The Association of Gender in the Management and Prognosis of Vertebral and Sacral Chordoma: A SEER Analysis

<b>Background/Objectives:</b> Chordomas are rare primary osseous tumors of the spine and skull base that may portend significant morbidity and mortality. Gender disparities in the management and outcomes of spinal and pelvic chordomas have been sparsely studied. This study aimed to examine the effect of gender on the treatment utilization and outcomes in patients with vertebral column and sacrum/pelvis chordomas. <b>Methods:</b> A retrospective cohort study was performed using the 2000 to 2020 Surveillance, Epidemiology, and End Results (SEER) Registry, a U.S. population-based cancer registry database. Patients with histologically confirmed chordoma of the vertebral column or the sacrum/pelvis were identified using ICD-O-3 codes. The study population was divided into gender-based cohorts: male and female. The patient demographics, tumor characteristics, treatment variables, and mortality were assessed. <b>Results:</b> A total of 791 patients were identified and stratified by gender: 485 (61.3%) male and 306 (38.7%) female. The mean tumor size was similar between the cohorts (<i>p</i> = 0.377), as was the tumor location, with most arising from the pelvic bones/sacrum/coccyx (<i>p</i> = 0.953). While the treatment characteristics did not significantly vary, among patients who received both radiotherapy and surgery, neo-adjuvant radiotherapy was utilized at higher frequencies in the male patients (<i>p</i> = 0.011). For vertebral column chordomas, the median (<i>p</i> = 0.230) and five-year survival (<i>p</i> = 0.220) was similar between cohorts, and gender was not a predictor of survival (<i>p</i> = 0.239). Similarly, for pelvic chordomas, the median (<i>p</i> = 0.820) and five-year survival (<i>p</i> = 0.820) was similar between cohorts, and gender was not associated with survival (<i>p</i> = 0.816). <b>Conclusions:</b> Our study suggests that gender may influence treatment utilization but not mortality in patients with chordomas of the spine and sacrum.