Changing incidence and improved survival of gliomas.

BACKGROUND Tumours of the central nervous system (CNS) represent a relatively rare but serious health burden. This study provides insight into the incidence and survival patterns of gliomas in the Netherlands diagnosed in adult patients during the time period 1989-2010, with a focus on glioblastoma and low-grade gliomas. METHODS Data on 21,085 gliomas (excluding grade I tumours) were obtained from the Netherlands Cancer Registry, including tumours of the CNS without pathological confirmation. We calculated the age-standardised incidence rates and the estimated annual percentage change (EAPC) for all glioma subtypes. Crude and relative survival rates were estimated using information on the vital status obtained from the Dutch Municipal Personal Records Database. RESULTS Incidence of gliomas in adults increased over time, from 4.9 per 100,000 in 1989 to 5.9 in 2010 (EAPC 0.7%, p<0.001). Two thirds were astrocytoma, 10% oligodendroglioma/oligoastrocytoma, 3% ependymoma and 21% were unspecified. Within the group of astrocytic tumours, the proportion of glioblastoma rose, while the proportion of anaplastic and unspecified astrocytoma decreased. Unspecified neoplasms also decreased, but this was significant only after 2005. Over the course of the study period, glioblastoma patients more often received multimodality treatment with chemotherapy concomitant and adjuvant to radiotherapy. The crude two-year survival rate of glioblastoma patients improved significantly, from 5% in the time period 1989-1994 to 15% in 2006-2010, with median survival increasing from 5.5 to 9 months. The incidence of low-grade gliomas did not change over time. Survival rates for low-grade oligodendroglial and mixed tumours show a modest improvement. CONCLUSIONS The incidence rate for the total group of gliomas slightly increased, with a decrease of anaplastic and unspecified tumours and an increase of glioblastoma. Following the introduction of combined chemoradiation, two-year survival rates for glioblastoma significantly improved. Survival improved for low-grade gliomas except for low-grade astrocytic tumours.

[1]  Caterina Giannini,et al.  Outcome in adult low-grade glioma , 2007, Neurology.

[2]  A. Polednak,et al.  Brain, other central nervous system, and eye cancer , 1995, Cancer.

[3]  J Berkel,et al.  General practitioners and completeness of cancer registry. , 1990, Journal of epidemiology and community health.

[4]  M. Primeau,et al.  Management of diffuse low-grade cerebral gliomas. , 2010, Neurologic clinics.

[5]  Thomas D. Wu,et al.  Molecular subclasses of high-grade glioma predict prognosis, delineate a pattern of disease progression, and resemble stages in neurogenesis. , 2006, Cancer cell.

[6]  I. Whittle,et al.  The dilemma of low grade glioma , 2004, Journal of Neurology, Neurosurgery & Psychiatry.

[7]  Damien C Weber,et al.  Epidemiology of glial and non-glial brain tumours in Europe. , 2012, European journal of cancer.

[8]  B. McCarthy,et al.  Temporal trends in incidence of primary brain tumors in the United States, 1985-1999. , 2006, Neuro-oncology.

[9]  D. Louis.  WHO classification of tumours of the central nervous system , 2007 .

[10]  E F Heineman,et al.  Cancer surveillance series [corrected]: brain and other central nervous system cancers: recent trends in incidence and mortality. , 1999, Journal of the National Cancer Institute.

[11]  M. J. van den Bent,et al.  Current treatment of low grade gliomas , 2012, memo - Magazine of European Medical Oncology.

[12]  M. Gilbert,et al.  Diffusely infiltrative low-grade gliomas in adults. , 2006, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[13]  J. Kros.  Grading of Gliomas: The Road From Eminence to Evidence , 2011, Journal of neuropathology and experimental neurology.

[14]  P. Kleihues,et al.  Population-based studies on incidence, survival rates, and genetic alterations in astrocytic and oligodendroglial gliomas. , 2005, Journal of neuropathology and experimental neurology.

[15]  Yoshito Tsushima,et al.  Incidental findings on brain magnetic resonance imaging: systematic review and meta-analysis , 2009, BMJ : British Medical Journal.

[16]  C. Avezaat,et al.  Supratentorial low grade astrocytoma: prognostic factors, dedifferentiation, and the issue of early versus late surgery , 1998, Journal of neurology, neurosurgery, and psychiatry.

