Sex as a prognostic factor in adult-type diffuse gliomas: an integrated clinical and molecular analysis according to the 2021 WHO classification

• DOI: 10.1007/s11060-022-04114-4
• Publication Date: 2022-08-21T05:02:20Z
• Authors: Minjae Kim; Sooyon Kim; Yae Won Park; Kyunghwa Han; Sung Soo Ahn; Ju Hyung Moon; Eui Hyun Kim; Jinna Kim; Seok-Gu Kang; Jong Hee Chang; Se Hoon Kim; Seung-Koo Lee
• Keywords: Adult; Male; Brain Neoplasms* / pathology; 610; World Health Organization; 03 medical and health sciences; 0302 clinical medicine; Humans; 10. No inequality; Aged; Retrospective Studies; Isocitrate Dehydrogenase / genetics; Brain Neoplasms; Glioblastoma*; O(6)-methylguanine-DNA methyltransferase; Glioma; Methyltransferases; Middle Aged; Prognosis; Isocitrate Dehydrogenase; Isocitrate dehydrogenase; 3. Good health; Adult-type diffuse gliomas; Mutation; Glioma* / pathology; Sex; Female; Glioblastoma

To investigate whether type-specific sex differences in survival exist independently of clinical and molecular factors in adult-type diffuse gliomas according to the 2021 World Health Organization (WHO) classification.A retrospective chart and imaging review of 1325 patients (mean age, 54 ± 15 years; 569 females) with adult-type diffuse gliomas (oligodendroglioma, IDH-mutant, and 1p/19q-codeleted, n = 183; astrocytoma, IDH-mutant, n = 211; glioblastoma, IDH-wildtype, n = 800; IDH-wildtype diffuse glioma, NOS, n = 131) was performed. The demographic information, extent of resection, imaging data, and molecular data including O6-methylguanine-methyltransferase promoter methylation (MGMT) promotor methylation were collected. Sex differences in survival were analyzed using Cox analysis.In patients with glioblastoma, IDH-wildtype, female sex remained as an independent predictor of better overall survival (hazard ratio = 0.91, P = 0.031), along with age, histological grade 4, MGMT promoter methylation status, and gross total resection. Female sex showed a higher prevalence of MGMT promoter methylation (40.2% vs 32.0%, P = 0.017) but there was no interaction effect between female sex and MGMT promoter methylation status (P-interaction = 0.194), indicating independent role of female sex. The median OS for females were 19.2 months (12.3-35.0) and 16.2 months (10.5-30.6) for males. No sex difference in survival was seen in other types of adult-type diffuse gliomas.There was a female survival advantage in glioblastoma, IDH-wildtype, independently of clinical data or MGMT promoter methylation status. There was no sex difference in survival in other types of adult-type diffuse gliomas, suggesting type-specific sex effects solely in glioblastoma, IDH-wildtype.