Abstract
Cancer is a heterogeneous disease with variable biology and often unpredictable clinical outcomes. Current clinicopathologic staging is often unable to accurately predict which individuals will suffer systemic relapse after definitive loco regional treatment. In fact, many patients with early-stage disease will develop metastases within 10 years after treatment.1 Conversely, up to 30% of patients with high-risk cancer experience long-term disease-free survival with loco regional therapy alone. Risk reduction for relapse and death is unquestionably improved by adjuvant systemic therapy; however, the absolute benefits of adjuvant therapy is achieved in less than 15% of patients overall, and precise identification of individuals who will benefit from systemic therapy is not possible on clinical or pathologic grounds.2 The distressing fact is that most cancer patients are overtreated in the adjuvant setting to avoid missing those few who might achieve benefit.
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