Carol Kruchko

Background: The Central Brain Tumor Registry of the United States (CBTRUS) uses a histology grouping model based on the World Health Organization (WHO) to classify cancer registry records for clinically relevant statistical reporting. Methods: CBTRUS, together with its consulting neuropathologists, reviewed and aligned its histology groupings with the 2021 WHO Classification update. Obsolete histology nomenclature along with their International Classification of Diseases for Oncology 3 ^rd edition (ICD-O-3) codes were identified, currently included histologies were reclassified as appropriate, and new codes found in 2021 WHO were incorporated. An evaluation was conducted of the frequency of histology codes affected in the reclassification process, as well as incidence and survival pre- and post-reclassification of CBTRUS Tumor Type Groupings. Results: After review of the CBTRUS grouping scheme, 205 codes were reclassified and 2 new codes were incorporated. Tumor type groups most affected were those classified as glioma. Reclassification resulted in 167,038 of 491,804 (34%) cases having a grouping reclassification or reporting change, indicating that the 2021 revision of the WHO Classification has significantly impacted the collection and reporting of primary b CNS tumors. Conclusion: This work demonstrates the need to be responsive to changes in classification and coding for statistics to reflect real-world clinical use. This will require collaboration from all parties to have the ability to reconcile clinical practices and surveillance requirements. KEY POINTS: Classification changes in cancer registration pose challenges to reporting clinically-relevant population-based epidemiologic statistics for central nervous system (CNS) tumors. The Central Brain Tumor Registry of the United States provides an example of aligning ICD-O-3 and 2021 WHO CNS classification with cancer registry reporting. Implementation of ICD-O-4 and the latest WHO (CNS6) will undoubtedly be challenging to cancer registry reporting yet will ultimately improve our understanding of these tumors and their impact on a population. IMPORTANCE OF THE STUDY: We performed this study to report on the Central Brain Tumor Registry of the United States (CBTRUS) tumor classification scheme which was revised to make it consistent with the 2021 WHO classification (CNS5) revision and to provide a roadmap for implementation of the recently published ICD-O 4 ^th edition. While we have previously published descriptive epidemiology for selected entities based on the CNS5 classifications, this is the first CBTRUS grouping scheme to include molecular information coded in the Brain Molecular Marker Site-Specific Data Item. LAY SUMMARY: Central nervous system (CNS) tumor classification systems help doctors, researchers, and cancer registries identify and track specific types of CNS tumors. When the World Health Organization (WHO) updated its CNS tumor classification in 2021, the Central Brain Tumor Registry of the United States (CBTRUS) reviewed and updated its reporting system to match these changes. More than 200 tumor codes were reclassified, affecting nearly one-third of CNS tumor records, and most heavily impacted gliomas. These updates improve the accuracy and clinical relevance of national CNS tumor statistics. Ongoing collaboration among treating physicians, pathologists, cancer registries, and researchers will be essential as future classification updates are implemented.

Background: Molecular profiling has become an integral part of glioma classification. The extent to which the incidence of molecularly defined adult-type gliomas varies by demographics is unknown. We describe national-level incidence and overall survival patterns of selected glioma subtypes by race/ethnicity. Methods: We generated standardized average annual age-adjusted incidence rates of molecularly defined glioma subtypes by race/ethnicity from the Central Brain Tumor Registry of the United States (CBTRUS) using newly diagnosed cases from January 1, 2018, to December 31, 2022. Survival data from the National Cancer Database (NCDB) were used from newly diagnosed cases from January 1, 2018, to December 31, 2021 (with follow-up through December 31, 2022) to evaluate 4-year overall survival, median survival, and multivariable Cox proportional hazards ratios. Results: CBTRUS identified 68 172 glioma cases; IDH-wild-type glioblastoma was most common (n = 51 548). Non-Hispanic White individuals had a significantly higher incidence of all gliomas compared to other groups (P > .001). Non-Hispanic Black individuals had the lowest incidence for IDH-mutant astrocytoma and oligodendroglioma, and shared lowest incidence of IDH-mutant glioblastoma and IDH-wild-type astrocytoma with non-Hispanic other individuals, who had the lowest incidence of IDH-wild-type glioblastoma (P < .001). The odds of having an IDH-mutant (versus IDH-wildtype) astrocytoma or glioblastoma were significantly lower for males, those of older age, and non-Hispanic Black individuals (P < .001). Non-Hispanic other individuals also had increased adjusted overall survival for most glioma subtypes compared to other racial/ethnic groups (P < .001). Four-year overall survival was lowest in all racial/ethnic groups for IDH-wild-type glioblastoma (P < .001). Conclusions: Our findings reveal significant disparities in incidence and survival by race/ethnicity with notable variations present based on glioma biomarkers.

