EPID-04. IMPACT OF SEX DIFFERENCES IN IRON SUPPLEMENTATION AND OUTCOMES IN ANEMIC GLIOBLASTOMA PATIENTS

Abstract

Abstract We performed a retrospective sex-stratified analysis on 1750 histologically confirmed surgical glioblastoma patients (737 female, 1013 male) diagnosed between January 1, 2000 – January 1, 2020 in the TriNetX Research Network. Among 737 female glioblastoma patients, 140 (18.99%) were classified as anemic (defined as having mean 5-year-post-diagnosis hemoglobin levels < 12 g/dL). Among 1013 male patients, 177 (17.4%) were classified as anemic (mean 5-year-post-diagnosis hemoglobin levels < 13 g/dL). Of the 140 anemic female patients, 30 (21.4%) received iron supplementation whereas 28 (15.8%) of 177 anemic male patients received iron supplementation. Anemic female patients receiving iron supplementation were on average younger than anemic female patients who did not receive supplementation (mean age at diagnosis (SD): 59.08 vs. 64.87, p = 0.037), however no statistically significant differences in presence of chemotherapy administration, radiation administration, or Charlson comorbidity index (CCI) were detected. Anemic male patients receiving iron supplementation had no significant difference in mean age at diagnosis, chemotherapy administration, radiation administration, or CCI compared to anemic male patients not receiving iron supplementation. Kaplan-Meier analysis revealed that iron supplementation in anemic female patients was associated with prolonged overall median survival (536 vs. 361 days, p = 0.03) whereas iron supplementation in anemic male patients was not associated with any significant increase in overall survival (392 vs. 361 days, p = 0.89). Multivariate analysis using a Cox proportional hazards model adjusted for mean 5-year-post-diagnosis hemoglobin levels, age at diagnosis, chemotherapy administration, radiation administration, and CCI revealed that iron supplementation was associated with improved survival in anemic female patients (HR: 0.53, 95% CI: 0.30 – 0.96) but not in anemic male patients (HR: 0.87, 95% CI: 0.54 – 1.43). These results highlight the importance of iron biology in glioblastoma and provide evidence for further investigation into iron supplementation of anemic glioblastoma patients.