Impact of marital status on the prognosis of liver cancer patients without surgery and the critical window

Background: Liver cancer (LC) is the second leading cause of cancer-associated mortality. However, the critical time window during the marital status may influence the prognosis of LC is still unknown. Methods: Information on a total of 4,933 patients diagnosed with primary LC who had not undergone surgery was collected from the Surveillance, Epidemiology, and End Results (SEER) database to analyze the impact of marital status on the risk of cancer-specific mortality (CSM). All confirmed patients were monitored from January 1, 2010 until December 31, 2015 for the occurrence of death. We performed 1:1 propensity score matching among the married and non-married groups to eliminate dissimilarities in age, sex, race and clinical characteristics. Cox proportional hazards regression model was adopted to investigate the associations between marital status and the risk of CSM. Results: Married patients were significantly negatively associated with the risk of CSM among patients compared to non-married status, with a hazard ratio (HR) [95% confidence interval (CI)] of 1.15 (1.07-1.23). The strongest associations were observed for patients with Grade II, American Joint Committee on Cancer (AJCC) I and III. Furthermore, the protective effect of marriage on the prognosis of LC was independent of sex, age, race, grade, AJCC and SEER stage. Unmarried or separated patients may have a worse prognosis. Conclusions: Marriage was strongly associated with a positive prognosis among patients with LC, especially in the critical window of Grade II, AJCC I and III. This study highlights the important impact of marriage on cancer prognosis.