Background: The Central Brain Tumor Registry of the United States (CBTRUS), in collaboration with the Centers for Disease Control and Prevention (CDC) and National Cancer Institute (NCI), is the largest aggregation of histopathology-specific population-based data for primary brain and other central nervous system tumors (BTs) in the United States. Summarized are the key findings from the 2025 CBTRUS annual statistical report and additional clinically relevant statistics for neuro-oncology healthcare providers. Methods: CBTRUS incidence data are an aggregation of 48 central cancer registries (CCRs) from the CDC’s National Program of Cancer Registries (NPCR) and four CCRs from the NCI’s Surveillance, Epidemiology, and End Results Program covering the entire US population. Puerto Rico was excluded. Survival data were obtained from 43 NPCR CCRs. Mortality data were obtained from the National Vital Statistics System. All incidence and mortality rates were age-adjusted using the 2000 US standard population. Relative survival was estimated using the life table method. Overall survival was estimated using Kaplan–Meier models. Results: The average annual age-adjusted incidence rate (AAAIR) of all BTs was 26.05 per 100,000 population. Incidence was higher among females and non-Hispanic Black individuals. The most common malignant tumors were gliomas. The most common non-malignant tumors were low-grade meningiomas. Mortality rates and median survival varied by age, sex, and tumor type. Conclusions: This summary describes the most up-to-date population-based incidence, mortality, and survival of primary BT types in the United States with an age-focused analysis and aims to serve as a concise resource for neuro-oncology healthcare providers.

Meningioma risk factors include older age, female sex, and African-American race. Limited data explore how meningioma risk in African-Americans varies across the lifespan, interacts with sex, and differs by tumor grade. The Central Brain Tumor Registry of the United States (CBTRUS) is a population-based registry covering the entire U.S. population. Meningioma diagnoses from 2004-2019 were used to calculate incidence rate ratios (IRRs) for non-Hispanic Black individuals (NHB) compared to non-Hispanic white individuals (NHW) across 10-year age intervals, and stratified by sex and by WHO tumor grade in this retrospective study. 53,890 NHB individuals and 322,373 NHW individuals with an intracranial meningioma diagnosis were included in analyses. Beginning in young adulthood, the NHB-to-NHW IRR was elevated for both grade 1 and grade 2/3 tumors. The IRR peaked in the seventh decade of life regardless of grade, and was higher for grade 2/3 tumors (IRR = 1.57; 95% CI: 1.46-1.69) than grade 1 tumors (IRR = 1.27; 95% CI: 1.25-1.30) in this age group. The NHB-to-NHW IRR was elevated in females (IRR = 1.17; 95% CI: 1.16-1.18) and was further elevated in males (IRR = 1.28; 95% CI: 1.26-1.30), revealing synergistic interaction between NHB race/ethnicity and male sex (P_Interaction=0.001). Relative to NHW individuals, NHB individuals are at elevated risk of meningioma from young adulthood through old age. NHB race/ethnicity conferred greater risk of meningioma among men than women, and greater risk of grade 2/3 tumors. Population-level differences in meningioma incidence and tumor behavior suggest potential disparities in the geographic, socioeconomic, and racial distribution of meningioma risk factors within the U.S.

