Skip to main content

Advertisement

SpringerLink
Log in

Unmarried status is a barrier for access to treatment in patients with metastatic renal cell carcinoma

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

We tested the effect of marital status on cytoreductive nephrectomy, metastasectomy, and systemic therapy rates, as well as on cancer-specific mortality (CSM) in patients with metastatic clear cell renal carcinoma (mccRCC).

Methods

Within the Surveillance, Epidemiology and End Results database (2004–2015), we identified 6975 patients (4806 men and 2169 women) with metastatic clear cell renal carcinoma. Temporal trend analyses, logistic regression models, cumulative incidence plots, and competing-risk regression models were used.

Results

Overall, 1450 men and 1018 women were unmarried (30.2% and 47.0%, respectively). In men, unmarried status was an independent predictor of lower cytoreductive nephrectomy rate (OR: 0.54), lower metastasectomy rate (OR: 0.70), and lower systemic therapy rate (OR: 0.70). Conversely, in women, unmarried status was an independent predictor of lower cytoreductive nephrectomy rate (OR: 0.63) and of lower systemic therapy rate (OR: 0.80), but not of lower metastasectomy rate (OR: 0.83; p = 0.12). In multivariable competing-risk regression analyses, unmarried status was an independent predictor of higher CSM in men (HR: 1.15), but not in women (HR 0.97, p = 0.6).

Conclusions

Unmarried men are at higher risk of not benefiting of cytoreductive nephrectomy, metastasectomy, or systemic therapy than their married counterparts. Unmarried women are at higher risk of not benefiting of cytoreductive nephrectomy or systemic therapy. These gender-related differences cumulate in higher CSM in unmarried men, but not in unmarried women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Abdollah F, Sun M, Thuret R, Abdo A, Morgan M, Jeldres C et al (2011) The effect of marital status on stage and survival of prostate cancer patients treated with radical prostatectomy: a population-based study. Cancer Causes Control 22:1085–1095. https://doi.org/10.1007/s10552-011-9784-x

    Article  PubMed  Google Scholar 

  2. Sammon JD, Morgan M, Djahangirian O, Trinh Q-D, Sun M, Ghani KR et al (2012) Marital status: a gender-independent risk factor for poorer survival after radical cystectomy: marital status and survival after radical cystectomy. BJU Int 110:1301–1309. https://doi.org/10.1111/j.1464-410X.2012.10993.x

    Article  PubMed  Google Scholar 

  3. Capitanio U, Bensalah K, Bex A, Boorjian SA, Bray F, Coleman J et al (2019) Epidemiology of renal cell carcinoma. Eur Urol 75:74–84. https://doi.org/10.1016/j.eururo.2018.08.036

    Article  PubMed  Google Scholar 

  4. Fosså SD, Cvancarova M, Chen L, Allan AL, Oldenburg J, Peterson DR et al (2011) Adverse prognostic factors for testicular cancer-specific survival: a population-based study of 27,948 patients. J Clin Oncol 29:963–970. https://doi.org/10.1200/JCO.2010.32.3204

    Article  PubMed  Google Scholar 

  5. He X-K, Lin Z-H, Qian Y, Xia D, Jin P, Sun L-M (2017) Marital status and survival in patients with primary liver cancer. Oncotarget. https://doi.org/10.18632/oncotarget.11066

    Article  PubMed  PubMed Central  Google Scholar 

  6. Goodwin JS, Hunt WC, Key CR, Samet JM (1987) The effect of marital status on stage, treatment, and survival of cancer patients. JAMA 258:3125–3130. https://doi.org/10.1001/jama.1987.03400210067027

    Article  CAS  PubMed  Google Scholar 

  7. Miao T, Li Y, Sheng X, Yao D (2017) Marital status and survival of patients with kidney cancer. Oncotarget. https://doi.org/10.18632/oncotarget.21029

    Article  PubMed  PubMed Central  Google Scholar 

  8. Aizer AA, Chen M-H, McCarthy EP, Mendu ML, Koo S, Wilhite TJ et al (2013) Marital status and survival in patients with cancer. J Clin Oncol 31:3869–3876. https://doi.org/10.1200/JCO.2013.49.6489

    Article  PubMed  PubMed Central  Google Scholar 

  9. Marchioni M, Martel T, Bandini M, Pompe RS, Tian Z, Kapoor A et al (2017) Marital status and gender affect stage, tumor grade, treatment type and cancer specific mortality in T1–2 N0 M0 renal cell carcinoma. World J Urol 35:1899–1905. https://doi.org/10.1007/s00345-017-2082-9

    Article  CAS  PubMed  Google Scholar 

  10. Li Y, Zhu M, Qi S (2018) Marital status and survival in patients with renal cell carcinoma. Medicine (Baltimore) 97:e0385. https://doi.org/10.1097/MD.0000000000010385

    Article  Google Scholar 

  11. Hellenthal NJ, Chamie K, Ramirez ML, deVere White RW (2009) Sociodemographic factors associated with nephrectomy in patients with metastatic renal cell carcinoma. J Urol 181:1013–1019. https://doi.org/10.1016/j.juro.2008.10.159

    Article  PubMed  Google Scholar 

  12. Rampersaud EN, Klatte T, Bass G, Patard J-J, Bensaleh K, Böhm M et al (2014) The effect of gender and age on kidney cancer survival: younger age is an independent prognostic factor in women with renal cell carcinoma. Urol Oncol 32(30):e9–e13. https://doi.org/10.1016/j.urolonc.2012.10.012

