Racial Disparities in the Surgical Treatment of Chordoma and Chondrosarcoma

Introduction: Chordoma is a rare primary malignant tumor and a remnant of the primitive notochord. Another rare neoplasm, chondrosarcoma, is thought to arise from primitive cartilaginous cells, fibroblasts, or mesenchymal cells. Chordoma and chondrosarcoma each account for <1% of all intracranial tumors. Despite indolent growth patterns and low metastatic risk, both chordomas and chondrosarcomas are locally aggressive and destructive with high rates of recurrence. To date, there are no reports of racial or ethnic disparities in surgical outcomes following resection of intracranial chordoma and chondrosarcoma. In the management of this rare cranial neoplasm which presents with its own innate challenges, it is crucial for surgeons to consider individual patient characteristics and potential underlying disparities that may affect patient outcomes.

Methods: The multicenter National Surgical and Quality Improvement Program (NSQIP) database was queried from years 2010 to 2021 for patients diagnosed with cranial chordoma or chondrosarcoma. Patients were selected using International Classification of Disease, 9th Revision (ICD-9) and 10th Revision (ICD-10) codes for chordoma and chondrosarcoma of skull and face. Patients were subdivided into three racial categories: Caucasian, African American (AA), and Asian. Other races were excluded from analysis due to insufficient data.

Analysis of variance and chi-square tests were used to examine the relationship between race and age, BMI, and peri- and postoperative outcomes. Fisher’s exact test was used for small cell sizes. Generalized linear regression models were used to examine the relationship between race and peri- and postoperative outcomes, while controlling for age and ASA score. All statistical analyses were conducted in SAS 9.4.

Results: Within the study cohort of 1,235 patients, there was a significant difference in age and BMI by race (p-value: <0.0001 and 0.04, respectively). Mean age among White individuals was approximately 63.67 years compared to 57.15 and 62.25 years for AA and Asian patients, respectively. Similarly, average BMI among White individuals was 27.54 compared to 28.63 and 25.96 among AA and Asian patients, respectively. There was a significantly higher proportion of postoperative blood transfusion among AA individuals (6.9%) compared to that among White (2.9%) and Asian (1.4%) individuals. After controlling for age and ASA score, AA individuals had higher odds of postoperative sepsis [OR (95% CI): 2.40 (1.06, 5.45)], blood transfusion [1.66 (1.09, 2.52)], and septic shock [2.40 (1.06, 5.45)] relative to White individuals. Similarly, Asian individuals had greater odds of postoperative blood transfusion [2.12 (1.27, 3.52)] compared to White individuals. No significant difference between the races was identified for length of stay, 30-day probability of morbidity/mortality, or 30-day reoperation rate.

Conclusion: We utilized a robust, multi-institutional dataset to identify racial disparities in operative course and surgical complications following resection of intracranial chordoma and chondrosarcoma. AA race was found to be an independent risk factor for multiple postoperative complications relative to White and Asian races. Our results call for continued investigation and heightened awareness of the racial disparities and underlying socioeconomic or unidentified factors which contribute to differences in patient outcomes.

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Artikel online veröffentlicht:
05. Februar 2024