The coronavirus disease 2019 (COVID-19) pandemic and subsequent public shutdowns led to significant disruptions to medical care in 2020, with 94% of neuro-oncology practitioners reporting changes to clinical practice.^1,2 Prior studies have shown that there was significant care disruption (including delays and cancelations) for cases diagnosed with cancer.³ Unlike many other cancer types, our prior work suggests that there was little disruption in the new diagnosis of glioblastoma (unpublished data). Disruptions in various aspects of brain tumor management due to the COVID-19 pandemic have also been previously documented by survey studies,⁴ but analysis of retrospective data has been limited. Here, we utilized a database containing >85% of new primary brain tumor diagnoses⁵ to assess the effect of the pandemic on treatment patterns for glioblastoma in the United States. IDHwt glioblastoma (ICD-O-3 code 9440 and Brain Molecular Marker site-specific data item #3816 value of 5) cases were retrieved from the National Cancer Database, a project of the Commission on Cancer, for cases 40+ years of age diagnosed from 2018 to 2020. Logistic regression was used to generate odds ratios, 95% confidence intervals, and P values of receiving resection, chemotherapy, or radiation after diagnosis for cases diagnosed in 2020 and 2018 as compared to 2019, after adjustment for potential confounders found to be significantly associated with treatment receipt, including age, sex, race/ethnicity, insurance type, average zip code household income, residential distance from facility, comorbidity score, facility type, region, and MGMT promoter methylation. Among individuals who received treatment and treatment time was known, logistic regression was used to estimate the odds of delayed time to treatment (>7 days for first surgery, >45 days for radiation, and >45 days for chemotherapy), adjusted for confounders. This cutoff was set at the 75th percentile of each time variable in the 2018–2019 period, representing a clinically significant delay in treatment. As a sensitivity analysis, we repeated analyses using only 2020 cases with a recorded COVID-19 test at an academic center (presumed to have earlier testing capability and indicative of diagnosis during the pandemic) compared to 2019.

Background: Prior literature suggests that individual socioeconomic status (SES) may influence incidence, treatments, and survival of brain tumor cases. We aim to conduct the first national study to evaluate the association between US county-level SES and incidence, treatment, and survival in meningioma. Methods: The Central Brain Tumor Registry of the United States analytic dataset, which combines data from CDC’s National Program of Cancer Registries (NPCR) and National Cancer Institute's Surveillance, Epidemiology, and End Results Program, was used to identify meningioma cases from 2006 to 2019. SES quintiles were created using American Community Survey data. Logistic regression models were used to evaluate associations between SES and meningioma. Cox proportional hazard models were constructed to assess the effect of SES on survival using the NPCR analytic dataset. Results: A total of 409 681 meningioma cases were identified. Meningioma incidence increased with higher county-level SES with Q5 (highest quintile) having a 12% higher incidence than Q1 (incidence rate ratios (IRR) = 1.12, 95%CI: 1.10–1.14; P < .0001). The Hispanic group was the only racial–ethnic group that had lower SES associated with increased meningioma incidence (Q5: age-adjusted incidence ratio (AAIR) = 9.02, 95%CI: 8.87–9.17 vs. Q1: AAIR = 9.33, 95%CI: 9.08–9.59; IRR = 0.97, 95%CI: 0.94–1.00; P = .0409). Increased likelihood of surgical treatment was associated with Asian or Pacific Islander non-Hispanic individuals (compared to White non-Hispanic (WNH)) (OR = 1.28, 95%CI: 1.23–1.33, P < .001) and males (OR = 1.31, 95%CI: 1.29–1.33, P < .001). Black non-Hispanic individuals (OR = 0.90, 95%CI: 0.88–0.92, P < .001) and those residing in metropolitan areas (OR = 0.96, 95%CI: 0.96–0.96, P < .001) were less likely to receive surgical treatment compared to WNH individuals. Overall median survival was 137 months, and survival was higher in higher SES counties (Q5 median survival = 142 months). Conclusions: Higher county-level SES was associated with increased meningioma incidence, surgical treatment, and overall survival. Racial–ethnic stratification identified potential disparities within the meningioma population. Further work is needed to understand the underpinnings of socioeconomic and racial disparities for meningioma patients.

