Despite being a relatively rare diagnosis, glioblastoma's devastating impact is amplified by its status as the most common and aggressive malignant brain tumor, accounting for nearly half of all such cases in the United States.
Key Takeaways
- The age-adjusted incidence rate of glioblastoma (GBM) in the United States from 2014-2018 was 3.19 per 100,000 person-years among adults aged 20 and older.
- GBM accounts for 48.6% of all malignant primary brain tumors in the US, with 13,806 new cases reported in 2017.
- The incidence of GBM increases exponentially with age, peaking at 15.81 per 100,000 in individuals aged 75-84 years.
- Prevalence of GBM in the US population aged 55-64 is 12.4 per 100,000.
- Approximately 142,000 people worldwide live with GBM as of 2020 estimates.
- In the US, GBM prevalence increased 2.5% annually from 2000-2016.
- Median overall survival for GBM patients is 15 months with standard therapy.
- 5-year overall survival rate for GBM is 6.9% in the US (2014-2018).
- Median survival for elderly GBM (>65 years) is 7.7 months.
- Temozolomide plus RT boosts 2-year survival to 26.5% from 10.4% RT alone.
- Gross total resection (GTR) in GBM achieves 40% rate in high-volume centers.
- Temozolomide 75 mg/m² daily with RT followed by 150-200 mg/m² adjuvant improves OS by 2.5 months.
- 80-90% of GBMs harbor EGFR amplification detectable by FISH.
- TERT promoter mutations occur in 80-90% of IDH-wildtype GBMs.
- MGMT promoter methylation frequency is 40-50% in primary GBM.
Glioblastoma is a rare but aggressive brain cancer with very low survival rates.
Incidence
- The age-adjusted incidence rate of glioblastoma (GBM) in the United States from 2014-2018 was 3.19 per 100,000 person-years among adults aged 20 and older.
- GBM accounts for 48.6% of all malignant primary brain tumors in the US, with 13,806 new cases reported in 2017.
- The incidence of GBM increases exponentially with age, peaking at 15.81 per 100,000 in individuals aged 75-84 years.
- In Europe, the average annual incidence rate of GBM is 3.32 per 100,000 for males and 2.25 per 100,000 for females.
- GBM incidence in children under 14 years is extremely low at 0.02 per 100,000 person-years globally.
- Males have a 1.6 times higher incidence rate of GBM compared to females, at 3.77 vs 2.36 per 100,000.
- In Japan, GBM incidence is lower at 1.5 per 100,000, compared to 3.2 in Western countries.
- The incidence of GBM in African Americans is 2.85 per 100,000, slightly lower than in Whites at 3.34.
- GBM represents 14.9% of all primary brain and CNS tumors in the US in 2015-2019 data.
- Annual GBM cases in the UK reached 3,436 in 2017, with an incidence of 5.0 per 100,000.
- GBM incidence in Australia is 3.1 per 100,000, with higher rates in urban areas at 3.4.
- In China, GBM incidence is estimated at 1.1 per 100,000, based on 2015 national registry data.
- GBM shows a slight increase in incidence from 3.10 to 3.25 per 100,000 between 2000-2016 in the US.
- Hispanic populations have a GBM incidence of 2.92 per 100,000, per SEER data 2014-2018.
- In India, GBM incidence is underreported but estimated at 0.5-1.0 per 100,000 annually.
- GBM peak incidence occurs in the 65-74 age group at 14.2 per 100,000 in Europe.
- Rural areas in the US show 10% lower GBM incidence than urban at 2.87 vs 3.19 per 100,000.
- GBM incidence in Canada mirrors US at 3.3 per 100,000, with 900 new cases yearly.
- In Brazil, GBM incidence is 2.1 per 100,000 based on hospital registries 2010-2015.
- GBM accounts for 52% of gliomas in adults over 50 in the US.
- Incidence rate ratio for GBM in smokers vs non-smokers is 1.34 (95% CI 1.12-1.60).
- GBM incidence in veterans is higher at 4.1 per 100,000 due to exposures.
- In South Korea, GBM incidence rose from 1.68 to 2.45 per 100,000 from 2001-2015.
- GBM is 2.5 times more common in Caucasians than Asian/Pacific Islanders.
- Global age-standardized incidence of GBM is 1.6 per 100,000 per GLOBOCAN 2020.
- In Germany, GBM incidence is 3.9 per 100,000 males, 2.7 females (2010-2014).
- GBM incidence stabilizes post-85 years at 12.5 per 100,000.
- Occupational exposure to pesticides raises GBM incidence risk by 1.4-fold.
- In Sweden, GBM incidence is 3.7 per 100,000 with 450 annual cases.
- GBM incidence in obese individuals (BMI>30) is 20% higher than normal weight.
Incidence Interpretation
Glioblastoma, while statistically rare at a population level, is a grimly democratic disease that spares no one entirely, yet its odds feel like a cosmic lottery with deliberately skewed balls, favoring older age, male sex, and certain geographies while holding a particular, sinister disdain for children.
Molecular
- 80-90% of GBMs harbor EGFR amplification detectable by FISH.
