Improved outcomes for responders to induction chemotherapy 45 CHAPTER 3 Figure 1. Pathologic response to treatment (a) and achievement of R0 resection (b) are independent prognostic variables after multivariable analysis. Combination of these variables help to fine-tune prognosis (c). For disease free survival, only response remained significant after multivariable analysis (HR 2.070; 95% CI 0.904–4.736 for ‘‘good’’ responders and HR 3.525; 95% CI 1.388–8.951 for ‘‘poor’’ responders, p = 0.024). Median DFS for complete responders, good responders, and poor responders was 35, 14, and 11 months, respectively. For local recurrence free survival, response (HR 2.232 95% CI 0.787–6.328 for ‘‘good’’ responders and HR 5.684; 95% CI 1.776–18.191 for ‘‘poor’’ responders, p = 0.004), resection margin (HR 2.104; 95% CI 1.125–3.933; p = 0.020), and lymph node status of the primary tumor (HR 0.816; 95% CI 0.388–1.719 for N1 and HR 2.156; 95% CI 1.001–4.640 for N2, p = 0.036) remained significant after multivariable analysis (Fig. 1a, b). For metastasis free survival, only response was significant after univariable analyses (p = 0.003). Hazard ratios were 2.0 and 5.0 for good and poor responders compared with complete responders. Median MFS for complete 0 1.0 0 1.0 0 1.0 0 12 24 36 0 12 24 36 0 12 24 36 months p=0.092* OS OS p=0.028 OS p=0.007 MFS p=0.003 MFS p=0.112 MFS p=0.013 LRFS p=0.004 LRFS p=0.020 LRFS p<0.000 pCR (Mandard 1) Good response (Mandard 2 or 3) Poor response (Mandard 4 or 5) pCR (R0) Good response and R0 Good response and R+ Poor response and R0 Poor response and R+ R0 resection R+ resection (R1 and R2) a pathologic response b Resection margin c Combination FIG. 1 Pathologic response to treatment (a) and achievement of R0 resection (b) are independent prognostic variables after multivariable analysis. Combination of these variables helps to fine-tune prognosis (c). OS overall survival; MFS metastasis-free survival; LRFS local recurrence-free survival. *Only for complete versus noncomplete responders significant (p = 0.045) Induction Chemotherapy for LRRC OS Overall survival; MFS metastasis-free survival; LRFS local recurrence-free survival. *Only for complete versus noncomplete responders significant (P = 0.045). Patients with synchronous metastases Patients presenting with LRRC and synchronous metastases had overall a poor oncological outcome. None of the patients had a DFS extending beyond 2 years. An R0 resection was a prognostic factor for overall survival and local recurrence (P = 0.033, HR 0.237, 95 percent CI 0.063–0.894 and P = 0.016, HR 0.236, 95 percent CI 0.73–0.768, respectively). Median OS was not reached for patients with an R0 resection (3-year OS 68 percent) and median OS was 23 months after an irradical resection. Median LRFS
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