The Effect of Treatment Facility, Race, and Chemoradiation on Survival for Signet Ring Cell Carcinoma of the Esophagus: An Analysis of the National Cancer Database

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.