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Sex as a prognostic factor in adult-type diffuse gliomas: an intergrated clinical and molecular analysis according to the 2021 WHO classification

 Minjae Kim  ;  Sooyon Kim  ;  Yae Won Park  ;  Kyunghwa Han  ;  Sung Soo Ahn  ;  Ju Hyung Moon  ;  Eui Hyun Kim  ;  Jinna Kim  ;  Seok-Gu Kang  ;  Jong Hee Chang  ;  Se Hoon Kim  ;  Seung-Koo Lee 
 JOURNAL OF NEURO-ONCOLOGY, Vol.159(3) : 695-703, 2022-09 
Journal Title
Issue Date
Adult ; Aged ; Brain Neoplasms* / pathology ; Female ; Glioblastoma* ; Glioma* / pathology ; Humans ; Isocitrate Dehydrogenase / genetics ; Male ; Methyltransferases ; Middle Aged ; Mutation ; Prognosis ; Retrospective Studies ; World Health Organization
Adult-type diffuse gliomas ; Isocitrate dehydrogenase ; O(6)-methylguanine-DNA methyltransferase ; Prognosis ; Sex
Purpose: To investigate whether type-specific sex differences in survival exist independently of clinical and molecular factors in adult-type diffuse gliomas according to the 2021 World Health Organization (WHO) classification.

Methods: A retrospective chart and imaging review of 1325 patients (mean age, 54 ± 15 years; 569 females) with adult-type diffuse gliomas (oligodendroglioma, IDH-mutant, and 1p/19q-codeleted, n = 183; astrocytoma, IDH-mutant, n = 211; glioblastoma, IDH-wildtype, n = 800; IDH-wildtype diffuse glioma, NOS, n = 131) was performed. The demographic information, extent of resection, imaging data, and molecular data including O6-methylguanine-methyltransferase promoter methylation (MGMT) promotor methylation were collected. Sex differences in survival were analyzed using Cox analysis.

Results: In patients with glioblastoma, IDH-wildtype, female sex remained as an independent predictor of better overall survival (hazard ratio = 0.91, P = 0.031), along with age, histological grade 4, MGMT promoter methylation status, and gross total resection. Female sex showed a higher prevalence of MGMT promoter methylation (40.2% vs 32.0%, P = 0.017) but there was no interaction effect between female sex and MGMT promoter methylation status (P-interaction = 0.194), indicating independent role of female sex. The median OS for females were 19.2 months (12.3-35.0) and 16.2 months (10.5-30.6) for males. No sex difference in survival was seen in other types of adult-type diffuse gliomas.

Conclusion: There was a female survival advantage in glioblastoma, IDH-wildtype, independently of clinical data or MGMT promoter methylation status. There was no sex difference in survival in other types of adult-type diffuse gliomas, suggesting type-specific sex effects solely in glioblastoma, IDH-wildtype.
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1. College of Medicine (의과대학) > Research Institute (부설연구소) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kang, Seok Gu(강석구) ORCID logo https://orcid.org/0000-0001-5676-2037
Kim, Min Jae(김민재)
Kim, Se Hoon(김세훈) ORCID logo https://orcid.org/0000-0001-7516-7372
Kim, Eui Hyun(김의현) ORCID logo https://orcid.org/0000-0002-2523-7122
Kim, Jinna(김진아) ORCID logo https://orcid.org/0000-0002-9978-4356
Moon, Ju Hyung(문주형)
Park, Yae Won(박예원) ORCID logo https://orcid.org/0000-0001-8907-5401
Ahn, Sung Soo(안성수) ORCID logo https://orcid.org/0000-0002-0503-5558
Lee, Seung Koo(이승구) ORCID logo https://orcid.org/0000-0001-5646-4072
Chang, Jong Hee(장종희) ORCID logo https://orcid.org/0000-0003-1509-9800
Han, Kyung Hwa(한경화)
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