Background: The Central Brain Tumor Registry of the United States (CBTRUS), in collaboration with the Centers for Disease Control and Prevention (CDC) and National Cancer Institute (NCI), is the largest aggregation of histopathology-specific population-based data for primary brain and other central nervous system (CNS) in the US. CBTRUS publishes an annual statistical report which provides critical reference data for the broad neuro-oncology community. Here, we summarize the key findings from the 2022 CBTRUS annual statistical report for healthcare providers. Methods: Incidence data were obtained from the CDC’s National Program of Cancer Registries (NPCR) and NCI’s Surveillance, Epidemiology, and End Results Program for 52 central cancer registries (CCRs). Survival data were obtained from 42 NPCR CCRs. All rates are per 100 000 and age-adjusted using the 2000 US standard population. Overall median survival was estimated using Kaplan–Meier models. Survival data for selected molecularly defined histopathologies are from the National Cancer Database. Mortality data are from the National Vital Statistics System. Results: The average annual age-adjusted incidence rate of all primary brain and other CNS tumors was 24.25/100 000. Incidence was higher in females and non-Hispanics. The most commonly occurring malignant and predominately non-malignant tumors was glioblastoma (14% of all primary brain tumors) and meningioma (39% of all primary brain tumors), respectively. Mortality rates and overall median survival varied by age, sex, and histopathology. Conclusions: This summary describes the most up-to-date population-based incidence, mortality, and survival, of primary brain and other CNS tumors in the US and aims to serve as a concise resource for neuro-oncology providers.

Background: Comprehensive analysis of brain tumor incidence and survival in the Veteran population has been lacking. Methods: Veteran data were obtained from the Veterans Health Administration (VHA) Medical Centers via VHA Corporate Data Warehouse. Brain tumor statistics on the overall US population were generated from the Central Brain Tumor Registry of the US data. Cases were individuals (≥18 years) with a primary brain tumor, diagnosed between 2004 and 2018. The average annual age-adjusted incidence rates (AAIR) and 95% confidence intervals were estimated per 100 000 population and Kaplan–Meier survival curves evaluated overall survival outcomes among Veterans. Results: The Veteran population was primarily white (78%), male (93%), and between 60 and 64 years old (18%). Individuals with a primary brain tumor in the general US population were mainly female (59%) and between 18 and 49 years old (28%). The overall AAIR of primary brain tumors from 2004 to 2018 within the Veterans Affairs cancer registry was 11.6. Nonmalignant tumors were more common than malignant tumors (AAIR:7.19 vs 4.42). The most diagnosed tumors in Veterans were nonmalignant pituitary tumors (AAIR:2.96), nonmalignant meningioma (AAIR:2.62), and glioblastoma (AAIR:1.96). In the Veteran population, survival outcomes became worse with age and were lowest among individuals diagnosed with glioblastoma. Conclusions: Differences between Veteran and US populations can be broadly attributed to demographic composition differences of these groups. Prior to this, there have been no reports on national-level incidence rates and survival outcomes for Veterans. These data provide vital information that can drive efforts to understand disease burden and improve outcomes for individuals with primary brain tumors.

Background: Previous research has identified older age, African-American race, and female sex as meningioma risk factors, but there is limited information on their joint effects, or on how these demographic factors vary across strata of tumor grade. Methods: The Central Brain Tumor Registry of the United States (CBTRUS) is a population-based registry combining data from the CDC’s National Program of Cancer Registries and NCI’s Surveillance, Epidemiology and End Results Program which covers ~100% of the U.S. population and aggregates incidence data on all primary malignant and nonmalignant brain tumors. These data were used to explore the joint impacts of sex and race/ethnicity on average annual age-adjusted incidence rates of meningioma. We calculated meningioma incidence rate ratios (IRRs) by sex and race/ethnicity, across strata of age and tumor grade. Results: Compared to individuals who are non-Hispanic White, individuals who are non-Hispanic Black had significantly higher risk of grade 1 (IRR = 1.23; 95% CI: 1.21–1.24) and grade 2–3 meningioma (IRR = 1.42; 95% CI: 1.37–1.47). The female-to-male IRR peaked in the fifth decade of life across all racial/ethnic groups and tumor grades, but was 3.59 (95% CI: 3.51–3.67) for WHO grade 1 meningioma and 1.74 (95% CI: 1.63–1.87) for WHO grade 2–3 meningioma. Conclusions: This study reveals the joint effects of sex and race/ethnicity on meningioma incidence throughout the lifespan and across strata of tumor grade, highlighting incidence disparities among females and African-Americans that may inform future strategies for tumor interception.