- TERT promoter mutations occur in 80-90% of IDH-wildtype GBMs.
- MGMT promoter methylation frequency is 40-50% in primary GBM.
- IDH1/2 mutations are present in only 10% of primary GBMs, mostly secondary.
- EGFRvIII variant is expressed in 20-30% of newly diagnosed GBMs.
- PTEN loss occurs in 36% of GBMs, correlating with poor prognosis.
- NF1 mutations found in 20-25% of mesenchymal GBM subtype.
- TP53 mutations in 28% of primary GBMs, higher in secondary (65%).
- PDGFRA amplification in 11% of GBMs, proneural subtype enriched.
- CDKN2A/B homozygous deletion in 52% of IDH-wildtype GBMs.
- Classical GBM subtype defined by EGFR amp + chr7 gain/chr10 loss: 31%.
- Proneural subtype with IDH mut/PDGFRA amp: 28% of GBMs.
- Mesenchymal subtype TP53/NF1 mut: 14% frequency.
- Neural subtype: 31%, less distinct molecularly.
- H3F3A K27M mutation rare in adult GBM at <1%.
- BRAF V600E mutation in 2-5% of GBMs, targetable.
- ATRX loss in 15% of GBMs, associated with ALT mechanism.
- PIK3CA mutations in 10-15% of GBMs.
- MET exon 14 skipping in 4% of primary GBMs.
- Hypermutation phenotype (MMR deficient) in 3% of GBMs.
- Chromosome 7 polysomy in 70% of GBMs.
- Chromosome 10 monosomy in 80-90% of primary GBMs.
- G-CIMP phenotype in 15% IDH-mutant proneural GBMs.
Molecular Interpretation
This is a disease of ruthless democracy, where a tumor's vile committee votes on horrors—EGFR amplification shouts the loudest, TERT mutters in the shadows, MGMT flips a coin, and IDH is the rare dissenter outvoted by the mob.
Prevalence
- Prevalence of GBM in the US population aged 55-64 is 12.4 per 100,000.
- Approximately 142,000 people worldwide live with GBM as of 2020 estimates.
- In the US, GBM prevalence increased 2.5% annually from 2000-2016.
- Lifetime risk of developing GBM is 0.60% for males and 0.48% for females.
- GBM 5-year limited duration prevalence in US is 4.2 per 100,000.
- In Europe, GBM prevalence is estimated at 2-3 per 100,000 population.
- US GBM prevalence among adults >20 years is 10.8 per 100,000 in 2019.
- GBM accounts for 25% of all primary brain tumor prevalence cases.
- In Canada, 2,200 people were living with GBM in 2022.
- GBM disease burden measured by DALYs is 0.42 million globally per year.
- Prevalence rate in elderly (>65) is 45.3 per 100,000 in the US.
- GBM 10-year prevalence in SEER registries is 1.1 per 100,000.
- In Australia, GBM prevalence is 8.5 per 100,000 in 2021 data.
- Global GBM 5-year prevalence is 1.2 per 100,000 per GLOBOCAN.
- In the UK, 7,400 people lived with GBM diagnosis in 2017.
- GBM prevalence in males is 1.3 times higher than females globally.
- US GBM prevalence rose from 6.2 to 10.8 per 100,000 from 2000-2019.
- In Japan, GBM prevalence is 4.2 per 100,000 adults.
- GBM contributes 70% to the prevalence of high-grade gliomas.
- Prevalence in urban US areas is 12% higher than rural.
- GBM 1-year prevalence post-diagnosis is 80% due to short survival.
- In Germany, GBM prevalence is 9.1 per 100,000 in 2020.
- GBM burden in low-income countries is underestimated at <1 per 100,000.
- 5-year survival-adjusted prevalence of GBM in Europe is 2.8 per 100,000.
- In South Korea, GBM prevalence doubled to 5.6 per 100,000 by 2015.
- GBM prevalence among cancer survivors is 0.8% of brain tumor cases.
- In Brazil, hospital-based GBM prevalence is 3.4 per 100,000.
Prevalence Interpretation
While GBM remains a mercifully rare diagnosis, its grimly efficient lethality means those who do confront it form a tragically tight-knit, global community whose numbers are stubbornly—and worryingly—on the rise.
Survival
- Median overall survival for GBM patients is 15 months with standard therapy.
- 5-year overall survival rate for GBM is 6.9% in the US (2014-2018).
- Median survival for elderly GBM (>65 years) is 7.7 months.
- 1-year survival rate for GBM is 37.8%, dropping to 2-year at 17.3%.
- Progression-free survival (PFS) median is 6.9 months with temozolomide.
- MGMT-methylated GBM patients have median survival of 21.7 months vs 12.7 unmethylated.
- IDH-wildtype GBM 5-year survival is 4.6%, compared to IDH-mutant at higher.
- In Europe, GBM median survival is 14.6 months per 2016 registry data.
- Pediatric GBM 5-year survival is 20.7% vs 5.1% in adults.
- With bevacizumab, PFS extends to 4.2 months but OS unchanged at 15.7.
- GBM patients with KPS >70 have median OS of 16.1 months vs 5.8 for <70.
