P-OGC45 Could lymphatic, vascular or perineural invasion status improve clinical staging prior to oesophagectomy?

Abstract Background Unimodal treatment of oesophagogastric cancer (OGC) with surgery only is currently reserved for patients with early disease. Presence of vascular (VI), perineural (PNI) or lymphatic vessel invasion (LI) in pathological samples have been shown to be negative prognostic indicators of survival. These factors have been found to be associated with more advanced disease. Staging of OGC has limitations and in neoadjuvant naive populations it has been shown to be imperfect. It is unknown whether VI, PNI or LI could play any role during the staging process. Methods Patients with early disease (cT2 or less and cN0) who underwent unimodal treatment of their oesophageal or junctional cancer with oesophagectomy between 2010 and 2019 in a single centre were included in this study. Therelationship between presence of LI, VI and PNI on pathological samples with incorrect staging/upstaging indicating locally advanced disease (defined as pT3+ or pN+) was studied using logistic regression model. Results There were 128 patients included. 26 patients (20%) were upstaged to pT3+ or pN+. LI, VI and PNI were present in 18%, 11% and 8% respectively. The presence of LI and clinical T stage were independently predictive of incorrect staging/upstaging in multivariable logistic regression analysis. LI (OR 12.5 95%CI 3.7-42.8, p < 0.001) and cT2 (OR 5.9 95%CI 1.5-23.2, p = 0.01). Conclusions These results indicate that the presence of LI from pathological samples is a strong independent prognostic factor of incorrect staging which would normally favour neoadjuvant treatment. The presence of LI suggests aggressive disease. Further studies should concentrate on the possibility of obtaining LI status from preoperative biopsies or endoscopic mucosal resection samples. This staging information could play an important role in deciding whether neoadjuvant therapy is indicated in patients staged as early disease.

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Abandoning resectional intent in patients initially deemed suitable for esophagectomy: a nationwide study of risk factors and outcomes

Diseases of the Esophagus ◽

10.1093/dote/doaa088 ◽

2020 ◽

Author(s):

David Edholm ◽

Mats Lindblad ◽

Gustav Linder

Keyword(s):

Risk Factors ◽

Cox Regression ◽

Advanced Disease ◽

Gastroesophageal Junction ◽

Neoadjuvant Treatment ◽

Multivariable Logistic Regression Analysis ◽

Factors Associated ◽

Gastroesophageal Junction Cancer ◽

Increased Risk ◽

Impact On Survival

Summary The main curative treatment modality for esophageal cancer is resection. Patients initially deemed suitable for resection may become unsuitable, most commonly due to signs of generalized disease or having become unfit for surgery. The aim was to assess risk factors for abandoning esophagectomy and its impact on survival. All patients diagnosed with an esophageal or gastroesophageal junction cancer in the Swedish National Register for Esophageal and Gastric Cancer from 2006–2016 were included and risk factors associated with becoming ineligible for resection were analyzed in multivariable logistic regression analysis. Overall survival was explored by multivariable Cox regression models. Among 1,792 patients planned for resection, 189 (11%) became unsuitable for resection before surgery and 114 (6%) had exploratory surgery without resection. Intermediate and high educational levels were associated with an increased probability of resection (odds ratio (OR) 1.46, 95% CI 1.05–2.05, OR 1.92, 95% CI 1.28–2.87, respectively) as was marital status (married: OR 1.37, 95% CI 1.01–1.85). Clinically advanced disease (cT4: OR 0.38, 95% CI 0.16–0.87; cN3: OR 0.27, 95% CI 0.09–0.81) and neoadjuvant treatment were associated with a decreased probability of resection (OR 0.62, 95% CI 0.46–0.88). Five-year survival for non-resected patients was only 4.5% although neoadjuvant treatment was associated with improved survival (HR 0.75, 95% CI 0.56–0.99). Non-resected patients with squamous cell carcinoma had comparatively reduced survival (HR 1.64, 95% CI 1.10–2.43). High socioeconomic status was associated with an increased probability of completing the plan to resect whereas clinically advanced disease and neoadjuvant treatment were independent factors associated with increased risk of abandoning resectional intent.

