Abstract
Background: Signet ring cell carcinoma of the esophagus (SRCCE) is an aggressive tumor that represents
approximately 3.5-5.0% of all esophageal cancers. Prior studies have shown a strong correlation between
treating facility and survival for different cancers, but this has not been studied in SRCCE. The goal of this
study is to assess differences in survival based on the type of treatment facility.
Methods: There were 2,021 patients with SRCCE identified using the histology 8490 and topography codes
C15.0-C15.9 in the National Cancer Database (NCDB). Descriptive analysis, Kaplan-Meier curves, and a
multivariable Cox hazard regression analysis were all utilized to determine the significance of treatment
facility type and other variables.
Results: The cohort mostly received treatment at academic centers (47.7%). As age increased, mortality
also increased (HR=1.01; 95% CI:1.01-1.02, p<0.001). Africans Americans (HR=1.44; 95% CI:1.02-2.02,
p=0.036) had an increased risk of mortality when compared to Non-Hispanic Caucasians. Patients at
academic facilities demonstrated a decreased risk of mortality when compared to community programmes
(HR=0.73; 95% CI:0.64-0.84, p<0.001) and integrated cancer programmes (HR=0.69; 95% CI:0.58-0.83,
p=0.008). Neoadjuvant chemoradiation resulted decreased mortality when compared to adjuvant
chemoradiation (HR=1.41; 95% CI:1.21-1.63, p<0.001) and no chemoradiation (HR=1.84; 95% CI:1.58-
2.14, p<0.001).
Conclusion: For patients diagnosed with SRCCE, receiving treatment at academic centers resulted in better
survival probabilities compared to nonacademic facilities. Older patients, African Americans, increasing
tumor stage, no and adjuvant chemoradiation, and comorbidities with Charlson-Deyo scores of 1 and 2+
were all associated with an increased risk of mortality from SRCCE.