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Within two years of follow-up, these patients may develop metastatic disease [ 4].
The group of patients after unplanned excision is also biased as compared with primary tumors, because part of this group before referral may develop metastatic disease and can never be eligible for local therapy.
The delay before surgery means that patients who fail to respond locally, progress and may develop metastatic disease (Rohatgi et al, 2005) or deteriorate because of excess toxicity, can be selected out.
Most patients presenting with breast cancer have disease localized to the breast and axillary lymph nodes and 40 50% of patients initially diagnosed with early breast cancer may develop metastatic disease.
Although response to NACT is associated with disease-free and overall survival some subgroups of patients do not benefit from achieving pCR and approximately 15%to25%5% of the patients may develop metastatic disease despite pCR [ 10- 15].
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Patients with a history of CCA may also develop metastatic disease several years after first presentation.
The majority of patients will be diagnosed with early stage disease [ 3], which is amenable to curative treatment with surgical care and/or radiation [ 4]; however, 6 10 % of patients will present with metastatic breast cancer [ 5], and up to 30%% of all patients may ultimately develop metastatic disease [ 6].
Both trials included a high proportion of men (>70%) who presented with de novo metastatic prostate cancer, and this patient population may not be representative of men who develop metastatic disease at some time after diagnosis of localised cancer.
Identifying patients likely to develop metastatic spread at an early stage in disease progression may have important clinical implications and may affect treatment regimens, and several prognostic factors are established.
Approximately 50%% of all patients with primary uveal melanoma will develop metastatic disease [8].
Unfortunately, 30percentt of those who had early stage breast cancer go on to develop metastatic breast cancer (please see this link for more information regarding metastatic breast cancer).
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