TY - JOUR
T1 - Sex-Specific Differences in Low-Grade Glioma Presentation and Outcome
AU - Tewari, Surabhi
AU - Tom, Martin C.
AU - Park, Deborah Y.J.
AU - Wei, Wei
AU - Chao, Samuel T.
AU - Yu, Jennifer S.
AU - Suh, John H.
AU - Kilic, Sarah
AU - Peereboom, David M.
AU - Stevens, Glen H.J.
AU - Lathia, Justin D.
AU - Prayson, Richard
AU - Barnett, Gene H.
AU - Angelov, Lilyana
AU - Mohammadi, Alireza M.
AU - Ahluwalia, Manmeet S.
AU - Murphy, Erin S.
N1 - Funding Information:
Disclosures: M.S.A. reports grants and personal fees from AbbVie, AstraZeneca, Bayer, and Novocure; grants from Bristol Myers Squibb, Merck, Incyte, and Pharmacyclics; personal fees from Apollomics, Cellularity, KIYATEC, Xoft, GSK, Nuvation, VBI Vaccines, Varian Medical Systems, Prelude, Janssen, Forma Therapeutics, Tocagen, Kadmon, Karyopharm, Insightec, and SDP Oncology; grants and other from Mimivax; and other from Doctible, Cytodyn, and MedInnovate LLC, all outside the submitted work. S.T.C. reports personal fees from Varian Medical Systems and nonfinancial support from Blue Earth Diagnostics, outside the submitted work. M.C.T. reports grants from Blue Earth Diagnostics, outside the submitted work.
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/10/1
Y1 - 2022/10/1
N2 - Purpose: In addition to established prognostic factors in low-grade glioma (LGG), studies suggest a sexual dimorphism with male sex portending worse prognosis. Our objective was to identify the effect of sex on presentation and outcomes in LGG. Methods and Materials: We conducted a retrospective cohort study of adults (aged ≥18 years) diagnosed with LGG (World Health Organization 2016 grade 2 glioma). Patients with IDH wild-type tumors were excluded. Patients were matched between male and female sex by age, treatment, and surgery via propensity score matching. Patient, tumor, and treatment characteristics were analyzed by sex. Endpoints included overall survival (OS), next intervention–free survival (NIFS), progression-free survival, and malignant transformation–free survival. Kaplan-Meier analyses and Cox proportional hazards regression multivariable analysis with backward elimination were completed. Results: Of the 532 patients identified, 258 (48%) were men. Men were more likely to present with seizure (69.38% vs 56.57%, P =.002), but no other statistically significant differences between sexes at presentation were identified. Five-year OS was higher in women at 87% (95% confidence interval [CI], 83%-91%) versus 78% (95% CI, 73%-84%) in men (P =.0045). NIFS was significantly higher in female patients at 68% (95% CI, 62%-74%) versus 57% (95% CI, 51%-64%) in men (P =.009). On multivariable analysis, female sex was independently associated with improved OS (hazard ratio [HR], 1.54; 95% CI, 1.16-2.05; P =.002), NIFS (HR, 1.42; 95% CI, 1.42; P =.004), and malignant transformation–free survival (HR, 1.62; 95% CI, 1.24-2.12; P =.0004). In patients with molecularly defined LGG (IDH and 1p19q status; n = 291), female sex remained independently associated with improved OS (HR, 1.79; 95% CI, 1.16-2.77; P =.008) and NIFS (HR, 1.45; 95% CI, 1.07-1.96; P =.016). Conclusions: In this study, female sex was independently associated with improved outcomes. These findings support intrinsic sex-specific differences in LGG behavior, justifying further studies to optimize management and therapeutics based on sex.
AB - Purpose: In addition to established prognostic factors in low-grade glioma (LGG), studies suggest a sexual dimorphism with male sex portending worse prognosis. Our objective was to identify the effect of sex on presentation and outcomes in LGG. Methods and Materials: We conducted a retrospective cohort study of adults (aged ≥18 years) diagnosed with LGG (World Health Organization 2016 grade 2 glioma). Patients with IDH wild-type tumors were excluded. Patients were matched between male and female sex by age, treatment, and surgery via propensity score matching. Patient, tumor, and treatment characteristics were analyzed by sex. Endpoints included overall survival (OS), next intervention–free survival (NIFS), progression-free survival, and malignant transformation–free survival. Kaplan-Meier analyses and Cox proportional hazards regression multivariable analysis with backward elimination were completed. Results: Of the 532 patients identified, 258 (48%) were men. Men were more likely to present with seizure (69.38% vs 56.57%, P =.002), but no other statistically significant differences between sexes at presentation were identified. Five-year OS was higher in women at 87% (95% confidence interval [CI], 83%-91%) versus 78% (95% CI, 73%-84%) in men (P =.0045). NIFS was significantly higher in female patients at 68% (95% CI, 62%-74%) versus 57% (95% CI, 51%-64%) in men (P =.009). On multivariable analysis, female sex was independently associated with improved OS (hazard ratio [HR], 1.54; 95% CI, 1.16-2.05; P =.002), NIFS (HR, 1.42; 95% CI, 1.42; P =.004), and malignant transformation–free survival (HR, 1.62; 95% CI, 1.24-2.12; P =.0004). In patients with molecularly defined LGG (IDH and 1p19q status; n = 291), female sex remained independently associated with improved OS (HR, 1.79; 95% CI, 1.16-2.77; P =.008) and NIFS (HR, 1.45; 95% CI, 1.07-1.96; P =.016). Conclusions: In this study, female sex was independently associated with improved outcomes. These findings support intrinsic sex-specific differences in LGG behavior, justifying further studies to optimize management and therapeutics based on sex.
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U2 - 10.1016/j.ijrobp.2022.05.036
DO - 10.1016/j.ijrobp.2022.05.036
M3 - Article
C2 - 35667529
AN - SCOPUS:85135529658
SN - 0360-3016
VL - 114
SP - 283
EP - 292
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 2
ER -