Abstract
Introduction In adults with skull base chordoma or chondrosarcoma, the impact of treatment center
and access to care have not been well described in regard to perioperative mortality
and survival.
Methods A query of the National Cancer Database (NCDB) and review of 1,102 adults—488 with
chordomas and 614 with chondrosarcomas—was performed. The Kaplan–Meier's product limit
method and chi-square analysis, respectively, assessed overall survival and 30-day
(30D) and 90-day (90D) mortalities.
Results For 925 patients who had surgery and available mortality data, the 30D and 90D mortality
rates were 0.9 and 1.5%. Lower education level (p = 0.0185) and treatment at a nonacademic facility (p = 0.016) were associated with increased risk of 90-day mortality. Median follow-up
was 52 months and analysis was dichotomized by histology. For those with skull base
chordoma, patients from a larger metro size (p = 0.002), age below the median 52 years (p ≤ 0.001), and private insurance (<0.001) were associated with prolonged survival,
whereas for skull base chondrosarcoma, the factors were treatment at an academic medical
center (p = 0.001), high-volume center (p = 0.007), age below the median 52 years (p ≤ 0.001), higher income (p = 0.043), higher education (p = 0.017), and private insurance (p ≤ 0.001). Comparing high-, medium-, and low-volume centers, high-volume centers were
most likely to be academic, deliver radiotherapy, escalate doses >70 Gy, and utilize
proton radiotherapy consistent across both disease subsets.
Conclusion Higher educational attainment and treatment at an academic facility were associated
with decreased 90D mortality for patients with skull base chordoma and chondrosarcoma.
For those with skull base chordoma, larger metro size, younger age, and private insurance
were associated with prolonged survival; for those with chondrosarcoma, it was treatment
at a high-volume or academic medical center, younger age, higher income or education,
and private insurance.
Keywords
skull base tumors - chordoma - chondrosarcoma
