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.

Sex differences in cancer mechanisms

“…In concordance, mutant IDH1/2 inhibitors, which are currently in clinical trials for multiple cancers [218] might exhibit sexspecific effects. In glioblastoma, a sex-specific effect of IDH mutations on overall survival has been evaluated in multiple publications [56,59,219]; however, the findings are inconsistent and further study will be required to define how interaction between IDH1 mutation and patient sex impacts on survival.…”