Signet ring cell carcinoma of the gastrointestinal tract: National trends on treatment effects and prognostic outcomes

•In this cohort study based on 913,059 gastrointestinal carcinomas reported to the United States national cancer Database, the signet ring cell carcinoma diagnosis was associated with significantly worsened overall survival (adjusted HR = 1.37).•The magnitude of survival disadvantage was site-dependent, and most evident for rectal signet ring cell carcinomas (adjusted HR = 2.37).•Both systemic therapies and resection were associated with benefit across examined histologies and primary sites. Signet ring cell carcinoma (SRCC) is a distinct malignancy occurring across the tubular gastrointestinal tract (tGIT). We comprehensively examined the outcomes of patients diagnosed with SRCC across tGIT. SRCC and not-otherwise-specified adenocarcinoma (NOS) patients reported to the National Cancer Database from 2004 to 2015 were included. Baseline characteristics, outcomes and site-specific adjusted hazard ratios (aHR) derived from Cox models of SRCC patients were compared to those of NOS patients. Overall survival (OS) was primary endpoint. A total of 41,686 SRCC (4.6%) and 871,373 NOS patients (95.4%) were included. SRCC patients were younger (63.1 ± 14.7 vs. 67.0 ± 13.4 y, p