Sex‐related Survival Differences in Patients With Glioblastoma – Results From a Retrospective Analysis

Jan Leppert; Claudia Ditz; Jakob Matschke; Harald Krenzlin; Naureen Keric; Christian Ziemann; Lorenz Hahn; Maria Vittoria Matone; Larysa Liubich; Karolin Streubel; Hannes Schacht; Christina Hillbricht; Patrick Kuppler; Dirk Rades; Anastassia Löser

doi:10.21873/anticanres.17580

Sex‐related Survival Differences in Patients With Glioblastoma – Results From a Retrospective Analysis

Jan Leppert^*, Claudia Ditz, Jakob Matschke, Harald Krenzlin, Naureen Keric, Christian Ziemann, Lorenz Hahn, Maria Vittoria Matone, Larysa Liubich, Karolin Streubel, Hannes Schacht, Christina Hillbricht, Patrick Kuppler, Dirk Rades, Anastassia Löser

^*Corresponding author for this work

Abstract

Background/Aim: Glioblastoma is more common in men than in women. The aim of this analysis was to investigate sex‑ specific differences with a particular focus on their impact on survival including overall survival (OS) and progression‑free survival (PFS). Patients and Methods: This retrospective study analyzed 209 GBM patients (91 females, 118 males) treated according to the Stupp regimen. Data on patient demographics, O6‑methylguanine‑DNA methyltransferase (MGMT) methylation status, treatment details [radiotherapy (RT) doses and temozolomide (TMZ) cycles], and survival endpoints were statistically analyzed using univariable Kaplan‑Meier [and 95% confidence intervals (CI)] and multivariable Cox regression hazards models. Results: In the whole cohort, median follow‑up was 14 (2‑119) months. We observed a trend towards a higher prevalence of multifocal tumors in males (30.5% vs. 22%, p=0.092). In univariable analysis, MGMT‑negative male patients who received >58 Gy RT had a significantly longer OS (14 vs. 5 months, log‑rank p<0.001). In multivariable analysis, OS was not significantly influenced by patient age (p=0.579), total RT dose (Gy) (p=0.348), and MGMT status (p=0.262). Female patients (HR=3.252, p=0.028) and patients with higher tumor volume (HR=1.031, p=0.005) had a significantly higher mortality risk. Better Karnofsky‑performance‑status (HR=0.918, p=0.008), complete resection (HR=6.759, p=0.022), and higher numbers of adjuvant TMZ cycles (HR=0.739, p=0.003) led to prolonged OS. Conclusion: Sex seems to impact survival in patients suffering from glioblastoma, although underlying mechanisms are not yet completely understood. Treatment intensity (complete resection and the maximum possible number of TMZ cycles) had a significant effect on the patients’ mortality risk.

Original language	English
Journal	Anticancer Research
Volume	45
Issue number	5
Pages (from-to)	2059-2069
Number of pages	11
ISSN	0250-7005
DOIs	https://doi.org/10.21873/anticanres.17580
Publication status	Published - 05.2025

Research Areas and Centers

Research Area: Luebeck Integrated Oncology Network (LION)
Centers: University Cancer Center Schleswig-Holstein (UCCSH)

DFG Research Classification Scheme

2.23-07 Clinical Neurology, Neurosurgery and Neuroradiology
2.22-02 Public Health, Healthcare Research, Social and Occupational Medicine
2.22-14 Hematology, Oncology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.21873/anticanres.17580

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Leppert, J., Ditz, C., Matschke, J., Krenzlin, H., Keric, N., Ziemann, C., Hahn, L., Matone, M. V., Liubich, L., Streubel, K., Schacht, H., Hillbricht, C., Kuppler, P., Rades, D., & Löser, A. (2025). Sex‐related Survival Differences in Patients With Glioblastoma – Results From a Retrospective Analysis. Anticancer Research, 45(5), 2059-2069. https://doi.org/10.21873/anticanres.17580

@article{ca3ba355e16f4fc083ada4ec6ffb5f99,

title = "Sex‐related Survival Differences in Patients With Glioblastoma – Results From a Retrospective Analysis",

abstract = "Background/Aim: Glioblastoma is more common in men than in women. The aim of this analysis was to investigate sex‑ specific differences with a particular focus on their impact on survival including overall survival (OS) and progression‑free survival (PFS). Patients and Methods: This retrospective study analyzed 209 GBM patients (91 females, 118 males) treated according to the Stupp regimen. Data on patient demographics, O6‑methylguanine‑DNA methyltransferase (MGMT) methylation status, treatment details [radiotherapy (RT) doses and temozolomide (TMZ) cycles], and survival endpoints were statistically analyzed using univariable Kaplan‑Meier [and 95% confidence intervals (CI)] and multivariable Cox regression hazards models. Results: In the whole cohort, median follow‑up was 14 (2‑119) months. We observed a trend towards a higher prevalence of multifocal tumors in males (30.5% vs. 22%, p=0.092). In univariable analysis, MGMT‑negative male patients who received >58 Gy RT had a significantly longer OS (14 vs. 5 months, log‑rank p<0.001). In multivariable analysis, OS was not significantly influenced by patient age (p=0.579), total RT dose (Gy) (p=0.348), and MGMT status (p=0.262). Female patients (HR=3.252, p=0.028) and patients with higher tumor volume (HR=1.031, p=0.005) had a significantly higher mortality risk. Better Karnofsky‑performance‑status (HR=0.918, p=0.008), complete resection (HR=6.759, p=0.022), and higher numbers of adjuvant TMZ cycles (HR=0.739, p=0.003) led to prolonged OS. Conclusion: Sex seems to impact survival in patients suffering from glioblastoma, although underlying mechanisms are not yet completely understood. Treatment intensity (complete resection and the maximum possible number of TMZ cycles) had a significant effect on the patients{\textquoteright} mortality risk.",

