Abstract
Sex disparities in glioblastoma (GBM) have received increasing attention. Sex-related differences for several molecular markers have been reported, which could impact on clinical factors and outcomes. We therefore analyzed data on all patients with GBM reported to the Swedish National Quality Registry for Primary Brain Tumors, according to sex, with a focus on prognostic factors and survival. All glioma patients registered during 20 years, from 1 January 1999 until 31 December 2018, with SNOMED codes 94403, 94413, and 94423, were analyzed. Chi2-test, log-rank test, and Kaplan–Meier analyses were performed. We identified 5243 patients, of which 2083 were females and 3160 males, resulting in a ratio of 1:1.5. We found sex related differences, with women having diagnostic surgery at a significantly higher age (p = 0.001). Women were also reported to have a worse preoperative performance status (PPS) (<0.001). There was no gender difference for the type of surgery performed. For women with radical surgery, overall survival was slightly better than for men (p = 0.045). The time period did not influence survival, neither for 1999–2005 nor 2006–2018, after temozolomide treatment was introduced (p = 0.35 and 0.10, respectively). In the multivariate analysis including sex, age, surgery, and PPS, a survival advantage was noted for women, but this was not clinically relevant (HR = 0.92, p = 0.006). For patients with GBM; sex-related differences in clinical factors could be identified in a population-based cohort. In this dataset, for survival, the only advantage noted was for women who had undergone radical surgery, although this was clinically almost negligible.
Highlights
Glioblastoma (GBM) is the most common and aggressive glioma, with the median survival for unselected, population-based cohorts reported to be between 9–11 months [1,2].For those with good prognostic factors, allowing for extensive, multimodal treatment with surgery, radiation, chemotherapy, and tumor treating fields, the median survival can be prolonged to nearly 21 months [3]
This means that approximately 90% of all patients diagnosed with GBM in Sweden were reported to the quality registry from all six regions every year, apart from two regions that did not report during 2000–2005 and 2005–2011, respectively
An interesting study investigating the discrepancy in GBM incidence between men and women found that intracranial volume (ICV), as a substitute for brain size, was correlated to the risk of developing high-grade glioma, with increasing ICV leading to a higher risk [22]
Summary
Glioblastoma (GBM) is the most common and aggressive glioma, with the median survival for unselected, population-based cohorts reported to be between 9–11 months [1,2]. For those with good prognostic factors, allowing for extensive, multimodal treatment with surgery, radiation, chemotherapy, and tumor treating fields, the median survival can be prolonged to nearly 21 months [3]. A well-known fact is that men are affected more often than women, with the ratio between men and women reported in the literature as being 1.4–1.6:1 [4,5] This relationship has received increasing attention in recent years, with researchers investigating the role of molecular patterns related to sex. Whether survival is affected by these disparities is debated [8,11,12,13]
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