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Influence of a Child's Sex on Medulloblastoma Outcome
Michael D. Weil, MD;
Kathleen Lamborn, PhD;
Michael S. B. Edwards, MD;
William M. Wara, MD
JAMA. 1998;279:1474-1476.
Context.— Aggressive treatment of medulloblastoma, the most common pediatric brain tumor, has not improved survival. Identifying better prognostic indicators may warrant less morbid therapy.
Objective.— To investigate the role of sex on outcome of medulloblastoma.
Design.— Retrospective study of significant factors for survival with a median follow-up of 82 months.
Setting.— University medical center.
Patients.— A total of 109 consecutive, pediatric patients treated for primary medulloblastoma from 1970 to 1995 with surgery and postoperative radiotherapy and, after 1979, chemotherapy.
Main Outcome Measures.— Factors independently associated with survival.
Results.— The final multivariate model predicting improved survival included sex (hazard ratio, 0.52; 95% confidence interval [CI], 0.29-0.92; P=.03; favoring female), metastases at presentation (hazard ratio, 2.01; 95% CI, 1.14-3.52; P=.02), and extent of surgical resection (hazard ratio, 0.60; 95% CI, 0.34-1.04; P=.07; favoring greater resection). The overall, 5-year freedom from progression was 40% and survival was 49%. Radiotherapy dose (P=.72), and chemotherapy (P=.90) did not significantly affect a disease outcome.
Conclusions.— The sex of the child was an important predictor for survival of medulloblastoma; girls had a much better outcome. The difference in survival between sexes should be evaluated in prospective, clinical trials.
From the Departments of Radiation Oncology (Drs Weil and Wara) and Neurologic Surgery (Drs Lamborn and Edwards), University of California, San Francisco.
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