Unmarried Status Effect on Stage at Presentation and Treatment Patterns in Non-Metastatic Upper Tract Urothelial Carcinoma Patients

Among 8,544 non -metastatic UTUC patients identified within the SEER database 20 0 0-2020, unmarried status was independently associated with lower nephroureterectomy (RNU) rates in males (Odds Ratio [OR]: 0.56; P < .001) but not females (OR: 0.81; P = .1) and with lower systemic therapy rates in both male (OR:0.73; P < .001) and female (0.64; P < .001). However, unmarried status did not correlate with an increased risk of locally advanced stage at presentation in either gender. Unmarried male UTUC patients may face challenges accessing RNU compared to their married counterparts. Moreover, unmarried UTUC patients appear to less benefit from ST, regardless of sex. Background: Unmarried status has been associated with higher proportions of locally advanced stage and lower treatment dose intensification rates in several urological and non-urological malignancies. However, no previous investigators focused on the association between unmarried status and advanced stage (T3-4N0-2) at presentation and lower nephroureterectomy (RNU) and systemic therapy (ST) rates in non-metastatic upper tract urothelial carcinoma (UTUC) patients. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database 2000-2020, all non-metastatic UTUC patients were identified. Multivariable logistic regression models (LRMs) tested for differences in stage at presentation and treatment (RNU and ST) according to marital status (married vs unmarried), in a sex-specific fashion. Results: Of all 8,544 non-metastatic UTUC patients, 4,748 (56%) were male vs 3,190 (44%) were female. Of all 4,748 male UTUC patients, 1,191 (25%) were unmarried. Of all 3,190 female UTUC patients, 1,608 (50%) were unmarried. In multivariable LRMs predicting RNU, unmarried status was an independent predictor of lower RNU rates in male (Odds Ratio [OR]: 0.56; p<0.001), but not in female (OR: 0.81; p=0.1) non-metastatic UTUC patients. In multivariable LRMs predicting ST exposure, unmarried status was an independent predictor of lower ST rates in both male (OR:0.73; p=0.03) and female (OR:0.64; p<0.001) UTUC patients. In multivariable LRMs predicting locally advanced stage (T3-4N0-2), unmarried status was not associated with an increased risk of locally advanced stage at presentation in either male (OR: 0.95; p=0.5) or female (OR: 0.99; p=0.9) UTUC patients. Conclusions: Unmarried male UTUC patients appear at risk of less being able to access RNU, relative to their married counterparts. Moreover, unmarried UTUC patients appear to less benefit from ST, regardless of sex. Conversely, unmarried status was not associated with an increased risk of locally advanced stage at presentation in either male or female UTUC patients.