Enrico Franceschi1, Alicia Tosoni1, Santino Minichillo1, Roberta Depenni2, Alexandro Paccapelo1, Stefania Bartolini1, Maria Michiara3, Giacomo Pavesi4, Benedetta Urbini5, Girolamo Crisi6, Michele A Cavallo7, Luigino Tosatto8, Claudio Dazzi9, Claudia Biasini10, Giuseppe Pasini11, Damiano Balestrini12, Francesca Zanelli13, Vania Ramponi14, Antonio Fioravanti14, Ermanno Giombelli15, Dario De Biase16, Agostino Baruzzi17, Alba A Brandes18. 1. Department of Medical Oncology, Bellaria Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy. 2. Department of Oncology, Hematology, and Respiratory Diseases, University Hospital of Modena, Modena, Italy. 3. Department of Medical Oncology, University Hospital of Parma, Parma, Italy. 4. Department of Neurosurgery, Agostino-Estense Hospital, Modena, Italy; Department of Oncology and Hematology, Romagnolo Scientific Institute for the Study and Treatment of Tumors-IRCCS, Cesena, Italy. 5. Clinical Oncology Unit, St. Anna University Hospital, Ferrara, Italy. 6. Department of Neuroradiology, University Hospital of Parma, Parma, Italy. 7. Department of Neurosurgery, St. Anna University Hospital, Ferrara, Italy. 8. Department of Neurosurgery, M. Bufalini Hospital, Cesena, Italy. 9. Department of Oncology and Hematology, General Hospital, Ravenna, Italy. 10. Department of Oncology and Hematology, Oncology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy. 11. Department of Medical Oncology, Infermi Hospital, Rimini, Italy. 12. Department of Radiotherapy, Bellaria Hospital, Bologna, Italy. 13. Department of Oncology, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy. 14. Department of Neurosurgery, Bellaria Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy. 15. Department of Special Surgeries, Unit of Neurosurgery, University Hospital of Parma, Parma, Italy. 16. Molecular Diagnostic Unit, Department of Pharmacy and Biotechnology, USL Company of Bologna, University of Bologna, Bologna, Italy. 17. IRCCS Institute of Neurological Sciences, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy. 18. Department of Medical Oncology, Bellaria Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy. Electronic address: alba.brandes@yahoo.it.
Abstract
BACKGROUND: Clinical and molecular factors are essential to define the prognosis in patients with glioblastoma (GBM). O6-methylguanine-DNA methyltransferase (MGMT) methylation status, age, Karnofsky Performance Status (KPS), and extent of surgical resection are the most relevant prognostic factors. Our investigation of the role of gender in predicting prognosis shows a slight survival advantage for female patients. METHODS: We performed a prospective evaluation of the Project of Emilia Romagna on Neuro-Oncology (PERNO) registry to identify prognostic factors in patients with GBM who received standard treatment. RESULTS: A total of 169 patients (99 males [58.6%] and 70 females [41.4%]) were evaluated prospectively. MGMT methylation was evaluable in 140 patients. Among the male patients, 36 were MGMT methylated (25.7%) and 47 were unmethylated (33.6%); among the female patients, 32 were methylated (22.9%) and 25 were unmethylated (17.9%). Survival was longer in the methylated females compared with the methylated males (P = 0.028) but was not significantly different between the unmethylated females and the unmethylated males (P = 0.395). In multivariate analysis, gender and MGMT methylation status considered together (methylated females vs. methylated males; hazard ratio [HR], 0.459; 95% confidence interval [CI], 0.242-0.827; P = 0.017), age (HR, 1.025; 95% CI, 1.002-1.049; P = 0.032), and KPS (HR, 0.965; 95% CI, 0.948-0.982; P < 0.001) were significantly correlated with survival. CONCLUSIONS: Survival was consistently longer among MGMT methylated females compared with males. Gender can be considered as a further prognostic factor.
BACKGROUND: Clinical and molecular factors are essential to define the prognosis in patients with glioblastoma (GBM). O6-methylguanine-DNA methyltransferase (MGMT) methylation status, age, Karnofsky Performance Status (KPS), and extent of surgical resection are the most relevant prognostic factors. Our investigation of the role of gender in predicting prognosis shows a slight survival advantage for female patients. METHODS: We performed a prospective evaluation of the Project of Emilia Romagna on Neuro-Oncology (PERNO) registry to identify prognostic factors in patients with GBM who received standard treatment. RESULTS: A total of 169 patients (99 males [58.6%] and 70 females [41.4%]) were evaluated prospectively. MGMT methylation was evaluable in 140 patients. Among the male patients, 36 were MGMT methylated (25.7%) and 47 were unmethylated (33.6%); among the female patients, 32 were methylated (22.9%) and 25 were unmethylated (17.9%). Survival was longer in the methylated females compared with the methylated males (P = 0.028) but was not significantly different between the unmethylated females and the unmethylated males (P = 0.395). In multivariate analysis, gender and MGMT methylation status considered together (methylated females vs. methylated males; hazard ratio [HR], 0.459; 95% confidence interval [CI], 0.242-0.827; P = 0.017), age (HR, 1.025; 95% CI, 1.002-1.049; P = 0.032), and KPS (HR, 0.965; 95% CI, 0.948-0.982; P < 0.001) were significantly correlated with survival. CONCLUSIONS: Survival was consistently longer among MGMT methylated females compared with males. Gender can be considered as a further prognostic factor.
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