Optimal care and survival for signet-ring cell and non-signet-ring cell gastric cancer are more achievable at academic cancer centers

• Published in: The American journal of surgery Vol. 222; no. 5; pp. 969 - 975
• Main Authors: Moslim, Maitham A., Deng, Mengying, Handorf, Elizabeth, Greco, Stephanie H., Farma, Jeffrey M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2021; Elsevier Limited
• Subjects: Academic; Academic Medical Centers - standards; Academic Medical Centers - statistics & numerical data; Adult; Aged; Aged, 80 and over; Cancer; Cancer therapies; Carcinoma, Signet Ring Cell - mortality; Carcinoma, Signet Ring Cell - surgery; Cell survival; Chemotherapy; Community centers; Comprehensive cancer center; Dissection; Female; Gastrectomy; Gastric cancer; Gastrointestinal surgery; Humans; Lymph nodes; Lymphatic system; Male; Middle Aged; Mortality; Patients; Population studies; Quality of Health Care; Retrospective Studies; Signet-ring cell gastric carcinoma; Stomach Neoplasms - mortality; Stomach Neoplasms - surgery; Survival; Survival Analysis; Tumors; United States > US; Academic; Gastrectomy; Gastric cancer; Signet-ring cell gastric carcinoma; Comprehensive cancer center
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2021.05.007

Western literature lacks large-scale population studies comparing the influence of academic and high-volume (HV) versus low-volume (LV) cancer centers on gastric cancer oncologic outcomes. The National Cancer Database from 2004 to 2016 was used. 22871 patients were studied. Patients with stage III signet-ring cell gastric carcinoma (SRGC) received neoadjuvant treatment (NAT) more frequently at academic and HV comprehensive cancer centers (OR: 4.27 and 2.42; p < 0.0001 and 0.009) compared to community centers. Patients with stage III non-SRGC (NSRGC) had a 2.4 times higher odds of receiving NAT at academic centers. The R1 resection rate for NSRGC was lower at academic centers (OR: 0.67; p = 0.0018). Lymph node harvest ≥15 nodes was 1.6 and 1.9 times higher at academic centers for NSRGC and SRGC, respectively. Patients treated at academic centers had a significantly improved overall survival (OS). Treatment at academic centers is associated with significant improvements in oncologic metrics and OS. [Display omitted] •Academic outperform community centers in management of resectable gastric cancer.•Despite delay in treatment initiation, survival is improved at academic centers.•Survival is greater in signet-ring cell gastric cancer treated at academic centers.