author = "Jan Leppert and Claudia Ditz and Jakob Matschke and Harald Krenzlin and Naureen Keric and Christian Ziemann and Lorenz Hahn and Matone, {Maria Vittoria} and Larysa Liubich and Karolin Streubel and Hannes Schacht and Christina Hillbricht and Patrick Kuppler and Dirk Rades and Anastassia L{\"o}ser",

year = "2025",

month = may,

doi = "10.21873/anticanres.17580",

language = "English",

volume = "45",

pages = "2059--2069",

journal = "Anticancer Research",

issn = "0250-7005",

number = "5",

}

Leppert, J , Ditz, C, Matschke, J, Krenzlin, H , Keric, N , Ziemann, C, Hahn, L, Matone, MV, Liubich, L, Streubel, K, Schacht, H , Hillbricht, C , Kuppler, P , Rades, D & Löser, A 2025, 'Sex‐related Survival Differences in Patients With Glioblastoma – Results From a Retrospective Analysis', Anticancer Research, vol. 45, no. 5, pp. 2059-2069. https://doi.org/10.21873/anticanres.17580

TY - JOUR

T1 - Sex‐related Survival Differences in Patients With Glioblastoma – Results From a Retrospective Analysis

AU - Leppert, Jan

AU - Ditz, Claudia

AU - Matschke, Jakob

AU - Krenzlin, Harald

AU - Keric, Naureen

AU - Ziemann, Christian

AU - Hahn, Lorenz

AU - Matone, Maria Vittoria

AU - Liubich, Larysa

AU - Streubel, Karolin

AU - Schacht, Hannes

AU - Hillbricht, Christina

AU - Kuppler, Patrick

AU - Rades, Dirk

AU - Löser, Anastassia

PY - 2025/5

Y1 - 2025/5

N2 - Background/Aim: Glioblastoma is more common in men than in women. The aim of this analysis was to investigate sex‑ specific differences with a particular focus on their impact on survival including overall survival (OS) and progression‑free survival (PFS). Patients and Methods: This retrospective study analyzed 209 GBM patients (91 females, 118 males) treated according to the Stupp regimen. Data on patient demographics, O6‑methylguanine‑DNA methyltransferase (MGMT) methylation status, treatment details [radiotherapy (RT) doses and temozolomide (TMZ) cycles], and survival endpoints were statistically analyzed using univariable Kaplan‑Meier [and 95% confidence intervals (CI)] and multivariable Cox regression hazards models. Results: In the whole cohort, median follow‑up was 14 (2‑119) months. We observed a trend towards a higher prevalence of multifocal tumors in males (30.5% vs. 22%, p=0.092). In univariable analysis, MGMT‑negative male patients who received >58 Gy RT had a significantly longer OS (14 vs. 5 months, log‑rank p<0.001). In multivariable analysis, OS was not significantly influenced by patient age (p=0.579), total RT dose (Gy) (p=0.348), and MGMT status (p=0.262). Female patients (HR=3.252, p=0.028) and patients with higher tumor volume (HR=1.031, p=0.005) had a significantly higher mortality risk. Better Karnofsky‑performance‑status (HR=0.918, p=0.008), complete resection (HR=6.759, p=0.022), and higher numbers of adjuvant TMZ cycles (HR=0.739, p=0.003) led to prolonged OS. Conclusion: Sex seems to impact survival in patients suffering from glioblastoma, although underlying mechanisms are not yet completely understood. Treatment intensity (complete resection and the maximum possible number of TMZ cycles) had a significant effect on the patients’ mortality risk.

AB - Background/Aim: Glioblastoma is more common in men than in women. The aim of this analysis was to investigate sex‑ specific differences with a particular focus on their impact on survival including overall survival (OS) and progression‑free survival (PFS). Patients and Methods: This retrospective study analyzed 209 GBM patients (91 females, 118 males) treated according to the Stupp regimen. Data on patient demographics, O6‑methylguanine‑DNA methyltransferase (MGMT) methylation status, treatment details [radiotherapy (RT) doses and temozolomide (TMZ) cycles], and survival endpoints were statistically analyzed using univariable Kaplan‑Meier [and 95% confidence intervals (CI)] and multivariable Cox regression hazards models. Results: In the whole cohort, median follow‑up was 14 (2‑119) months. We observed a trend towards a higher prevalence of multifocal tumors in males (30.5% vs. 22%, p=0.092). In univariable analysis, MGMT‑negative male patients who received >58 Gy RT had a significantly longer OS (14 vs. 5 months, log‑rank p<0.001). In multivariable analysis, OS was not significantly influenced by patient age (p=0.579), total RT dose (Gy) (p=0.348), and MGMT status (p=0.262). Female patients (HR=3.252, p=0.028) and patients with higher tumor volume (HR=1.031, p=0.005) had a significantly higher mortality risk. Better Karnofsky‑performance‑status (HR=0.918, p=0.008), complete resection (HR=6.759, p=0.022), and higher numbers of adjuvant TMZ cycles (HR=0.739, p=0.003) led to prolonged OS. Conclusion: Sex seems to impact survival in patients suffering from glioblastoma, although underlying mechanisms are not yet completely understood. Treatment intensity (complete resection and the maximum possible number of TMZ cycles) had a significant effect on the patients’ mortality risk.

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DO - 10.21873/anticanres.17580

M3 - Journal articles

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SN - 0250-7005

VL - 45

SP - 2059

EP - 2069

JO - Anticancer Research

JF - Anticancer Research

IS - 5

ER -

Sex‐related Survival Differences in Patients With Glioblastoma – Results From a Retrospective Analysis

Abstract

Research Areas and Centers

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UN SDGs

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