Racial and Socioeconomic Disparities in Treatment Outcomes and Survival among Skull Base Chordoma and Chondrosarcoma Patients: A U.S. Population-Based Study

Introduction: Skull base chordoma and chondrosarcoma are rare osseous tumors. Due to their low incidence, the impact of racial and socioeconomic factors on treatment outcomes and survival of these patients is not well understood. Utilizing the National Cancer Institute’s population-based tumor registry SEER (Surveillance, Epidemiology, and End Results) database, we aimed to analyze nationwide patterns in clinical outcomes for chordoma and chondrosarcoma.

Methods: Data were extracted from the SEER records (1992–2021), focusing on demographics, time to treatment, and survival for patients with skull base chordoma and chondrosarcoma. Statistical analyses were performed to identify disparities in treatment initiation and survival outcomes.

Results: The study population comprised 562 patients, 348 (61.9%) with chordoma and 214 (38.1%) with chondrosarcoma. Racial distribution included White (n = 332), Hispanic (n = 113), Asian (n = 82), Black (n = 25), and Native American (n = 4) patients. White (51.9 ± 17.3 years) and Native American (49.3 ± 13.8 years) patients were older than Asian (47.4 ± 17.6 years), Black (43.2 ± 15.7 years), and Hispanic (44.5 ± 15.1 years) patients. White (86.1%), Asian (95.1%), and Hispanic (91.2%) patients were more likely to receive surgery than their Black (64.0%) and Native American (50.0%) counterparts. Tumor size (p = 0.22), grade (p = 0.84), and stage (p = 0.10) were similar across different racial groups. No significant difference in the extent of resection (local excision/biopsy vs. subtotal resection vs. gross total resection) was observed among different racial groups who underwent surgery (p = 0.88).

A multivariate regression analysis revealed significant delays in treatment initiation and differences in survival based on racial background. When adjusted for age, sex, stage, tumor size, marital status, income, rural–urban environment, and education level, Black patients with chordoma or chondrosarcoma were more likely to have a longer duration of time between diagnosis and treatment (adjusted coefficient: 54.6, p = 0.04). White race (adjusted coefficient: −23.44, p = 0.03) predicted shorter time to treatment among patients with chondrosarcoma but not in the chordoma-only cohort. Across both tumor types, predictors of decreased survival included older age (adjusted coefficient: −1.6, p < 0.001), lower education level (adjusted coefficient: −20.4, p = 0.02), and larger tumor size (adjusted coefficient: −0.45, p = 0.05). White race (adjusted coefficient: 30.1, p = 0.003) and higher median household income (adjusted coefficient: 2.4, p = 0.02), on the other hand, predicted longer survival. For chordoma, younger age (adjusted coefficient: −1.18, p < 0.001), white race (adjusted coefficient: 27.44, p = 0.02), and higher education level (adjusted coefficient: −31.64, p = 0.003) predicted longer survival. For chondrosarcoma, significant predictors of a longer survival were age (adjusted coefficient: −2.30, p < 0.001) and median household income (adjusted coefficient: 4.89, p = 0.02).

Conclusion: This population-based study highlights significant racial and socioeconomic disparities in the treatment and survival outcomes of patients with skull base chordoma and chondrosarcoma. Black patients experienced greater delays in treatment initiation. White race and higher income were predictors of longer survival while older age and lower education level predicted decreased survival. Addressing these disparities will require targeted interventions to ensure timely treatment and equitable care for all patient groups.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
07 February 2025