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.

原发性中枢神经系统淋巴瘤（PCNSL）的预后较差，明确其预后危险因素是改善其预后的关键。生物-心理-社会医学模式提示社会心理因素的重要性。婚姻是重要的社会心理因素之一，但婚姻状态对PNSCL患者预后的影响尚不明确。

探究婚姻状态对PCNSL患者总生存（OS）和癌因生存（CSS）的影响。

于2020年，提取2000—2016年美国"监测、流行病学和结果"数据库的3 993例PCNSL患者的病例资料，包括社会人口学资料（婚姻状态、确诊年龄、种族、性别和确诊年份）、临床病理资料（病理类型、肿瘤位置）、治疗资料（手术、放疗和化疗）及结局资料（生存信息和随访时间）。依据婚姻状态将患者分为已婚和非已婚两组，其中非已婚包括单身、离异和丧偶。采用倾向性评分匹配均衡基线资料，采用Kaplan-Meier分析（Log-rank检验）、Cox回归评估婚姻状态对患者OS和CSS的影响。

倾向性评分匹配后，已婚组和非已婚组患者基线资料比较，差异均无统计学意义（P>0.05）。将患者按婚姻状态分为已婚和非已婚组：Log-rank检验结果显示，与已婚患者相比，非已婚患者的OS和CSS更差（P<0.05）；倾向性评分匹配后，校正确诊年龄、种族、性别、确诊年份、病理类型、肿瘤位置、手术、放疗和化疗因素后，多因素Cox回归分析结果显示，非已婚患者的OS风险是已婚患者的1.24倍〔95%CI（1.14，1.36），P<0.001〕，非已婚患者的CSS风险是已婚患者的1.22倍〔95%CI（1.11，1.33），P<0.001〕。将患者按婚姻状态分为已婚、单身、离异、丧偶组：Log-rank检验结果显示，与已婚患者相比，丧偶患者的OS和CSS预后更差（P<0.05）；校正确诊年龄、种族、性别、确诊年份、病理类型、肿瘤位置、手术、放疗和化疗因素后，多因素Cox回归结果显示，单身患者OS和CSS风险分别是已婚患者的1.14倍〔95%CI（1.03，1.27），P=0.013〕和1.15倍〔95%CI（1.03，1.29），P=0.012〕，离异患者OS和CSS风险分别是已婚患者的1.23倍〔95%CI（1.07，1.41），P=0.004〕和1.22倍〔95%CI（1.05，1.41），P=0.009〕，丧偶患者OS和CSS风险分别是已婚患者的1.37倍〔95%CI（1.21，1.54），P<0.001〕和1.28倍〔95%CI（1.12，1.46），P=0.013〕。

婚姻状态影响PCNSL患者OS和CSS，与已婚相比，单身、离异和丧偶患者的预后更差，这提示在临床管理和决策中，除了传统的肿瘤生物学特征，还应关注婚姻状态对PCNSL患者预后的影响。