Prosperetti Chiara, Yenigün Meltem, Pagnamenta Alberto, Tabaee Damavandi Payam, Disanto Giulio, Marchi Francesco, Espeli Vittoria, Muoio Barbara, Spina Paolo, Pesce Gianfranco, Agazzi Pamela
Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland.
Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland.
Biomedicines. 2025 Jul 14;13(7):1715. doi: 10.3390/biomedicines13071715.
: Sex differences play a significant role in the epidemiology, biology, and outcomes of many cancers, including glioblastoma (GB), the most common and aggressive primary brain tumor. GB is more frequent in males, while females tend to have longer survival, though the underlying reasons for these differences remain poorly understood. Potential contributors include hormonal influences, sex-specific risk factors, and treatment disparities. Understanding these differences is critical for optimizing personalized treatment strategies. : We conducted a retrospective analysis of patients with gliomas from a neuro-oncological database, with a primary focus on GB cases. Variables collected included sex, age, tumor type, molecular biomarker, and treatment modalities. The primary objective was to assess sex-based differences in tumor characteristics and outcomes, while the secondary objective was to identify predictors of time to progression and mortality. : The cohort comprised 125 GB, 48 astrocytomas, and 16 oligodendrogliomas, with no significant sex-based differences in age or tumor type distribution. Among GB patients, multifocality was more prevalent in females (14% vs. 8%; = 0.01); also, EGFR amplification was more frequent in females (25.5% vs. 52.5%; = 0.007). Males received chemotherapy (80% vs. 63%; = 0.04) and radiotherapy (84% vs. 67%; = 0.03) more frequently than females. Survival was positively associated with methylation ( = 0.002) and negatively associated with TERT mutation ( = 0.01). Multivariable analysis identified TERT mutation as a predictor of increased mortality (HR = 4.1; 95% CI: 1.2-14; = 0.025), while multifocality predicted both mortality (HR = 2.3; 95% CI: 1.3-3.9; = 0.003) and reduced time to progression (HR = 3.3; 95% CI: 1.02-10.6; = 0.04). : This study underscores the importance of sex and molecular profiling in GB management, revealing distinct patterns in tumor characteristics and treatment administration between males and females. Our findings advocate for the integration of sex-specific considerations and molecular profiling into clinical decision-making to improve outcomes for GB patients.
性别差异在许多癌症的流行病学、生物学及预后方面发挥着重要作用，包括胶质母细胞瘤（GB），这是最常见且侵袭性最强的原发性脑肿瘤。GB在男性中更为常见，而女性的生存期往往更长，不过这些差异背后的原因仍知之甚少。潜在因素包括激素影响、性别特异性风险因素及治疗差异。了解这些差异对于优化个性化治疗策略至关重要。
我们对一个神经肿瘤学数据库中的胶质瘤患者进行了回顾性分析，主要聚焦于GB病例。收集的变量包括性别、年龄、肿瘤类型、分子生物标志物及治疗方式。主要目的是评估肿瘤特征和预后方面基于性别的差异，次要目的是确定疾病进展时间和死亡率的预测因素。
该队列包括125例GB、48例星形细胞瘤和16例少突胶质细胞瘤，在年龄或肿瘤类型分布上不存在显著的基于性别的差异。在GB患者中，多灶性在女性中更为普遍（14%对8%；P = 0.01）；此外，表皮生长因子受体（EGFR）扩增在女性中更常见（25.5%对52.5%；P = 0.007）。男性接受化疗（80%对63%；P = 0.04）和放疗（84%对67%；P = 0.03）的频率高于女性。生存期与甲基化呈正相关（P = 0.002），与端粒酶逆转录酶（TERT）突变呈负相关（P = 0.01）。多变量分析确定TERT突变是死亡率增加的预测因素（风险比[HR] = 4.1；95%置信区间[CI]：1.2 - 14；P = 0.025），而多灶性既预测死亡率（HR = 2.3；95% CI：1.3 - 3.9；P = 0.003）又预测疾病进展时间缩短（HR = 3.3；95% CI：1.02 - 10.6；P = 0.04）。
本研究强调了性别和分子特征分析在GB治疗中的重要性，揭示了男性和女性在肿瘤特征及治疗实施方面的不同模式。我们的研究结果主张将性别特异性考量和分子特征分析纳入临床决策，以改善GB患者的预后。