    Article  Google Scholar 

  13. Krongrad A, Lai H, Burke MA, Goodkin K, Lai S (1996) Marriage and mortality in prostate cancer. J Urol 156:1696–1670

    Article  CAS  Google Scholar 

  14. Motzer RJ, Bacik J, Mariani T, Russo P, Mazumdar M, Reuter V (2002) Treatment outcome and survival associated with metastatic renal cell carcinoma of non-clear-cell histology. J Clin Oncol 20:2376–2381. https://doi.org/10.1200/JCO.2002.11.123

    Article  PubMed  Google Scholar 

  15. Bhindi B, Wallis CJD, Boorjian SA, Thompson RH, Farrell A, Kim SP et al (2018) The role of lymph node dissection in the management of renal cell carcinoma: a systematic review and meta-analysis. BJU Int 121:684–698. https://doi.org/10.1111/bju.14127

    Article  PubMed  Google Scholar 

  16. Kim DY, Karam JA, Wood CG (2014) Role of metastasectomy for metastatic renal cell carcinoma in the era of targeted therapy. World J Urol 32:631–642. https://doi.org/10.1007/s00345-014-1293-6

    Article  PubMed  Google Scholar 

  17. Dabestani S, Marconi L, Hofmann F, Stewart F, Lam TBL, Canfield SE et al (2014) Local treatments for metastases of renal cell carcinoma: a systematic review. Lancet Oncol 15:e549–e561. https://doi.org/10.1016/S1470-2045(14)70235-9

    Article  PubMed  Google Scholar 

  18. Larcher A, Wallis CJD, Bex A, Blute ML, Ficarra V, Mejean A et al (2019) Individualised indications for cytoreductive nephrectomy: which criteria define the optimal candidates? Eur Urol Oncol 2:365–378. https://doi.org/10.1016/j.euo.2019.04.007

    Article  PubMed  Google Scholar 

  19. Ouzaid I, Capitanio U, Staehler M, Wood CG, Leibovich BC, Ljungberg B et al (2019) Surgical metastasectomy in renal cell carcinoma: a systematic review. Eur Urol Oncol. https://doi.org/10.1016/j.euo.2018.08.028

    Article  PubMed  Google Scholar 

  20. Xiao W-J, Zhu Y, Dai B, Zhang H-L, Ye D-W (2015) Assessment of survival of patients with metastatic clear cell renal cell carcinoma after radical cytoreductive nephrectomy versus no surgery: a SEER analysis. Int Braz J Urol 41:288–295. https://doi.org/10.1590/S1677-5538.IBJU.2015.02.15

    Article  PubMed  PubMed Central  Google Scholar 

  21. Méjean A, Ravaud A, Thezenas S, Colas S, Beauval J-B, Bensalah K et al (2018) Sunitinib alone or after nephrectomy in metastatic renal-cell carcinoma. N Engl J Med 379:417–427. https://doi.org/10.1056/NEJMoa1803675

    Article  PubMed  Google Scholar 

  22. Sharma V, Thompson RH (2019) Cytoreductive nephrectomy in the wake of CARMENA: when to consider it. Eur Urol Oncol. https://doi.org/10.1016/j.euo.2019.05.003

    Article  PubMed  Google Scholar 

  23. Palumbo C, Pecoraro A, Knipper S, Rosiello G, Tian Z, Shariat SF et al (2019) Survival and complication rates of metastasectomy in patients with metastatic renal cell carcinoma treated exclusively with targeted therapy: a combined population-based analysis. Anticancer Res 39:4357–4361. https://doi.org/10.21873/anticanres.13604

    Article  PubMed  Google Scholar 

  24. Hanna N, Sun M, Meyer CP, Nguyen PL, Pal SK, Chang SL et al (2016) Survival analyses of patients with metastatic renal cancer treated with targeted therapy with or without cytoreductive nephrectomy: a national cancer data base study. J Clin Oncol 34:3267–3275. https://doi.org/10.1200/JCO.2016.66.7931

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada

    Giuseppe Rosiello, Sophie Knipper, Carlotta Palumbo, Cristina Dzyuba-Negrean, Angela Pecoraro, Francesco A. Mistretta, Zhe Tian, Fred Saad & Pierre I. Karakiewicz

  2. Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina, 52, 20132, Milan, Italy

    Giuseppe Rosiello, Elio Mazzone, Umberto Capitanio, Francesco Montorsi & Alberto Briganti

  3. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Sophie Knipper

  4. Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy

    Carlotta Palumbo

  5. Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy

    Angela Pecoraro

  6. Department of Urology, European Institute of Oncology, Milan, Italy

    Francesco A. Mistretta

  7. Department of Urology, Medical University of Vienna, Vienna, Austria

    Shahrokh F. Shariat

Authors
  1. Giuseppe Rosiello
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sophie Knipper
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carlotta Palumbo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cristina Dzyuba-Negrean
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Angela Pecoraro
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Elio Mazzone
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Francesco A. Mistretta
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Zhe Tian
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Umberto Capitanio
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Francesco Montorsi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Shahrokh F. Shariat
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Fred Saad
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Alberto Briganti
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Pierre I. Karakiewicz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giuseppe Rosiello.

Ethics declarations

Conflict of interest

All authors declare no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rosiello, G., Knipper, S., Palumbo, C. et al. Unmarried status is a barrier for access to treatment in patients with metastatic renal cell carcinoma. Int Urol Nephrol 51, 2181–2188 (2019). https://doi.org/10.1007/s11255-019-02266-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-019-02266-3

Keywords

Search

Navigation