[17]  J. Gurney,et al.  Brain and other central nervous system tumors: rates, trends, and epidemiology , 2001, Current opinion in oncology.

[18]  P. Kleihues,et al.  The Definition of Primary and Secondary Glioblastoma , 2012, Clinical Cancer Research.

[19]  J. Barnholtz-Sloan,et al.  CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2007-2011. , 2012, Neuro-oncology.

[20]  Robert N. Anderson,et al.  Annual Report to the Nation on the Status of Cancer, 1975–2007, Featuring Tumors of the Brain and Other Nervous System , 2011, Journal of the National Cancer Institute.

[21]  Winand N M Dinjens,et al.  Adjuvant procarbazine, lomustine, and vincristine chemotherapy in newly diagnosed anaplastic oligodendroglioma: long-term follow-up of EORTC brain tumor group study 26951. , 2013, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[22]  M. Taphoorn,et al.  Cognitive status and quality of life in patients with suspected versus proven low-grade gliomas , 2001, Neurology.

[23]  R. Mirimanoff,et al.  Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. , 2009, The Lancet. Oncology.

[24]  Samy Suissa,et al.  Problem of immortal time bias in cohort studies: example using statins for preventing progression of diabetes , 2010, BMJ : British Medical Journal.

[25]  Martin J. van den Bent,et al.  Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. , 2005, The New England journal of medicine.

[26]  F. Langmark,et al.  Trends in Incidence of Brain and Central Nervous System Tumors in Norway, 1970–1999 , 2004, Neuroepidemiology.

[27]  Webster K. Cavenee,et al.  WHO Classification of Tumours of the Central Nervous System. 4th Ed. , 2007 .

[28]  T. Golub,et al.  Gene expression-based classification of malignant gliomas correlates better with survival than histological classification. , 2003, Cancer research.

[29]  J A Knottnerus,et al.  Completeness of cancer registration in Limburg, The Netherlands. , 1993, International journal of epidemiology.

[30]  J. Coebergh,et al.  Stable incidence of childhood and adult glioma in the Netherlands, 1989–2003 , 2006, Acta oncologica.

[31]  Geirmund Unsgård,et al.  Comparison of a strategy favoring early surgical resection vs a strategy favoring watchful waiting in low-grade gliomas. , 2012, JAMA.

[32]  L. Chin,et al.  Malignant astrocytic glioma: genetics, biology, and paths to treatment. , 2007, Genes & development.

[33]  A. Helseth.  The incidence of primary central nervous system neoplasms before and after computerized tomography availability. , 1995, Journal of neurosurgery.

[34]  Anssi Auvinen,et al.  Incidence trends of adult primary intracerebral tumors in four Nordic countries , 2004, International journal of cancer.

[35]  R Grant,et al.  Guidelines on management of low‐grade gliomas: report of an EFNS–EANO * Task Force , 2010, European journal of neurology.

[36]  J. Coebergh,et al.  A Uniform Histological Cluster Scheme for ICD-O-Coded Primary Central Nervous System Tumors , 1998, Neuroepidemiology.

[37]  A. Verma.  MGMT Gene Silencing and Benefit From Temozolomide in Glioblastoma , 2006 .

[38]  H. Heinzl,et al.  The Austrian Brain Tumour Registry: a cooperative way to establish a population-based brain tumour registry , 2009, Journal of Neuro-Oncology.

[39]  L. Recht,et al.  Suspected low‐grade glioma: Is deferring treatment safe? , 1992, Annals of neurology.

[40]  A. Neugut,et al.  Trends in incidence of primary malignant brain tumors in USA, 1981-1990. , 1995, International journal of epidemiology.

[41]  Didier Frappaz,et al.  Temozolomide versus standard 6-week radiotherapy versus hypofractionated radiotherapy in patients older than 60 years with glioblastoma: the Nordic randomised, phase 3 trial. , 2012, The Lancet. Oncology.

[42]  G. Reifenberger,et al.  Temozolomide chemotherapy alone versus radiotherapy alone for malignant astrocytoma in the elderly: the NOA-08 randomised, phase 3 trial. , 2012, The Lancet. Oncology.

[43]  G. Lyman,et al.  The increasing incidence of malignant gliomas and primary central nervous system lymphoma in the elderly , 1995, Cancer.

[44]  Li Zhang,et al.  Epidermal growth factor receptor variant III status defines clinically distinct subtypes of glioblastoma. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.