The prognostic role of gender and MGMT methylation status in glioblastoma patients: The female power

Background: Glioblastoma (GBM) remains an incurable disease. Radiotherapy and temozolomide are the backbone of the treatment. Clinical and molecular factors are essential to define prognosis. Methods: Data on all new cases of primary brain tumors observed from January 1, 2009, to December 31, 2010, in adults residing within the Emilia-Romagna region were recorded in a prospective registry in the Project of Emilia Romagna on Neuro-Oncology (PERNO). We perform a prospective evaluation about prognostic factors in GBM patients treated with temozolomide concurrent with and adjuvant to radiotherapy. Results: One hundred sixty-nine GBM patients (median age, 60 years; range 29 – 82) were prospectively evaluated. MGMT methylation status was available in 140 patients. Combining gender and MGMT methylation status we obtained four groups of patients: 36 male pts with methylated MGMT (25.7%), 47 male pts with unmethylated MGMT (33.6%), 32 female pts with methylated MGMT (22.9%), 25 female pts with unmethylated MGMT (17.9%). Results of univariate analysis are summarized in the Table. Overall survival (OS) was significantly different between methylated male and methylated female (p = 0.028), methylated male and unmethylated female (p = 0.031), unmethylated male and methylated female (p = 0.002), methylated female and unmethylated female (p < 0.001). In multivariate analysis, gender and MGMT methylation considered together (met female vs met male HR = 0.459; 95% CI 0.242 – 0.827; p = 0.017), age (HR 1.025; 95% CI 1.002 – 1.049; p = 0.032) and Karnofsky Performance Status (KPS) (HR 0.965; 95% CI 0.948 – 0.982; p < 0.001) were significantly correlated with OS