胶质瘤治疗时间和预后的性别差异。
Sex Differences in Time to Treat and Outcomes for Gliomas.
作者信息
Stabellini Nickolas, Krebs Halle, Patil Nirav, Waite Kristin, Barnholtz-Sloan Jill S
机构信息
Department of Population Health and Quantitative Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, United States.
Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), Hospital Israelita Albert Einstein, São Paulo, Brazil.
出版信息
Front Oncol. 2021 Feb 19;11:630597. doi: 10.3389/fonc.2021.630597. eCollection 2021.
BACKGROUND
Gliomas are the most common type of primary malignant brain tumor in adults, representing one third of all primary and central nervous system (CNS) tumors and 80% of malignant tumors diagnosed in the Western world. Epidemiological data indicate that the overall incidence and mortality of cancer is higher in males, while females have a better prognosis. The goal of this study is to determine whether there are sex differences in the time to treat and clinical outcomes in patients with glioma.
METHODS
Glioblastoma (GB) and Lower Grade Glioma (LGG) patients were defined per the Central Brain Tumor Registry of the United States (CBTRUS) from the National Cancer Database (NCDB) for diagnosis years 2004 to 2016. Associations between sex and time to treatment variables as well as associations between sex and multiple clinical outcomes were assessed using univariable and multivariable models.
RESULTS
A total of 176,100 patients were used for analysis (124,502 GBM and 51,598 LGG). Males had a statistically significant association with >7 days to surgery (OR = 1.09, CI 1.05-1.13, p < 0.001) but this association was not observed in the multivariable model (OR = 1.05, CI 0.96-1.16, p = 0.25). After adjustment for key variables including time to treat variables, males with GB and LGG had a higher risk of death (HR = 1.11, CI 1.09-1.13, p < 0.001, HR = 1.09, CI 1.03-1.15, p < 0.001; respectfully). Sex differences in 90-day mortality for GBM were not found after adjustment (OR for males = 0.99, CI 0.91-1.08, p = 0.93). For LGG, both the univariable and multivariable logistic regression models showed no sex differences in 90-day mortality (OR for males = 1.03, CI 0.94-1.12, p = 0.45; multivariable OR for males = 0.81, CI 0.62-1.06, p = 0.13).
CONCLUSIONS
Based on NCDB data, there were no statistically significant differences in time to treatment between males and females, however males had a higher proportion of GB and LGG as well as a higher risk of death compared to females.
背景
胶质瘤是成人中最常见的原发性恶性脑肿瘤类型，占所有原发性中枢神经系统（CNS）肿瘤的三分之一，在西方世界诊断出的恶性肿瘤中占80%。流行病学数据表明，癌症的总体发病率和死亡率男性更高，而女性预后更好。本研究的目的是确定胶质瘤患者在治疗时间和临床结局方面是否存在性别差异。
方法
根据美国中央脑肿瘤登记处（CBTRUS）从国家癌症数据库（NCDB）中定义2004年至2016年诊断的胶质母细胞瘤（GB）和低级别胶质瘤（LGG）患者。使用单变量和多变量模型评估性别与治疗时间变量之间的关联以及性别与多种临床结局之间的关联。
结果
共有176,100名患者用于分析（124,502例GBM和51,598例LGG）。男性与手术时间>7天有统计学显著关联（OR = 1.09，CI 1.05 - 1.13，p < 0.001），但在多变量模型中未观察到这种关联（OR = 1.05，CI 0.96 - 1.16，p = 0.25）。在调整包括治疗时间变量在内的关键变量后，GB和LGG男性的死亡风险更高（HR = 1.11，CI 1.09 - 1.13，p < 0.001；HR = 1.09，CI 1.03 - 1.15，p < 0.001；分别）。调整后未发现GBM患者90天死亡率存在性别差异（男性OR = 0.99，CI 0.91 - 1.08，p = 0.93）。对于LGG，单变量和多变量逻辑回归模型均显示90天死亡率不存在性别差异（男性OR = 1.03，CI 0.94 - 1.12，p = 0.45；男性多变量OR = 0.81，CI 0.62 - 1.06，p = 0.13）。
结论
基于NCDB数据，男性和女性在治疗时间上无统计学显著差异，然而与女性相比，男性的GB和LGG比例更高且死亡风险更高。
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