Background/Objective: Elucidation of prognostic factors is key to personalizing management approach for patients with glioblastoma (GBM). In patients who are treated with conventionally fractionated radiotherapy (cvRT), sex and other demographic variables (e.g., income level) were recently found to predict for treatment outcomes. However, it is unknown whether these factors predict for outcomes in elderly or poor performance status patients who receive hypofractionated RT (hyRT). In this study, we assess the association of clinical and non-clinical factors to outcomes in GBM patients treated with hyRT concurrent with temozolomide (TMZ). Methods: The records of 61 adult patients with newly diagnosed GBM consecutively treated at our institution with post-operative hyRT (4005 cGy in 15 daily fractions) and TMZ were retrospectively analyzed. Established clinical variables as well as key demographic variables were compared using chi-squared tests. Kaplan–Meier analyses were used to compare overall survival (OS) and progression-free survival (PFS) between clinical and demographic subgroups. Multivariate modeling was performed using Cox proportional hazards regression. Results: Female and male patients composed 44.3% and 55.7% of the study population, respectively, and did not differ significantly in their clinical or tumor characteristics. Most patients were 65 years or older (85.2%), and over half resided in middle/high-income regions (55.7%) and were privately insured (55.7%). On an univariate analysis, female sex was associated with shorter OS (median 10.0 months vs. 13.3 months in males,p= 0.0224) and PFS (median 3.00 months vs. 4.60 months in males,p= 0.0134). Female sex remained significantly associated with inferior outcomes on multivariate analysis. Income level, type of insurance and marital status were not significantly associated with treatment outcomes. Conclusion: Our study is the first to report sex differences in GBM outcomes following hyRT-TMZ. Contrary to responses following cvRT-TMZ, females appear to have inferior outcomes after hyRT-TMZ versus males. Further investigation is warranted to define the optimal treatment approach for sex subgroups in GBM.
背景/目的：阐明预后因素是胶质母细胞瘤（GBM）患者个体化管理策略的关键。在采用常规分割放疗（cvRT）治疗的患者中，近期发现性别及其他人口统计学变量（如收入水平）可预测治疗结果。然而，这些因素是否能够预测接受大分割放疗（hyRT）的老年或体能状态较差患者的预后尚不明确。本研究旨在评估接受hyRT联合替莫唑胺（TMZ）治疗的GBM患者中，临床与非临床因素与治疗结果之间的关联。 方法：回顾性分析我院连续收治的61例新诊断GBM成年患者的临床资料，所有患者术后均接受hyRT（4005 cGy/15次）联合TMZ治疗。采用卡方检验比较既定临床变量与关键人口统计学变量。通过Kaplan-Meier分析比较不同临床与人口统计学亚组间的总生存期（OS）和无进展生存期（PFS）。采用Cox比例风险回归模型进行多变量分析。 结果：研究人群中女性与男性患者分别占44.3%和55.7%，其临床及肿瘤特征无显著差异。大多数患者年龄≥65岁（85.2%），超过半数居住于中/高收入地区（55.7%）且拥有私人医疗保险（55.7%）。单变量分析显示，女性与较短的OS（中位10.0个月 vs 男性13.3个月，p=0.0224）及PFS（中位3.00个月 vs 男性4.60个月，p=0.0134）显著相关。多变量分析中女性仍与不良预后显著相关。收入水平、保险类型及婚姻状况与治疗结果无显著关联。 结论：本研究首次报道了hyRT-TMZ治疗后GBM患者预后的性别差异。与cvRT-TMZ治疗后的反应相反，女性在接受hyRT-TMZ治疗后较男性预后更差。有必要开展进一步研究以明确GBM不同性别亚组的最佳治疗方案。
肿瘤(癌症)患者之家