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503 QUALITY OF LIFE AS A PREDICTOR OF POST-ESOPHAGECTOMY SHORT TERM OUTCOMES AND SURVIVAL

Diseases of the Esophagus ◽

10.1093/dote/doaa087.129 ◽

2020 ◽

Vol 33 (Supplement_1) ◽

Author(s):

A Katz ◽

J Ramirez-GraciaLuna ◽

A Kammili ◽

F Abureida ◽

J Cools-Lartigue ◽

...

Keyword(s):

Quality Of Life ◽

Operative Mortality ◽

Advanced Disease ◽

Locally Advanced ◽

Stage I ◽

Disease Stage ◽

Clinical Staging ◽

Term Survival ◽

Locally Advanced Disease

Abstract Most esophageal cancer patients present with symptoms that impact quality of life (QOL). In this study, we sought to determine the influence of QOL at diagnosis on postoperative outcomes and survival (OS). Methods A prospectively-collected esophagectomy database (2006–17) was queried to identify patients who completed Functional Assessment of Cancer Therapy-Esophageal module (FACT-E). Demographics/tumor/treatment details, operative variables, complications and OS were collected. Statistical analysis was done using Cox regression, logistic regression, ANOVA or Chi-square tests. Results Of 647 patients underwent esophagectomy in the study period, 359 how completed FACT-E at diagnosis were included in the study (age 64 ± 11, male 82%, stage I:9%, II:15%, III:69%, IV:7%, adenocarcinoma: 78%, neoadjuvant therapy: 70%). Clinical stage I was associated with better QOL at diagnosis (131 ± 2 vs 118 ± 28, p < 0.02). FACT-E > 125 was associated with lower peri-operative mortality (9% vs 1%, 0R = 6.1, P = 0.01), and when divided into quintiles, correlated directly with OS (Figure 1a), more over it was able to prognostically differentiate patients with locally-advanced disease (stage II + III) (Figure 1b) better than the clinical staging (Figure 1c). Conclusion QOL at diagnosis predicts peri-operative mortality and long-term survival. It can help to prognostically differentiate between patients with locally advanced disease. Attempts to improve QOL prior to surgery, such as with pre-habilitation, remain an attractive area of investigation.

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Deferral of rectal surgery following a continued response to preoperative chemoradiotherapy (Watch and Wait) study: A phase II multicenter study in the United Kingdom.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.489 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 489-489 ◽

Cited By ~ 11

Author(s):

S. K. Yu ◽

G. Brown ◽

R. J. Heald ◽

S. Chua ◽

G. Cook ◽

...

Keyword(s):

Rectal Cancer ◽

Surgical Resection ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Neoadjuvant Chemoradiotherapy ◽

Complete Response ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Clinical Staging ◽

Pet Ct

489 Background: Neoadjuvant chemoradiotherapy (CRT) and surgical resection are standard components of therapy for patients locally advanced rectal cancer (T3,T4 or N+) in UK. In 15%-30% of patients treated pre-operatively with CRT will develop pathological complete response (CR). The time from completion of CRT to maximal tumour response is as yet unknown. This study is the first prospective study to attempt to identify the percentage of patients who can safely omit surgery and the safety of deferred surgery in patients who achieve clinical complete response post CRT. Of the 59 patients required for the study, this provides an update on 19 patients entered. Methods: Patients with locally advanced rectal cancer requiring neoadjuvant treatment are identified in the multidisciplinary meet (MDT). Patients undergo CRT using a minimum of 50.4Gy in 28 # daily conformal CT planned CRT with concomitant Capecitabine at 825mg/m2 BD. MRI pelvis and body CT are repeated 4 weeks post CRT and rediscussed at MDT. If there is a good partial response or CR, patients are considered for Deferral of Surgery Study. Based on the pre treatment clinical staging, patients are considered for adjuvant chemotherapy as per NICE guidance. At any point of the study, if there is histology proven tumour regrowth or progression, patient undergo surgery. Results: 10 (53%) patients remain in CR. 6 (32%) patients underwent surgical resection with clear margin after detection of tumour regrowth at from 2-23 months post CRT. 5 out of 6 of the patients with tumour regrowth underwent PET CT as per protocol, and all tumour regrowth in those 5 patients were detected by PET CT, i.e. FDG avid disease. The pathological stages on these 6 patients were ypT2N0 CRM negative in 5 and ypT3N0 CRM negative in 1. 3 (15%) patients with tumour regrowth refused surgery. Conclusions: In the 19 recruited patients, all the patients with tumour regrowth underwent surgical resection with clear margins. PET CT appears a useful tool for detecting tumour regrowth. The median time for tumour regrowth is 17.5 months post CRT. The trial will be successful if at least 11/59 patients are able to safely omit surgery. Accrual of patients continues. No significant financial relationships to disclose.

