Gender affects survival for medulloblastoma only in older children and adults: A study from the surveillance epidemiology and end results registry

Abstract

Background. Males have a higher incidence of medulloblastoma (MB) than females, but the effect of gender on survival is unclear. Studies have yielded conflicting results, possibly due to small sample sizes or differences in how researchers defined MB. We aimed to determine the effect of gender on survival in MB using a large data set and strict criteria for defining MB. Procedure. A sample of 1,226 subjects (763 males and 463 females) was identified from 1973 to 2002, using the Surveillance Epidemiology and End Results (SEER-9) registry. MB was strictly defined to exclude non-cerebellar embryonal tumors (primitive neuro-ectodermal tumors). Because children <3 years of age are known to have worse survival, patients were stratified by age <3 years at diagnosis (95 males, 82 females) and >3 years (668 males, 381 females). Results. Overall, there was no significant difference in survival between males and females (log rank P ¼ 0.22). However, among subjects >3 years, females had significantly greater survival than males (log rank P ¼ 0.02). In children <3 years, there was a non-significant trend toward poorer survival in females (median survival: males 27 months, females 13 months; log rank P ¼ 0.24). This interaction between age group and gender was statistically significant (P ¼ 0.03). Conclusion. Females with MB have a survival advantage only in subjects >3 years. In children <3 years, females may even have poorer outcome. The effect of gender on survival and incidence in MB warrants additional biologic investigation, and may differ in very young children with MB.

MYC family amplification and clinical risk-factors interact to predict an extremely poor prognosis in childhood medulloblastoma

“…Notably, this group by definition encompasses all patients with MYC family amplification in the context of clinical high-risk disease. The poorer prognosis observed for male cases in our study is consistent with some recent studies in retrospective cohorts encompassing equivalent age groups [5], but not with other large or trials-based studies [21,23,27]. We therefore excluded gender from survival modelling on the basis of these inconsistent findings; however, the prognostic impact of gender clearly now merits investigation in future trialsbased studies.…”

Incidence, Trends, and Survival of Children With Embryonal Tumors

“…This has been seen for medulloblastomas in other studies as well. 48,49 In 1 study, the effect was seen only for girls .3 years old. 49 In our data set, the effect was seen for girls $1 year (data not shown).…”

“…48,49 In 1 study, the effect was seen only for girls .3 years old. 49 In our data set, the effect was seen for girls $1 year (data not shown). The reason for the girls' better survival is unclear but might stem from biological or hormonal differences or a varying response to treatment.…”

Molecular subgroups of medulloblastoma

“…Recent integration of molecular subgrouping with gender information has shown that males and females exhibit distinct frequencies with respect to their molecular subgroup makeup. Indeed, differences in subgroup distribution may explain the disparate responses to treatment that have been observed between males and females in the clinic [35]. …”