Abstract
BACKGROUND: The prognostic value of gender in classical BCR::ABL1 negative myeloproliferative neoplasms (MPNs) including polycythemia vera (PV), essential thrombocythemia (ET) and primary myelofibrosis (PMF) remains unclear. METHODS: We conducted a retrospective study utilizing the Surveillance, Epidemiology, and End Results (SEER) database to evaluate the prognostication of gender in MPNs patients. The Kaplan-Meier and Cox proportional hazards regression analysis were performed to calculate the survival outcomes of male and female patients with MPNs. RESULTS: Of 50,510 patients diagnosed with MPNs from 2000 - 2021, 24,583 patients (48.7%) were male and 25,927 patients (51.3%) were female. The Kaplan-Meier survival analysis revealed decreased overall survival in male against female in entire MPNs (median survival: 132.0 versus 145.0 months; P < 0.001), which was also documented in ET (median survival: 131.0 versus 168.0 months, P < 0.001) and PMF (median survival: 43.0 versus 66.0 months, P < 0.001) but opposite results in PV (median survival: 162.0 versus 137.0 months, P < 0.001). In multivariate analysis adjusted with age, year of diagnosis, race, annual income and marital status, male gender independently predicted shortened overall survival compared with female in entire MPNs (HR 1.39, 95% CI 1.35-1.43; P < 0.001). Male gender predicted decreased overall survivalacross ET and PMF (HR 1.65, 95% CI 1.57-1.73 and HR 1.48, 95% CI 1.38-1.59 respectively; all P < 0.001) but alsoin PV (HR 1.14, 95% CI 1.09-1.19, P < 0.001). Propensity score matching analysis revealed that male patients suffered worse outcomes in entire MPNs, but heterogeneous effect of male gender on survival were seen across subgroups: no prognostic impact was detected in PV, whereas -decreased overall survival were consistently observed in ET and PMF. In entire MPNs, the dynamic risk of male gender against female for overall survival increased with year of diagnosis but decreased with age of diagnosis. From early years of diagnosis to later years, the hazard ratio of male gender on survival prognosis displayed an upward trend in PV and PMF, whereas a downward trend from 2000 to 2005 followed by an upward trend in later years was documented in ET. From younger to older aging, the adverse effect of male gender on survival prognosis remained nearly stable in PV but displayed a downward trend in ET, whereas it culminated around age 70 followed by a gradual decline in PMF. CONCLUSIONS: Gender should be considered in prognosis stratification of ET and PMF, whereas the prognostic value of gender in PV remained elusive.