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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 (299 males and 195 females).    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).    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.

Sex-specific impact of patterns of imageable tumor growth on survival of primary glioblastoma patients