The Central Brain Tumor Registry of the United States (CBTRUS), in collaboration with the Centers for Disease Control and Prevention and National Cancer Institute, is the largest population-based registry focused exclusively on primary brain and other central nervous system (CNS) tumors in the United States (US) and represents the entire US population. This report contains the most up-to-date population-based data on primary brain tumors available and supersedes all previous reports in terms of completeness and accuracy. All rates are age-adjusted using the 2000 US standard population and presented per 100,000 population. The average annual age-adjusted incidence rate (AAAIR) of all malignant and non-malignant brain and other CNS tumors was 23.41 (Malignant AAAIR = 7.08, non-Malignant AAAIR = 16.33). This rate was higher in females compared to males (25.84 versus 20.82), Whites compared to Blacks (23.50 versus 23.34), and non-Hispanics compared to Hispanics (23.84 versus 21.28). The most commonly occurring malignant brain and other CNS tumor was glioblastoma (14.6% of all tumors), and the most common non-malignant tumor was meningioma (37.6% of all tumors). Glioblastoma was more common in males, and meningioma was more common in females. In children and adolescents (age 0–19 years), the incidence rate of all primary brain and other CNS tumors was 6.06. An estimated 86,010 new cases of malignant and non-malignant brain and other CNS tumors are expected to be diagnosed in the US in 2019 (25,510 malignant and 60,490 non-malignant). There were 79,718 deaths attributed to malignant brain and other CNS tumors between 2012 and 2016. This represents an average annual mortality rate of 4.42. The five-year relative survival rate following diagnosis of a malignant brain and other CNS tumor was 35.8%, and the five-year relative survival rate following diagnosis of a non-malignant brain and other CNS tumors was 91.5%.

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Various terms are used to describe the regions of the brain and central nervous system. The specific sites used in this report are broadly based on the categories and site codes defined in the SEER Site/Histology Validation List. 19 See Table 1 for an overview of CBTRUS primary site groupings. The CBTRUS Site/Validation List can be found on the CBTRUS website (http://www.cbtrus.org). Measurement MethodsCounts, means, rates, ratios, proportions, and other relevant statistics were calculated using R 3.1.2 statistical software 20 and/or SEER*Stat 8.2.1. 21 Statistics are suppressed when counts are fewer than 16 within a cell but included in totals except when data from only one cell are suppressed within a category to prevent identification of the number in the suppressed cell. Note that reported percentages may not add up to 100% due to rounding.Population data for each geographic region were obtained from the SEER program website 22 for the purpose of rate calculation.Age-adjusted incidence rates and 95% confidence intervals 23 for malignant and non-malignant tumors and for selected histology groupings by gender, race, Hispanic ethnicity, and pediatric, young adult, and adult age groups were estimated per 100,000 population. Age-adjustment was based on oneyear age groupings and standardized to the 2000 US standard population. The age distribution of the 2000 US standard population is shown in Appendix A. Combined populations for the regions included in this report are shown in Appendix B and Appendix C.CBTRUS presents statistics on the pediatric and adolescent age group 0-19 years for clinical relevance and in order to Ostrom et al: CBTRUS Statistical Report Neuro-Oncology iv3The overall average annual age-adjusted incidence rates by age, behavior and CCR, are presented in Table 5, Figures 7a -c. † There is less variation by region for malignant tumor incidence rates as compared to incidence rates for nonmalignant tumors. CCR and regional variations likely reflect differences in reporting and case ascertainment practices. † A slight majority of non-malignant brain and CNS tumors are histologically confirmed (50.4%) (Table 6). † The overall average annual age-adjusted incidence rates of all tumors (malignant and non-malignant) for each individual CCR ranged from 16.30 to 28.06 per 100,000 population. † Average annual age-adjusted incidence rates of all primary malignant tumors ranged from 4.79 to 8.48 per 100,000 population, and average annual age-adjusted incidence rates of all primary non-malignant tumors ranged from 9.41 to 20.04 per 100,000 population. † Among adults 20 years of age and older, CCR-specific incidence rates ranged from 5.63 to 10.27 per 100,000 population for malignant tumors and from 13.02 to 27.30 per 100,000 population for non-malignant tumors. † In those less than 20 years of age, incidence rates listed ranged from 2.27 to 4.81 per 100,000 population for malignant tumors and from 1.02 to 3.65 per 100,000 population for non-malignant tumors.

