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Article first published online: 31 AUG 2011
Copyright © 2011 American Cancer Society
Volume 118, Issue 8, pages 2163–2172, 15 April 2012
How to Cite
Darefsky, A. S., King, J. T. and Dubrow, R. (2012), Adult glioblastoma multiforme survival in the temozolomide era: A population-based analysis of Surveillance, Epidemiology, and End Results registries. Cancer, 118: 2163–2172. doi: 10.1002/cncr.26494
We are grateful to the SEER Program for making its data publicly available.
After this work was completed, the following American Society of Clinical Oncology Annual Meeting Proceedings abstract was published: Koshy M, Villano JL, Dolecek TA, et al. Improved survival time trends for glioblastoma using the SEER 17 population-based registries. J Clin Oncol. 2011; 29 (May 20 Supplement):2013. This abstract, which utilized 2000-2006 SEER data, concluded that there was a survival improvement for GBM patients, consistent with the present study.
- Issue published online: 6 APR 2012
- Article first published online: 31 AUG 2011
- Manuscript Accepted: 15 JUL 2011
- Manuscript Received: 18 JUN 2011
- brain neoplasms;
- SEER Program
Survival after a glioblastoma multiforme (GBM) diagnosis remained static during the several decades before 1999. We hypothesized that the progressive increase in temozolomide use for GBM treatment that began in 1999 in the United States would be paralleled by a corresponding improvement in survival.
We included 19,674 GBM cases, ages 20 years or greater, diagnosed 1993 to 2007 in the population-based Surveillance, Epidemiology, and End Results Program database. We used proportional hazards models to calculate calendar period hazard ratios (HR) and 95% confidence intervals (CI), adjusted for demographic covariates. We compared survival across periods using the Kaplan-Meier method.
Starting with cases diagnosed in 1999 to 2001, we observed a progressive decrease in HRs compared with cases diagnosed in 1993 to 1995. The multivariate-adjusted HR for 2005 to 2007 versus 1993 to 1995 was 0.69 (95% CI, 0.65-0.72). Age-stratified analyses revealed that this progressive decrease occurred in all age groups except 80+ years. Two-year survival increased from 7% among cases diagnosed in 1993 to 1995 and 1996 to 1998 to 9% among cases diagnosed in 1999 to 2001, 13% in 2002 to 2004, and 17% in 2005 to 2007. The disparity in survival between young and old patients increased in the temozolomide era, with 2-year survival of 39% among cases diagnosed at ages 20 to 44 years and 1% among cases diagnosed at 80+ years in 2005 to 2007.
We observed a modest, but meaningful, population-based survival improvement for GBM patients in the United States. Widespread adoption of temozolomide represents the most likely explanation, although other treatment advances, such as increased extent of surgical resection, also may have played a role. Cancer 2012;. © 2011 American Cancer Society.