脊索瘤是罕见的肿瘤，起源于未分化的脊索残余物。目前，对于脊索瘤手术治疗患者的辅助放射方式的选择，尚无既定指南。作者利用全国性多中心数据库，旨在比较使用质子或光子辅助疗法治疗颅底和脊柱脊索瘤的长期生存结果。在国家癌症数据库 (NCDB) 中查询了脊索瘤病例从 2004 年到 2017 年。从数据库中提取患者、肿瘤和治疗特征。主要结局是总生存期（OS）。进行 Kaplan-Meier 生存分析以调查接受质子或光子辅助放射治疗的倾向评分匹配队列的结果差异。在 3490 名患者中，424 名符合本研究的纳入标准。在预匹配分析中，与接受质子治疗的患者相比，接受辅助光子治疗的患者年龄明显较大（中位年龄 57.0 岁 vs 45.0 岁，p < 0.001），并且男性更常见（61% vs 43%，p < 0.001）。放射治疗方式中的种族分布均匀（p = 0.64）。与光子疗法相比，患有活动脊柱或骶骨脊索瘤的患者接受质子治疗的可能性较小（37% vs 58%）。接受质子治疗的患者更多地属于私人保险持有者（69% vs 52%，p < 0.001）以及最高收入四分位数（52% vs 40%，p = 0.008）。与光子治疗相比，接受质子治疗的患者需要走更远的距离（中位距离为 59.0 英里 vs 34.9 英里，p < 0.001）。在涵盖所有脊索瘤病例的匹配后 Kaplan-Meier 分析中，未发现光子治疗和质子治疗之间的 OS 存在差异（HR 0.75，95% CI 0.39-1.44；p = 0.39）。仅包括颅底脊索瘤患者的 Kaplan-Meier 分析得出了相似的结果（HR 0.83，95% CI 0.31-2.22；p = 0.71）。然而，在脊柱脊索瘤患者中，发现了显着差异，因为质子治疗表现出优于光子治疗的 OS（HR 0.28，95% CI 0.09-0.81；p = 0.012）。根据这项全国性分析，拥有私人保险的患者收入较高的人更有可能接受质子辅助放疗，而患有脊柱或骶骨脊索瘤的人接受这种治疗的可能性较小。尽管存在这种差异，但与接受光子治疗的匹配患者队列相比，接受质子辅助治疗的脊柱和骶骨脊索瘤患者观察到 OS 获益。相反，在位于颅底的脊索瘤病例中，这种有利的结果并不明显。

Chordomas are rare tumors that originate from undifferentiated remnants of the notochord. Currently, there are no established guidelines regarding the choice of adjuvant radiation modality for patients surgically treated for chordomas. Using a nationwide, multicenter database, the authors aimed to compare long-term survival outcomes associated with the use of proton or photon adjuvant therapy for the management of chordomas of skull base and spine.The National Cancer Database (NCDB) was queried for chordoma cases from 2004 to 2017. Patient, tumor, and treatment characteristics were extracted from the database. The primary outcome was overall survival (OS). Kaplan-Meier survival analyses were conducted to investigate differences in outcome on propensity score-matched cohorts of patients treated with proton or photon adjuvant radiotherapy.Of the 3490 patients available, 424 met the inclusion criteria for this study. In the prematching analysis, patients receiving adjuvant photon therapy were significantly older (median age 57.0 vs 45.0 years, p < 0.001) and were more commonly male (61% vs 43%, p < 0.001) compared with those receiving proton therapy. Races were equally distributed among radiotherapy modalities (p = 0.64). Patients with chordomas of the mobile spine or sacrum were less likely to receive proton compared with photon therapy (37% vs 58%). Patients receiving proton therapy were more often represented among private insurance holders (69% vs 52%, p < 0.001) as well as in the highest income quartile (52% vs 40%, p = 0.008). Patients traveled farther to receive proton, as opposed to photon, therapy (median 59.0 vs 34.9 miles, p < 0.001). On postmatching Kaplan-Meier analysis encompassing all chordoma cases, no difference in OS between photon and proton therapy was revealed (HR 0.75, 95% CI 0.39-1.44; p = 0.39). A Kaplan-Meier analysis only including patients with skull base chordomas reached similar results (HR 0.83, 95% CI 0.31-2.22; p = 0.71). In patients with spine chordomas, however, a significant difference was found, as proton therapy exhibited a superior OS over photon therapy (HR 0.28, 95% CI 0.09-0.81; p = 0.012).Based on this nationwide analysis, patients with private insurance and higher income were more likely to receive proton adjuvant radiotherapy, while those with spinal or sacral chordomas were less likely to receive this modality. Despite this disparity, an OS benefit was observed in patients with chordomas of the spine and sacrum who received adjuvant proton therapy, in comparison with a matched cohort of patients treated with photon therapy. Conversely, this advantageous outcome was not evident in cases of chordomas located at the skull base.