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Esophageal squamous cell carcinoma in the VA population: What is the optimal treatment modality

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.15042 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 15042-15042

Author(s):

M. M. Safa ◽

M. S. Beg ◽

M. Atiq ◽

S. Ali ◽

R. Komrokji

Keyword(s):

Squamous Cell Carcinoma ◽

Esophageal Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Treatment Modality ◽

Advanced Disease ◽

Locally Advanced ◽

Early Disease ◽

Trimodality Therapy ◽

Squamous Cell Esophageal Cancer

15042 Introduction: Surgery for esophageal squamous cell carcinoma (SCC) has been the mainstay of treatment despite dismal outcome and significant surgical complications. There is no standard treatment modality for esophageal SCC. Methods: The VA (veteran affairs) Central Cancer Registry (VACCR) is a function of the Chief, Program Office for Oncology at VA Headquarters in Washington DC. We queried the VACCR database for all diagnosed squamous cell esophageal cancer cases between 1995 and 2005 using ICD codes 150–159. The data was transformed, entered and analyzed using SPSS v.13.0. We analyzed, in a retrospective fashion, survival in VA patients with early disease (stages 1–2), and locally advanced (stage 3) SCC comparing the treatment modality: chemoradiation alone (CRT), surgical resection alone (SUR) or trimodality therapy (TMT) which includes all three treatment options. Results: Out of a total of 6874 patients diagnosed with esophageal carcinoma, 2894 patients had SCC. A total of 433 patients were included in this study that were staged as 1–3 and had complete treatment information available. Baseline characteristics were not different between the three groups and are summarized in table 1 . Out of those, 57 (13.2%) received SUR, 323 (74.6%) CRT, and 53 (12.2%) TMT. Kaplan Meier analysis for median survival in early disease was 14 mo for SUR, 17 mo in CR, and 79 mo in TMT (p = 0.0288). There was no difference in survival among patients with locally advanced disease between the treatment groups (p = 0.7079) Conclusion: In VA patients with early esophageal SCC, TMT confers better survival than SUR or CRT. However, in patients with advanced disease, SUR, CRT and TMT groups showed comparable outcome. [Table: see text] No significant financial relationships to disclose.

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Prognostic indicators of aggressive disease in patients with locally advanced or metastatic prostate cancer: A focus on neutrophil to lymphocyte and platelet to lymphocyte ratios.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.7_suppl.62 ◽

2011 ◽

Vol 29 (7_suppl) ◽

pp. 62-62

Author(s):

A. Dabaja ◽

M. Menon ◽

P. Agarwal

Keyword(s):

