The Influence of Facility Volume and Type on Skull Base Chordoma Treatment and Outcomes

-OBJECTIVE: To evaluate the influence of facility case volume and type on skull base chordoma treatment and overall survival (OS). -METHODS: The 2004-2016 National Cancer Database was queried for skull base chordoma patients receiving definitive treatment. Facilities were categorized into 2 cohorts by calculating the mean number of patients treated per facility and using cutoff numbers that were 0.5 SD above and below the computed mean to separate the groups. As, by definition of the inclusion criteria, all included facilities treated at least 1 patient, low-volume facilities were defined as treating 1 patient, and high -volume facilities were defined as treating double dagger 7 patients; mid-volume facilities (facilities treating double dagger 2 but 6 pound patients) were excluded. Differences in treatment course, outcomes, and OS by facility type were assessed.-RESULTS: The study included 658 patients (44.8% female, 79.5% White). The 187 unique facilities were categorized into 95 low-volume facilities (treating 1 patient during timeline) and 26 high-volume facilities (treating double dagger 7 patients during timeline). Kaplan-Meier log-rank analysis demon-strated a significant positive association between facility volume and OS (P < 0.001) and an improvement in OS in patients at academic facilities (P = 0.018). On Cox pro-portional hazards multivariate regression after adjusting for sex, age, Charlson-Deyo comorbidity index, and insur-ance type, high-volume facilities and academic facilities were associated with a lower mortality risk than low -volume facilities and nonacademic facilities (P < 0.001 and P = 0.03, respectively).-CONCLUSIONS: Higher facility case volume and aca-demic facility type appear to be associated with improved survival outcomes in treatment of skull base chordomas.