A population based survival analysis of skull base and sacral-coccygeal chordomas in an elderly population: 2000-2021

Chordoma is an aggressive primary osseous tumor that most often arises from the sacral-coccygeal region and the skull base. Treatment typically requires en bloc gross total resection necessitating significant iatrogenic tissue disruption and physiological stress making management in a vulnerable elderly cohort challenging. The Surveillance, Epidemiology, and End Results (SEER) database was employed to isolate cases of chordoma in patients 65+ years of age between the years 2000-2021. Kaplan Meier survival analyses were used to identify survival trends. Multivariate cox regression analysis controlled for confounding variables. A subgroup analysis comparing geriatric survival to an adult cohort was performed. A total of 380 cases (128 skull base, 252 sacral-coccygeal) were included. Surgery not performed improved cumulative tumor-specific survival in both univariate and multivariate analyses (HR = 0.49, 95 % CI [0.27-0.88], p = 0.016), but surgery did not impact cumulative all-cause survival nor primary site-specific all-cause survival. Geriatric survival (89.2 ± 4.6 months) was significantly shorter than adult survival (187.6 ± 4.9 months) in subgroup analysis (p < 0.001). Year of diagnosis did not significantly impact survival. Minimal improvements in geriatric chordoma survival have been made over the last two decades. Worsened tumor-specific survival with surgery likely results from the need for resection of advanced disease that inherently carries high risk within this population and surgery being deferred in the event of less advanced disease. Further study is needed to improve medical and surgical therapies within this cohort to improve survival.