Prostate Cancer ◽

Overall Survival ◽

Logistic Regression ◽

Hormone Therapy ◽

Metastatic Disease ◽

Odds Ratio ◽

Locally Advanced ◽

Prognostic Indicators ◽

Aggressive Disease ◽

Increased Risk

62 Background: Prostate specific antigen (PSA) and Gleason Score (GS) are helpful in predicting aggressive disease. Recently, the neutrophil:lymphocyte ratio (NLR) and platlet:lymphocyte ratio (PLR) were identified as prognostic indicators in gastric cancer which has an inflammatory pathogenesis. We hypothesized that these indicators may be prognostic in prostate cancer which is also postulated to have an inflammatory mechanism of carcinogenesis. Our goal was to assess if NLR and PLR is predictive of aggressive prostate cancer, which will be measured by metastasis and overall survival in patients on hormonal therapy as treatment. Methods: We performed a retrospective analysis of 246 patients that were being treated with hormone therapy for either locally advanced or metastatic disease, or who were not surgical candidates or refused surgery. A logistic regression model was used to analyze various prognostic factors including total GS, pre-biopsy PSA, perineural invasion, % of core biopsies positive, NLR, and PLR. Endpoints studied were overall survival and metastasis. Results: The logistic regression showed only pre biopsy PSA as a predictor of metastasis (n=82). The increased risk when measured continuously was 0.6% increase in odds ratio (p<0.015). When PSA was measured categorically the % biopsy cores positive were predictive of increased risk of metastatic disease with a 2.9% increase in odds ratio (p<0.002). The % biopsy cores positive were predictive of a 3.7% increased odds ratio in cancer-specific mortality (p<0.002). These results were controlled for age, which gave a 7% increase in odds ratio of overall survival (p<0.049). Conclusions: Despite the thought that prostate cancer has an inflammatory pathogenesis, no correlation was found between N:L and P:L ratios and overall survival or bone metastasis in patients on hormone therapy for locally advanced disease. There was a negative correlation between increased % positive biopsy cores a decreased risk of survival. Further investigation is necessary to investigate the role of NLR and PLR as prognostic indicators in organ confined prostate cancer. No significant financial relationships to disclose.

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Accuracy of clinical staging with EUS for early stage esophageal cancer: Are we denying patients beneficial neoadjuvant chemo-radiation?

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.163 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 163-163

Author(s):

Carrie Luu ◽

Norbert Garcia-Henriquez ◽

Jason Klapman ◽

Cynthia L. Harris ◽

Khaldoun Almhanna ◽

...

Keyword(s):

Esophageal Cancer ◽

Neoadjuvant Therapy ◽

Early Stage ◽

Gastroesophageal Junction ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Significant Proportion ◽

Surgical Pathology ◽

Clinical Staging ◽

Cancer Center

163 Background: Esophagectomy alone has been considered the standard of care for early stage esophageal cancer (EC) while neoadjuvant therapy is now standard for locally advanced disease. The choice of treatment therefore hinges on accurate locoregional staging by endoscopic ultrasound (EUS). Our objective is to evaluate the accuracy of EUS performed in a high-volume tertiary cancer center in clinical stage T1N0 (cT1N0) and T2N0 (cT2N0) esophageal cancer patients undergoing esophagectomy without neoadjuvant therapy. Methods: A retrospective review of the esophageal cancer database at a single institution was performed. Patients with cT1N0 and cT2N0 esophageal cancer based on EUS undergoing esophagectomy without neoadjuvant treatment were evaluated. Patient demographics, tumor characteristics, and treatment were reviewed. Surgical pathology was compared to EUS staging. Results: Between 2000 and 2015, 139 patients were identified. There were 25 (18%) female and 114 (82%) male patients. The tumor location included the middle 1/3 of the esophagus in 11 (8%) and lower 1/3 and gastroesophageal junction in 128 (92%) patients. Eighty-one percent of patients had adenocarcinoma, 9% had squamous cell carcinoma, 9% had Barrett’s dysplasia, and 1% had mixed histology. Clinical staging were as follows: 110 (79%) patients had cT1N0 and 29 (21%) patients had cT2N0 tumors. For the entire cohort, preoperative EUS matched the final surgical pathology in 76/139 patients for an accuracy rate of 53%. Twenty-nine patients (21%) were under-staged by EUS; of those, 19 (14%) had unrecognized nodal disease. This included 12/109 (11%) of cT1N0 and 7/29 (24%) of cT2N0 patients. Conclusions: The accuracy of preoperative EUS staging in early esophageal cancer remains sub-optimal. Interestingly, a significant proportion (24%) of cT2N0 EC patients were found to have positive lymph nodes on surgical pathology, and perhaps these patients could have benefitted from neoadjuvant therapy. In light of these findings, the current management of cT2N0 esophageal cancer should be reconsidered.

