Glioblastoma survival in rural America: a 10-year experience from a quaternary care center

Glioblastoma (GBM) is the most aggressive primary brain tumor with dismal prognosis. Patients residing in rural and Appalachian regions encounter multiple barriers to timely diagnosis and access to multidisciplinary neuro-oncology care, but whether these barriers translate into worse survival remains uncertain. West Virginia (WV), a predominantly rural Appalachian state, is served by a primary academic medical center (WV University Ruby Memorial Hospital) with a dedicated neuro-oncology program. We performed a retrospective analysis of the electronic health record to characterize overall survival and prognostic factors among WV residents diagnosed with GBM.

Retrospective cohort of 380 adults (≥ 18 years) with pathologically confirmed Isocitrate Dehydrogenase-wildtype (IDH-WT) GBM (2015-2025). Rurality defined by ZIP-code RUCA. Cox proportional hazards models were used to assess the association between overall survival (OS) and age, sex, treatment, rurality, and O⁶-methylguanine-DNA methyltransferase (MGMT) promoter methylation status.

Median OS was 12.7 months. Age ≥ 65 was associated with worse survival (15.9 vs. 9.1 months; p < 0.001). Rural and non-rural survival was equivalent (12.5 vs. 12.7 months; p = 0.87). Temozolomide (TMZ) use significantly improved OS (14.0 vs. 6.2 months; p < 0.001). Gross total resection and MGMT promoter methylation were both associated with significantly improved overall survival (p < 0.001 and p = 0.0005, respectively).

In a predominantly rural state served by a primary academic neuro-oncology program, median overall survival for GBM was 12.7 months indicating centralized care eliminates rural-urban survival gaps in GBM.