This report presents the following population-based measures: incidence rates, mortality rates, and relative survival rates (for more information on definitions of terms and measures used see: http://www.cbtrus.org/glossary/ glossary1.html).

This report presents the following population-based measures: incidence rates, mortality rates, and relative survival rates (for more information on definitions of terms and Estimation of Expected Numbers of Brain and Other CNS Tumors in 2017 and 2018Estimated numbers of expected malignant and non-malignant brain and other CNS tumors were calculated for 2017 and 2018. To project estimates of newly diagnosed brain and other CNS tumors in 2017 and 2018, age-adjusted annual brain tumor incidence rates were generated for 2000-2014 for malignant tumors, and 2006-2014 for nonmalignant tumors. These were generated by state, age, and histologic type. Joinpoint 4.2.0.2 32 was used to fit regression models to these incidence rates, 33 which were used to predict numbers of cases in future years using the parameter from the selected models. Joinpoint regression allows for multiple lines to be fit to incidence data across time, rather than assuming a consistent trend across the whole period. The points where these lines intersect are called 'joinpoints'. The models allowed for a maximum of 2 joinpoints (1 for non-malignant tumors), a minimum of 3 observations from a joinpoint to either end of the data, and a minimum of 3 observations between joinpoints. 34 Modified Bayesian Information Criterion procedures included in Joinpoint were used to select the best fitting model. Overall total rates presented are based on total malignant and

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Measurement and Statistical MethodsCounts, means, rates, ratios, proportions, and other relevant statistics were calculated using R 3.2.3 statistical software 21 and/or SEER*Stat 8.3.2. 22 Figures were created in R 3.2.3 21 using rgeos, 23 rgdal, 24 maptools, 25 ggplot2, 26 plotrix, 27 and SEER2R. 28 Statistics are suppressed when counts are fewer than 16 within a cell but included in totals except when data are suppressed from only one cell within a category to prevent identification of the number in the suppressed cell. Note that reported percentages may not add up to 100% due to rounding.Population data for each geographic region were obtained from the SEER program website 29 for the purpose of rate calculation.Age-adjusted incidence rates and 95% confidence intervals 30 for malignant and non-malignant tumors and for selected histology groupings by sex, race, Hispanic ethnicity, and pediatric, adolescent, young adult, and adult age groups were estimated per 100,000 population. Age-adjustment was based on one-year age groupings and standardized to the 2000 US standard population. The age distribution of the 2000 US standard population is shown in Appendix A. Combined populations for the regions included in this report are shown in Appendix B and Appendix C.CBTRUS presents statistics on the pediatric and adolescent age group 0-19 years for clinical relevance and describes specific brain and other CNS tumor patterns in age groups 0-4, 5-9, 10-14, and 15-19 years. However, the 0-14 year age group is a standard age category for childhood cancer used by other cancer surveillance organizations and has been included in this report for consistency and comparison purposes. Race categories in this report are all races, White, Black, American Indian/Alaskan Native (AIAN), and Asian/Pacific Islander (API). Other race, unspecified, and unknown race are included in statistics that are not race-specific. Hispanic ethnicity was defined using the NAACCR Hispanic Identification Algorithm, version 2, data element, which utilizes a combination of cancer registry data fields (Spanish/Hispanic Origin data element, birthplace, race, and surnames) to directly and indirectly classify cases as Hispanic or non-Hispanic. 31 When comparing two rates to one another, it is important to consider whether they are truly different or whether the difference in the estimates may be due to random error. There are several methods used in this report for determining whether two values are 'significantly different,' meaning whether the evidence meets a level of strength (usually a 5% chance of error) where the difference can be assumed to not be due to random error. There are two methods that are used to determine whether a difference between rates is statistically significant in this report. The first is through 95% confidence intervals, which are calculated for all presented rates. A 95% confidence interval is a range around an estimate which, if sampling of the population was repeated, should contain the 'true' value for the population 95% of the t...

Glioblastoma is an aggressive brain tumor that carries a poor prognosis. The tumor's molecular and cellular landscapes are complex, and their relationships to histologic features routinely used for diagnosis are unclear. We present the Ivy Glioblastoma Atlas, an anatomically based transcriptional atlas of human glioblastoma that aligns individual histologic features with genomic alterations and gene expression patterns, thus assigning molecular information to the most important morphologic hallmarks of the tumor. The atlas and its clinical and genomic database are freely accessible online data resources that will serve as a valuable platform for future investigations of glioblastoma pathogenesis, diagnosis, and treatment.