End Results(SEER) database, and analyzed the impact of various marital status on cancer-specific survival(CSS) of OPSCC by Kaplan-Meier method and Cox regression model. Then we used propensity-score matching analysis to balance baseline characteristics between married, single, divorced and widowed patients. The impact of various marital status after pairwise matching using p-value adjusted and PSM on CSS was re-analyzed by Kaplan-Meier method.ResultsThe age, sex, race, tumor location, pathologic grades, SEER stages, treatments, composite socioeconomic status(C-SES), insurance, and marital status were identified as independent prognostic factors for CSS of OPSCC. Widowed patients presented the worst CSS, compared with married, single, and divorced patients(P<0.001). Subgroup analysis indicated that widowed patients always presented with the significantly decreasing risk of CSS compared with other marital status in different SEER stages(P<0.001), and different C-SES(P<0.001). After propensity-score matching, widowed patients were still found to be associated with significantly decreased CSS compared with other marital groups(P<0.001).ConclusionMarital status was first analyzed after using PSM to balance clinicopathological and socioeconomic confounding factors and identified as an independent prognostic factor for CSS of OPSCC. Widowed patients was significantly associated with a decreasing CSS, which indicated that absence of spousal support and optimal psychosocial coping strategies may explain the phenomenons.