Prognostic Analysis of Survival Disparities for Squamous Cell Carcinoma in the Anal Canal: The Role of Gender, and Marital Status in the United States

Purpose Squamous cell carcinoma (SCC) at the anal canal (AC) site presents significant challenges in prognosis and treatment. Identifying key prognostic factors is essential for improving survival outcomes and guiding clinical decisions. This study aimed to evaluate demographic, clinical, and treatment-related factors influencing survival in SCC at the AC site, focusing on differences in sex and marital status. Methods We conducted a population-based cohort study utilizing the SEER cancer registry dataset. Kaplan Meier and Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for survival, adjusting for demographic and clinical factors. Stratified analyses were performed to examine sex-specific survival differences. A nomogram was developed to predict five-year survival probabilities. Results The cohort included 24,892 patients with SCC of the AC (median survival: 43 months, IQR: 16–97). Males had shorter survival (38 months, IQR: 13–92) than females (46 months, IQR: 17–100) had a higher mortality risk (HR: 1.66, 95% CI: 1.57–1.76, p<0.001). Married individuals had better survival outcomes (HR: 0.77, 95% CI: 0.72–0.82, p<0.001), while divorced/separated individuals had poorer prognosis (HR: 1.10, 95% CI: 1.03–1.18, p=0.005). Advanced-stage cancer significantly increased mortality risk, with distant-stage SCC showing the highest hazard ratio (HR: 3.22, 95% CI: 3.00–3.46, p<0.001). Chemotherapy, radiotherapy, and surgery significantly improved survival for the disease condition, where the nomogram demonstrated high predictive accuracy for five-year survival probabilities. Conclusion: Women and marital patients demonstrated better survival outcomes than their counterparts, while Non-White, advanced age, and cancer stages negatively affected survival. Surgery and chemotherapy significantly improved survival, highlighting existing disparities and warrants patient-centered, multimodal treatment strategies to improve quality of life for this disease condition.