PT  - JOURNAL ARTICLE
AU  - Paula Whitmire
AU  - Cassandra R. Rickertsen
AU  - Andrea Hawkins-Daarud
AU  - Eduardo Carrasco, Jr
AU  - Julia Lorence
AU  - Gustavo De Leon
AU  - Lee Curtin
AU  - Spencer Bayless
AU  - Kamala Clark-Swanson
AU  - Noah C. Peeri
AU  - Christina Corpuz
AU  - Christine Paula Lewis-de los Angeles
AU  - Bernard R. Bendok
AU  - Luis Gonzalez-Cuyar
AU  - Sujay Vora
AU  - Maciej Mrugala
AU  - Leland S. Hu
AU  - Lei Wang
AU  - Alyx Porter
AU  - Priya Kumthekar
AU  - Sandra K. Johnston
AU  - Kathleen M. Egan
AU  - Robert Gatenby
AU  - Peter Canoll
AU  - Joshua B. Rubin
AU  - Kristin R. Swanson
TI  - Sex-specific impact of patterns of imageable tumor growth on survival of primary glioblastoma patients
AID  - 10.1101/325464
DP  - 2018 Jan 01
TA  - bioRxiv
PG  - 325464
4099  - http://biorxiv.org/content/early/2018/09/25/325464.short
4100  - http://biorxiv.org/content/early/2018/09/25/325464.full
AB  - Background Sex is recognized as a significant determinant of outcome among glioblastoma patients, but the relative prognostic importance of glioblastoma features has not been thoroughly explored for sex differences.Methods Combining multi-modal MR images, biomathematical models, and patient clinical information, this investigation assesses which pretreatment variables have a sex-specific impact on the survival of glioblastoma patients. Pretreatment MR images of 494 glioblastoma patients (299 males and 195 females) were segmented to quantify tumor volumes. Cox proportional hazard (CPH) models and Student’s t-tests were used to assess which variables were associated with survival outcomes.Results Among males, tumor (T1Gd) radius was a predictor of overall survival (HR=1.027, p=0.044). Among females, higher tumor cell net invasion rate was a significant detriment to overall survival (HR=1.011, p<0.001). Female extreme survivors had significantly smaller tumors (T1Gd) (p=0.010 t-test), but tumor size was not correlated with female overall survival (p=0.955 CPH). Both male and female extreme survivors had significantly lower tumor cell net proliferation rates than other patients (M p=0.004, F p=0.001, t-test). Additionally, extent of resection, tumor laterality, and IDH1 mutation status were also found to have sex-specific effects on overall survival.Conclusion Despite similar distributions of the MR imaging parameters between males and females, there was a sex-specific difference in how these parameters related to outcomes, which emphasizes the importance of considering sex as a biological factor when determining patient prognosis and treatment approach.