Sex-specific impact of patterns of imageable tumor growth on survival of primary glioblastoma patients

Abstract

Background: Sex is recognized as a significant determinant of outcome among glioblastoma patients, but the relative prognostic importance of glioblastoma features has not been thoroughly explored for sex differences. Methods: Combining multi-modal MR images, biomathematical models, and patient clinical information, this investigation assesses which pretreatment variables have a sex-specific impact on the survival of glioblastoma patients (299 males and 195 females). Results: Among males, tumor (T1Gd) radius was a predictor of overall survival (HR = 1.027, p = 0.044). Among females, higher tumor cell net invasion rate was a significant detriment to overall survival (HR = 1.011, p < 0.001). Female extreme survivors had significantly smaller tumors (T1Gd) (p = 0.010 t-test), but tumor size was not correlated with female overall survival (p = 0.955 CPH). Both male and female extreme survivors had significantly lower tumor cell net proliferation rates than other patients (M p = 0.004, F p = 0.001, t-test). Conclusion: Despite similar distributions of the MR imaging parameters between males and females, there was a sex-specific difference in how these parameters related to outcomes.

Sexual dimorphism of the immune system predicts clinical outcomes in glioblastoma immunotherapy: A systematic review and meta-analysis

“…Clinically, sex-specific patterns of tumor growth, measured via imaging, have also been identified by Whitmire et al 66 They demonstrate that tumor cell diffuse invasion rate is negatively correlated with survival in females but not males, while the size of the tumor overall is correlated with survival in males but not in females. Furthermore, male incidence bias has been seen clinically in both high- and low-grade brain tumors in data from six different countries with tumors such as astrocytomas, oligodendrogliomas, ependymoma, and medulloblastoma.…”

Individualized survival prediction and surgery recommendation for patients with glioblastoma

“…Most previous studies have focused on the effect of different EOR on survival time ( 3 , 44 , 45 ), with fewer findings on how to select resection scopes in different populations and patients with different tumor characteristics at the same time. Among the important characteristics on the basis of which the model recommended different EOR, age ( 46 ), sex ( 47 ), tumor size ( 48 ), and crossing the midline ( 49 ) were considered to interact with EOR in the prognosis of patients with GBM in previous studies; that is, the effect of EOR on survival outcome was specific to the above variables. As for the tumor location and laterality, the finding that patients with tumors located in the right frontal lobe are more suitable for SpTR is consistent with the recent expert consensus ( 50 ).…”

Potent in vivo efficacy of oral gallium maltolate in treatment-resistant glioblastoma

“…Recently, we demonstrated that basal ganglia iron levels may be a useful biomarker in glioma prognosis ( 89 ). Advanced MR imaging techniques already have the potential to predict the influence of sex on GBM outcomes ( 16 , 90 ). Finally, on PET/CT, 68 Ga tracer uptake was found to correlate to brain tumor grade, with the ability to distinguish between low and high grade, as well as between grade III and IV, gliomas ( 91 ).…”