Contemporary sex-specific analysis of the association of marital status with cancer-specific mortality in primary urethral carcinoma patients

Simone Morra; Lukas Scheipner; Andrea Baudo; Letizia Maria Ippolita Jannello; Mario de Angelis; Carolin Siech; Jordan A Goyal; Nawar Touma; Zhe Tian; Fred Saad; Massimiliano Creta; Gianluigi Califano; Giuseppe Celentano; Shahrokh F Shariat; Sascha Ahyai; Luca Carmignani; Ottavio de Cobelli; Gennaro Musi; Alberto Briganti; Felix K H Chun; Nicola Longo; Pierre I Karakiewicz

doi:10.1016/j.urolonc.2023.10.013

Contemporary sex-specific analysis of the association of marital status with cancer-specific mortality in primary urethral carcinoma patients

Urol Oncol. 2024 Feb;42(2):31.e1-31.e8. doi: 10.1016/j.urolonc.2023.10.013. Epub 2023 Dec 14.

Authors

Simone Morra¹, Lukas Scheipner², Andrea Baudo³, Letizia Maria Ippolita Jannello⁴, Mario de Angelis⁵, Carolin Siech⁶, Jordan A Goyal⁷, Nawar Touma⁷, Zhe Tian⁷, Fred Saad⁷, Massimiliano Creta⁸, Gianluigi Califano⁸, Giuseppe Celentano⁸, Shahrokh F Shariat⁹, Sascha Ahyai¹⁰, Luca Carmignani¹¹, Ottavio de Cobelli¹², Gennaro Musi¹², Alberto Briganti¹³, Felix K H Chun¹⁴, Nicola Longo⁸, Pierre I Karakiewicz⁷

Affiliations

¹ Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada; Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy. Electronic address: [email protected].
² Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, Medical University of Graz, Graz, Austria.
³ Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, IRCCS Policlinico San Donato, Milan, Italy.
⁴ Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, IEO European Institute of Oncology, , Milan, Italy; Università degli Studi di Milano, Milan, Italy.
⁵ Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada; Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy.
⁶ Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, Goethe University, University Hospital, Frankfurt am Main, Germany.
⁷ Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada.
⁸ Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy.
⁹ Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Hourani Center of Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.
¹⁰ Department of Urology, Medical University of Graz, Graz, Austria.
¹¹ Department of Urology, IRCCS Policlinico San Donato, Milan, Italy; Department of Urology, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy.
¹² Department of Urology, IEO European Institute of Oncology, , Milan, Italy; Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, Milan, Italy.
¹³ Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy.
¹⁴ Department of Urology, Goethe University, University Hospital, Frankfurt am Main, Germany.

PMID: 38101989
DOI: 10.1016/j.urolonc.2023.10.013

Abstract

Background: It is unknown whether married status may be associated with lower cancer-specific mortality (CSM) rates in primary urethral carcinoma (PUC) patients. To test for differences in CSM rates, according to marital status, we relied on the Surveillance, Epidemiology, and End Results (SEER) database 2000-2020.

Methods: Patient (age, sex, race/ethnicity, marital status), tumor (stage, histology), and treatment (surgery, systemic therapy) characteristics of PUC patients were tabulated. Then, Kaplan-Meier plots, as well as univariable and multivariable Cox regression (MCR) models tested for differences in CSM rates according to marital status in overall cohort and then in sex-specific subgroup analyses.

Results: Of all 1,571 PUC patients, 70% were male vs. 30% female. Females were statistically significantly younger (68 vs. 73 years), more frequently unmarried (54 vs. 28%), non-Caucasian (43 vs. 24%), more frequently harbored T_3-4N₀M₀ (39 vs. 18%) and less frequently T_1-2N₀M₀ (53 vs. 69%) or T_anyN_1-2M₀/T_anyN_anyM₁ (8 vs. 13%), relative to males. Moreover, we recorded differences in histotype proportions in females vs. males (urothelial 30 vs. 64%; squamous 24 vs. 22%; adenocarcinoma 36 vs. 7%; others 10 vs. 6%) and surgical treatment (none 22 vs. 17%; excisional biopsy 22 vs. 36%; partial urethrectomy 14 vs. 16%; radical urethrectomy 42 vs. 31%). In MCR models focusing on the entire cohort, married status independently predicted lower CSM (hazard ratio [HR]:0.82; P = 0.02). Similarly, in MCR models focusing on females, married status independently predicted lower CSM (HR:0.73; P = 0.03). Conversely, in MCR models focusing on males, married status failed to independently predict lower CSM (HR:0.89; P = 0.3).

Conclusions: Married status was associated with lower CSM in PUC patients. However, this benefit applies to female PUC patients, but not to their male counterparts.

Keywords: SEER program; marital status; primary urethral carcinoma; sex-specific analysis; survival differences.

MeSH terms

Adenocarcinoma*
Female
Humans
Male
Marital Status
Proportional Hazards Models
SEER Program