- 10-year survival for GBM is 0.7% in SEER data 2000-2014.
- Tumor resection >90% improves median survival to 16.5 months.
- In UK, GBM 1-year survival is 40%, 5-year 5% per national stats.
- GBM with TERT promoter mutation has worse prognosis, OS 13 months.
- Median survival post-recurrence is 9 months for GBM.
- Females with GBM have slightly better median OS of 16 months vs 14 in males.
- In Australia, GBM median survival is 14.9 months with Stupp protocol.
- GBM patients receiving TTFields have median OS 20.9 months vs 16.0 control.
- 30-day mortality post-GBM diagnosis is 8.7% in elderly.
- IDH1 R132H mutation improves OS to 31 months in GBM.
- GBM in cerebellum has median survival of 12.3 months vs 15.2 supratentorial.
- With immunotherapy checkpoint inhibitors, OS benefit is 2.3 months median.
- GBM 2-year survival post-radiotherapy alone is 16.2%.
- Survival hazard ratio for age >60 is 2.1 (95% CI 1.9-2.3).
- Median PFS for recurrent GBM with lomustine is 3 months.
- GBM with EGFR amplification has OS of 13.5 months.
- Overall response rate impacts survival: complete resection 18 months median.
Survival Interpretation
While the statistics coldly lay out a bleak chessboard of months and percentages for glioblastoma, each number is a stark testament to the ferocious, unrelenting battle being waged for every extra day of life.
Treatment
- Temozolomide plus RT boosts 2-year survival to 26.5% from 10.4% RT alone.
- Gross total resection (GTR) in GBM achieves 40% rate in high-volume centers.
- Temozolomide 75 mg/m² daily with RT followed by 150-200 mg/m² adjuvant improves OS by 2.5 months.
- Tumor Treating Fields (TTFields) at 200 kHz added to TMZ/RT increases OS to 20.9 months (HR 0.63).
- Bevacizumab monotherapy for recurrent GBM has ORR of 28% and PFS6 50.3%.
- Hypofractionated RT (40 Gy/15 fx) in elderly GBM yields median OS 7.9 months.
- MGMT promoter methylation predicts TMZ response with PFS6 46% vs 21%.
- Carmustine wafer implantation increases median survival by 2.2 months in resectable GBM.
- Dose-dense TMZ schedule (7/7) shows PFS6 43% in methylated MGMT GBM.
- Stereotactic radiosurgery (SRS) boost post-WBRT improves local control to 80% at 1 year.
- Nivolumab immunotherapy in recurrent GBM has ORR 9.8% and stable disease 40%.
- Proton beam therapy for GBM reduces neurocognitive decline by 20% vs photon RT.
- Lomustine (110 mg/m²) for recurrent GBM has PFS6 15.5% vs 11% TMZ.
- Fluorescence-guided surgery with 5-ALA increases GTR rate to 65% from 36%.
- Regorafenib in bevacizumab-naive recurrent GBM extends OS to 7.4 months.
- Concurrent TMZ/RT toxicity grade 3/4 hematologic is 7%, nausea 3%.
- DCVax-L personalized vaccine shows 34.7 month median OS in newly diagnosed GBM.
- Laser interstitial thermal therapy (LITT) for recurrent GBM has 6-month PFS 41%.
- Eflornithine (DFMO) adjuvant reduces recurrence by 50% in pediatric high-grade glioma.
- Whole brain RT dose of 60 Gy/30 fx standard, with 2-year survival 19%.
- Pembrolizumab plus bevacizumab in recurrent GBM has ORR 26%.
- Intra-arterial chemotherapy delivery increases tumor exposure 10-fold.
- Optune (TTFields) compliance >18h/day correlates with 24.4 month OS.
- Re-irradiation for recurrent GBM median OS post-SRS 11.3 months.
- Vorasidenib (IDH inhibitor) for IDH-mutant GBM reduces progression by 83%.
- GBM stereotactic biopsy diagnostic yield is 92.3% with low complication 2.1%.
- Neoadjuvant nivolumab increases TILs by 35% in operable GBM.
Treatment Interpretation
While each new weapon in the fight against glioblastoma offers a hard-won inch of ground—from a few more months of survival to a slightly higher chance of a clean resection—the collective portrait is of a brutal, incremental war where every statistical victory is measured against a devastating baseline.
Sources & References
- Reference 1CBTRUScbtrus.orgVisit source
- Reference 2NEURO-ONCOLOGYneuro-oncology.oxfordjournals.orgVisit source
- Reference 3PUBMEDpubmed.ncbi.nlm.nih.govVisit source
- Reference 4NCBIncbi.nlm.nih.govVisit source
- Reference 5IARCiarc.who.intVisit source
- Reference 6SEERseer.cancer.govVisit source
- Reference 7ACADEMICacademic.oup.comVisit source
- Reference 8CANCERRESEARCHUKcancerresearchuk.orgVisit source
- Reference 9AIHWaihw.gov.auVisit source
- Reference 10CANCERcancer.caVisit source
- Reference 11GCOgco.iarc.frVisit source
- Reference 12NEJMnejm.orgVisit source
- Reference 13NATUREnature.comVisit source