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P-OGC60 Predicting the risk of venous thromboembolism during neoadjuvant therapy for oesophagogastric cancer

British Journal of Surgery ◽

10.1093/bjs/znab430.188 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Michele Calabrese ◽

Jakub Chmelo ◽

Pooja Prasad ◽

Joshua Brown ◽

Lauren Wallace ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Multivariable Analysis ◽

Previous History ◽

Vena Cava ◽

Radio Therapy ◽

Independent Risk Factors ◽

Oesophagogastric Cancer

Abstract Background Locally advanced oesophageal cancer is usually treated with neoadjuvant treatment (NAT) followed by surgery. Venous thromboembolism (VTE) is a recognised complication in these patients. Those who develop VTE may have an inferior vena cava filter placed prior to surgery to reduce the risk of further complications. This study aimed to identify specific risks for VTE during (NAT) for oesophagogastric cancer (OGC) and whether this increases postoperative morbidity. Methods Patients undergoing NAT for OGC followed by surgery at a single high-volume centre between January 2015 and June 2020 were identified from a prospectively maintained database. Univariable and multivariable logistic regression analyses were performed to identify independent risk factors for the development of VTE as well as the association between diagnosis of VTE and morbidity. Results The incidence of VTE in this cohort was 6.7% (27/406). Independent risk factors for developing VTE in multivariable analysis were BMI – OR 1.093 (p = 0.045) and age – OR 1.067 (p = 0.019). Type of chemo(radio)therapy regimen used, pT, pN stage, previous history of ischaemic heart disease or being an active smoker at diagnosis was not associated with VTE occurrence. Diagnosis of VTE during neoadjuvant treatment was not associated with a higher risk of developing a serious postoperative complication (Clavien-Dindo grade III and above) (p = 0.699). Conclusions Patients with a raised BMI or older age are at higher risk of developing VTE during NAT for OGC. These patients must be appropriately counseled on the higher risk of VTE prior to commencing NAT. However, the development of a VTE does not appear to confer any additional post-operative complication risk.

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Using circulating tumor DNA (ctDNA) to predict surgical outcome after neoadjuvant chemoradiation for locally advanced pancreatic cancer (LAPC).

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.272 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 272-272 ◽

Cited By ~ 3

Author(s):

Susan McDuff ◽

Aparna Raj Parikh ◽

Mehlika Hazar-Rethinam ◽

Hui Zheng ◽

Emily Van Seventer ◽

...

Keyword(s):

Logistic Regression ◽

Surgical Outcome ◽

Tumor Regression ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Advanced Pancreatic Cancer ◽

Digital Pcr ◽

Neoadjuvant Chemoradiation ◽

Tumor Regression Grade ◽

Entire Cohort

272 Background: Curative resection is possible following neoadjuvant treatment for LAPC, yet there is no method to identify patients beforehand who will have a favorable surgical outcome. This study was designed to assess the ability of ctDNA measured during neoadjuvant chemoradiation (CRT) to predict surgical outcome for LAPC. Methods: 38 LAPC pts were enrolled at our institution between 10/2015 - 5/2017. Pts received neoadjuvant FOLFIRINOX followed by CRT: either short-course ( n = 9, 25 Gy/5 fractions), or long-course ( n = 29, 50.4 Gy/28 fractions). Serum ctDNA was measured at baseline, weekly during CRT, and preoperatively. After extracting DNA from plasma, a tumor mutation specific droplet digital PCR assay was used to detect the fraction of ctDNA molecules. The following clinical and pathologic outcomes were noted: CA19-9, CEA, RECIST score, tumor grade, T stage, tumor regression grade (TRG), R-resection status, pathologically involved lymph nodes, LVI, and PNI. Results: The median age of the cohort was 67 years (range 42-85 years). Following CRT, 32 (84%) were operable. The overall R0-node negative (R0-NN) resection rate was 66% for the entire cohort. The rate of R0-NN resection was significantly higher among patients with an undetectable preoperative ctDNA ( n= 16) compared to those with a detectable ( n= 22) preoperative ctDNA (88% R0-NN vs 50% R0-NN, respectively, Fisher’s exact p = 0.036). On univariate logistic regression, only ctDNA status was significantly associated with R0-NN resection (p = 0.025), whereas preoperative RECIST score, CA19-9, and CEA were not associated. On multivariable logistic regression, ctDNA remained a borderline significant predictor for R0-NN resection when controlling for CA19-9 ( p = 0.058). For patients who received surgery, the ctDNA allele fraction was significantly correlated with TRG ( Pearson R = 0.399, p = 0.024). Conclusions: Undetectable preoperative ctDNA is associated with R0-NN surgical outcome in a cohort of patients treated with neoadjuvant CRT for LAPC. This approach is worthy of further study to establish guidelines for incorporating ctDNA into clinic with the goal of improving patient selection for surgery.

