The association between treatment rates and cancer specific mortality (CSM) according to married status in male and female clear cell renal cell carcinoma (ccRCC) patients across all stages is unknown. Using the Surveillance, Epidemiology, and End Results database (2004-2020), ccRCC patients were stratified according to married status (married vs. unmarried). Logistic regression models addressed treatment rates; Cox regression models addressed CSM rates. Of 98,142 patients, 43,999 (72%) males and 20,287 (55%) females were married. In stage-specific analyses, married status independently predicted higher nephrectomy rates in males and females (all ≤ .03). In stage IV, married status predicted higher systemic therapy rate in males (001), but not in females. In survival analyses, married males exhibited lower CSM rates relative to unmarried males (all ≤ .02). Conversely, married females exhibited lower CSM rates only in stages I and III (all ≤ .02), but not in stages II and IV. In subgroup analyses of T1aN0M0 patients, married status was associated with higher partial nephrectomy rates in both males and females (all ≤ .005). In ccRCC, married status invariably predicts higher rates of guideline recommended surgical management (nephrectomy and partial nephrectomy). Moreover, even after adjustment for treatment type, married status independently predicted lower CSM rates in males across all stages. However, the effect of married status in females is only operational in stages I and III. Lack of association between married status in stages II and IV may potentially be explained by stronger association with treatment assignment which reduces the residual effect on survival.

中文翻译：

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婚姻状况影响各个阶段男性和女性肾细胞癌患者的治疗率和死亡率

根据不同阶段的男性和女性透明细胞肾细胞癌 (ccRCC) 患者的婚姻状况，治疗率与癌症特异性死亡率 (CSM) 之间的关联尚不清楚。使用监测、流行病学和最终结果数据库（2004-2020），根据婚姻状况（已婚与未婚）对 ccRCC 患者进行分层。逻辑回归模型解决了治疗率问题； Cox 回归模型解决了 CSM 率问题。在 98,142 名患者中，43,999 名（72%）男性和 20,287 名（55%）女性已婚。在特定阶段的分析中，婚姻状况独立预测男性和女性较高的肾切除率（均≤ .03）。在 IV 期，已婚状态预示男性 (001) 的全身治疗率较高，但女性则不然。在生存分析中，已婚男性相对于未婚男性表现出较低的 CSM 率（全部 ≤ .02）。相反，已婚女性仅在 I 和 III 阶段表现出较低的 CSM 率（全部 ≤ .02），但在 II 和 IV 阶段则不然。在 T1aN0M0 患者的亚组分析中，男性和女性的已婚状况与较高的部分肾切除率相关（均≤ .005）。在 ccRCC 中，婚姻状况总是预示着指南推荐的手术治疗（肾切除术和部分肾切除术）的比率较高。此外，即使在调整治疗类型后，婚姻状况也可以独立预测各个阶段男性的 CSM 率较低。然而，女性婚姻状况的影响仅在第一阶段和第三阶段起作用。 II 期和 IV 期婚姻状况之间缺乏关联可能是因为与治疗分配的关联性更强，从而减少了对生存的残余影响。