性别作为成人弥漫性胶质瘤的预后因素：根据 2021 年 WHO 分类的综合临床和分子分析。
Sex as a prognostic factor in adult-type diffuse gliomas: an integrated clinical and molecular analysis according to the 2021 WHO classification.
机构信息
Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
Department of Statistics and Data Science, Yonsei University, Seoul, Korea.
出版信息
J Neurooncol. 2022 Sep;159(3):695-703. doi: 10.1007/s11060-022-04114-4. Epub 2022 Aug 21.
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 O-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.
目的
根据 2021 年世界卫生组织（WHO）分类，研究在成人弥漫性神经胶质瘤中，生存是否存在与临床和分子因素无关的特定性别差异。
方法
对 1325 名成人弥漫性神经胶质瘤（少突胶质细胞瘤，IDH 突变且 1p/19q 共缺失，n=183；星形细胞瘤，IDH 突变，n=211；胶质母细胞瘤，IDH 野生型，n=800；IDH 野生型弥漫性神经胶质瘤，NOS，n=131）患者的病历和影像学进行回顾性分析。收集了人口统计学信息、切除程度、影像学数据和分子数据，包括 O-甲基鸟嘌呤-DNA 甲基转移酶启动子甲基化（MGMT）启动子甲基化。使用 Cox 分析来分析生存中的性别差异。
结果
在胶质母细胞瘤，IDH 野生型患者中，女性仍然是总生存期更好的独立预测因素（风险比=0.91，P=0.031），此外还有年龄、组织学分级 4 级、MGMT 启动子甲基化状态和大体全切除。女性 MGMT 启动子甲基化的发生率更高（40.2%比 32.0%，P=0.017），但女性性别和 MGMT 启动子甲基化状态之间没有交互作用（P 交互=0.194），表明女性性别具有独立作用。女性的中位 OS 为 19.2 个月（12.3-35.0），男性为 16.2 个月（10.5-30.6）。在其他类型的成人弥漫性神经胶质瘤中，性别与生存之间没有差异。
结论
在胶质母细胞瘤，IDH 野生型中，女性生存存在优势，与临床数据或 MGMT 启动子甲基化状态无关。在其他类型的成人弥漫性神经胶质瘤中，性别与生存之间没有差异，这表明性别效应仅存在于胶质母细胞瘤，IDH 野生型中。
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