Influence of a Child's Sex on Medulloblastoma Outcome

Abstract

Context.-Aggressive treatment of medulloblastoma, the most common pediatric brain tumor, has not improved survival. Identifying better prognostic indicators may warrant less morbid therapy.Objective.-To investigate the role of sex on outcome of medulloblastoma. Design.-Retrospective study of significant factors for survival with a median follow-up of 82 months. Setting.-University medical center. Patients.-A total of 109 consecutive, pediatric patients treated for primary medulloblastoma from 1970 to 1995 with surgery and postoperative radiotherapy and, after 1979, chemotherapy. Main Outcome Measures.-Factors independently associated with survival. Results.-The final multivariate model predicting improved survival included sex (hazard ratio, 0.52; 95% confidence interval [CI], 0.29-0.92; P=.03; favoring female), metastases at presentation (hazard ratio, 2.01; 95% CI, 1.14-3.52; P=.02), and extent of surgical resection (hazard ratio, 0.60; 95% CI, 0.34-1.04; P=.07; favoring greater resection). The overall, 5-year freedom from progression was 40% and survival was 49%. Radiotherapy dose (P=.72), and chemotherapy (P=.90) did not significantly affect a disease outcome.Conclusions.-The sex of the child was an important predictor for survival of medulloblastoma; girls had a much better outcome. The difference in survival between sexes should be evaluated in prospective, clinical trials.

Immunohistochemical expression of markers Ki-67, neun, synaptophysin, p53 and HER2 in medulloblastoma and its correlation with clinicopathological parameters

“…Male patients presented significantly reduced survival as compared to females (p=0.002). This finding was also reported by Jaros et al and weil et al 14,18 . As previously described by other authors 2,15 , the variables age, histological subtype, and presence of residual tumor did not have a statistically significant correlation with survival.…”

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).…”

Survival and prognostic factors in a series of adults with medulloblastomas

“…23 Some explanations for these findings have been suggested as follows: a behavior of medulloblastoma intrinsically different between sexes, favoring a more indolent, well-localized, and more easily resectable form in female patients; the presence of female hormones, which may provide protection against tumor recurrence; and the precocious puberty induced by therapy that confers a survival advantage in children as well as the fact that girls were usually more sensitive to therapy. 32,45,47 However, we have not been able to determine particular features of the tumors in our female patients that might have suggested such different behavior. This sex-based difference for survival and disease control remains an enigma and should be viewed cautiously because of the small sample size of our series.…”

“…This impact has already been reported in other adult series 12,18,32,40 as well as in children. 13,45,47 Others 1,3,4,10,25,26,36 have found that sex did not affect survival or, on the contrary, noted better outcome for male patients. 23 Some explanations for these findings have been suggested as follows: a behavior of medulloblastoma intrinsically different between sexes, favoring a more indolent, well-localized, and more easily resectable form in female patients; the presence of female hormones, which may provide protection against tumor recurrence; and the precocious puberty induced by therapy that confers a survival advantage in children as well as the fact that girls were usually more sensitive to therapy.…”