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MC (cisplatin and methotrexate) adjuvant chemotherapy after cystectomy versus MC neoadjuvant chemotherapy following cystectomy in locally advanced bladder cancer: Results after 10 years of experience

Urologia Journal ◽

10.1177/039156039506201s41 ◽

1995 ◽

Vol 62 (1_suppl) ◽

pp. 150-154

Author(s):

L Rigoni ◽

V. Scattoni ◽

P. Rovellini ◽

G. Pavia ◽

A. Bottanelli ◽

...

Keyword(s):

Overall Survival ◽

Bladder Cancer ◽

Adjuvant Chemotherapy ◽

Neoadjuvant Chemotherapy ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Clinical Staging ◽

Number Of Patients ◽

Significant Difference ◽

Advanced Bladder Cancer

— We report the results of a retrospective study of two groups of patients affected by locally advanced bladder cancer: the first group was submitted to adjuvant chemotherapy with Cisplatin and Methotrexate after cystectomy and the second group was submitted to neoadjuvant chemotherapy with the same scheme following radical cystectomy. The validity of the study is given by the homogeneity of the two groups for period of recruitment, number of patients, patient's age, stage of disease and treatment. The overall survival of 5 years in the first group was 30%, while the 5-year survival rate of the second group was 38%, 63% and 17% for all the patients, the responders and the nonresponders respectively. No significant difference in terms of survival was found between the two groups, but the results of the neoadjuvant approach may be influenced by clinical staging errors. The chemosensitivity, that can be assessed only with the neoadjuvant treatment, is the main prognostic factor.

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Breast Cancer Survival Disparities in Mexican Women Under a Comprehensive Health Reform

JCO Global Oncology ◽

10.1200/go.20.64000 ◽

2020 ◽

Vol 6 (Supplement_1) ◽

pp. 67-67

Author(s):

Rodrigo Huerta-Gutierrez ◽

Martin Lajous ◽

Salvador Zamora-Muñoz ◽

Juan Eugenio Hernández-Ávila ◽

Alejandro Mohar ◽

...

Keyword(s):

Breast Cancer ◽

Healthcare Reform ◽

Cancer Survival ◽

Advanced Disease ◽

Locally Advanced ◽

Mexican Women ◽

Early Disease ◽

Marginalized Communities ◽

Locally Advanced Disease ◽

Very High

PURPOSE One of the goals of Seguro Popular, Mexico’s landmark healthcare reform, was bridging the existing disparities in access to health care and health status. In 2007, this program began reimbursement of breast cancer treatment of previously uninsured Mexican women. We evaluated geographic disparities in breast cancer survival in women treated under this program and explored potential sources of heterogeneity. METHODS We classified women who were treated between 2007 and 2016 as having early (stages 0-IIA), locally advanced (stages IIB-IIIC), or metastatic (stage IV) disease. We categorized women based on a widely used marginalization index that considers education, household characteristics, rural population, and poverty levels in Mexican municipalities (low, moderate, high, and very high marginalization). We cross-linked reimbursement data with a national death registry and estimated 5-year overall survival according to clinical stage, marginalization levels, and state where women received treated. RESULTS Among 53,990 women treated for breast cancer the mean age was 52.9 years (± SD 12.4). Most patients had locally advanced disease (57.4%, n = 30,996). Early disease was more common in women with very low marginalization levels compared with women with very high levels (34% v 19%). Survival was 89.4% (95% CI: 88.8 to 89.9) for early disease, 69.8% (95% CI: 69.2 to 70.4) for locally advanced disease, and 36.1% (95% CI: 34.6 to 37.6) for metastatic disease. The least marginalized state experienced the highest survival for locally-advanced disease [76.0% (95% CI: 71.4 to 80.0)] whereas the most marginalized state experienced the lowest survival [50.2% (95% CI: 45.5 to 54.7)]. Survival in women from very highly marginalized communities was 68.7% (95% CI: 64.7 to 72.4), whereas survival in women from low marginalized communities was 74.8% (95% CI: 74.1 to 75.5). CONCLUSION In the face of a new wave of healthcare reform, Mexico will need to monitor and evaluate health disparities to achieve universal care for women with breast cancer.

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