Can gallbladder cancer patients experience benefits from marriage? A competing risk analysis in a real-world context

Background: The association between marital status and gallbladder cancer (GBC) remains uncertain. This study aimed to verify the relationship between marital status and GBC and construct a prognostic nomogram to predict the impact of marital status on GBC patients. Method: GBC patients were split into married and unmarried groups and added to the Surveillance, Epidemiology, and End Results (SEER) database. We employed competing risk analyses, propensity score matching (PSM), and Kaplan-Meier survival analyses. After that, the relationship between marital status and GBC was verified and the predicted nomogram was constructed. Results: A cohort of 76 patients from Hangzhou Traditional Chinese Medicine (TCM) Hospital was selected as the external validation group, with an additional 3193 GBC patients obtained from the SEER database. Following PSM, both cohorts exhibited comparable 5-year cancer-specific survival rates. Notably, the results of the competing risk analysis unveiled a significant disparity in the 5-year cumulative incidence of cancer-specific death (CSD) between the two cohorts (59.1% vs. 65.2%, p = 0.003). Furthermore, the multivariate competing hazards regression analysis identified a noteworthy association (HR, 1.17; 95% CI, 1.04-1.31; p = 0.007) between marital status and CSD. To assess the 1-, 3-, and 5-year risks of CSD, a comprehensive competing event nomogram was constructed utilizing factors derived from the multivariate analysis. The area under the receiver operating characteristic curve (AUC) values for the 1-, 3-, and 5-year training cohorts were 0.806, 0.785, and 0.776, respectively. In the internal validation cohort, these values were 0.798, 0.790, and 0.790, while the external validation cohort exhibited AUC values of 0.748, 0.835, and 0.883 for the corresponding time intervals. Furthermore, calibration curves manifested a commendable level of concordance between the observed and predicted probabilities of CSD. Conclusion: Marital status offers potential benefits for GBC. Married GBC patients have better cancer-specific survival. The suggested nomogram demonstrates exceptional predictive power.