The prognosis of patients with primary lymphoma of the central nervous system (PCNSL) is poor, and identifying the prognostic predictors is the key to improving their prognosis. Biopsychosocial models suggest the important prognostic value of psychosocial factors, but the association of marital status, one important psychosocial factor, with the prognosis of PNSCL patients remains unclear.

To assess the association of marital status with the overall survival (OS) and cancer-specific survival (CSS) in patients with PCNSL.

The data of 3 993 patients diagnosed with PCNSL between 2000 and 2016 were extracted from the Surveillance, Epidemiology and End Results database in 2020, including sociodemographics〔marital status (married, or single containing unmarried, divorced or widowed) , age of diagnosis, year of diagnosis, ethnicity, gender〕, clinicopathological features (pathological type and location of the PCNSL) , treatment (surgery, radiotherapy and chemotherapy) and outcome data (survival and follow-up time) . The propensity score matching (PSM) was used to balance the baseline variables of the married and singles. The Log-rank test was used to compare the Kaplan-Meier curves of OS and CSS by marital status. Cox regression was used to identify the association of marital status with OS and CSS.

After PSM, there were no significant differences in baseline variables between married and single patients (P>0.05) . The Log-rank test demonstrated that single patients had worse OS and CSS than the married (P<0.05) . Further analysis revealed that the widowed singles had worse OS and CSS than the married (P<0.05) . After adjusting for age of diagnosis, ethnicity, gender, year of diagnosis, pathological type and location of the PCNSL, surgery, radiotherapy and chemotherapy, multivariate analysis found that compared to those married, the risk of death was 1.24 times higher〔95%CI (1.14, 1.36) , P<0.001〕 and the risk of cancer-specific death was 1.22 times higher〔95%CI (1.11, 1.33) , P<0.001〕in singles. Further analysis revealed that compared with married patients, the risk of worse OS increased by a factor of 1.14〔95%CI (1.03, 1.27) , P=0.013〕 and that of worse CSS increased by a factor of 1.15〔95%CI (1.03, 1.29) , P=0.012〕in unmarried singles; the risk of worse OS and CSS increased by a factor of 1.23〔95%CI (1.07, 1.41) , P=0.004〕 and by a factor of 1.22〔95%CI (1.05, 1.41) , P=0.009〕, respectively, in divorced singles; the risk of worse OS and CSS increased by a factor of 1.37〔95%CI (1.21, 1.54) , P<0.001〕 and by a factor of 1.28〔95%CI (1.12, 1.46) , P=0.013〕, respectively, in widowed singles.

Marital status was associated with OS and CSS in PCNSL patients. The unmarried, divorced and widowed singles may have worse OS and CSS, suggesting that more attention should be given to the marital status of these patients besides biological characteristics of PCNSL during the clinical management.