Fertsch Sonia, Hagouan Mazen, Munder Beatrix, Schulz Tino, Abu-Ghazaleh Alina, Schaberick Julia, Stambera Peter, Aldeeri Mohammed, Andree Christoph, Thamm Oliver Christian
Department of Plastic and Reconstructive Surgery, SANA Krankenhaus Düsseldorf Gerresheim, Gräulingerstraße 120, Düsseldorf, Germany.
Gland Surg. 2017 Aug;6(4):315-323. doi: 10.21037/gs.2017.03.11.
BACKGROUND: Lipofilling is performed in breast cancer patients to optimize the aesthetic outcome following breast reconstruction after mastectomy. Despite its common usage worldwide, little is known about the interaction of the lipoaspirate and dormant cancer cells. Up to date, no risk factors that increase the risk for cancer recurrence have been established. This study aims to identify risk factors for lipofilling candidates after breast cancer and questions the oncological safety of lipofilling in lymph node positive disease. METHODS: Matched retrospective cohort study: the disease-free survival (DFS) between 100 breast cancer patients undergoing a lipofilling after their DIEP-flap reconstruction and 100 matched control patients with no subsequent lipofilling was analyzed. Further, patients were subdivided according to risk factors, which were categorized as patient-dependent factors (PDFs) and tumor-dependent factors (TDFs). DFS and hazard ratios (HR) were compared to identify potential risk factors that may increase cancer recurrence. RESULTS: Median follow-up was 76.5 months from the mastectomy, and 31 months from the startpoint to the end of follow-up. Seven and eleven patients had recurrence in the lipofilling and control group, respectively, presenting with comparable DFS rates and an insignificant HR =0.57, 95% confidence interval (CI): 0.22-1.47, P=0.24. According to subgroup survival analysis, lipofilling increased the risk of recurrence in women with a positive nodal status (P=0.035) and a high-grade neoplasia (P=0.049). CONCLUSIONS: No general increased recurrence risk was observed between the lipofilling and control group. The subgroup analysis identified high-grade neoplasia and positive nodal status to be a risk factor for cancer recurrence. Patients with a known node positive disease have an increased risk of occult micrometastases in their lymph nodes. Further studies are necessary to clarify whether dormant breast cancer cells in form of micrometastases in the lymph nodes can be reactivated by the factors secreted by adipose derived stem cells.
背景：在乳腺癌患者中进行脂肪填充，以优化乳房切除术后乳房重建的美学效果。尽管其在全球范围内广泛应用，但关于脂肪抽吸物与休眠癌细胞之间的相互作用知之甚少。迄今为止，尚未确定增加癌症复发风险的危险因素。本研究旨在确定乳腺癌后脂肪填充候选者的危险因素，并质疑脂肪填充在淋巴结阳性疾病中的肿瘤学安全性。 方法：配对回顾性队列研究：分析了100例在腹壁下动脉穿支皮瓣重建后进行脂肪填充的乳腺癌患者与100例未进行后续脂肪填充的配对对照患者之间的无病生存期（DFS）。此外，根据危险因素对患者进行细分，这些危险因素分为患者相关因素（PDFs）和肿瘤相关因素（TDFs）。比较DFS和风险比（HR），以确定可能增加癌症复发的潜在危险因素。 结果：从乳房切除术后的中位随访时间为76.5个月，从随访起点到终点为31个月。脂肪填充组和对照组分别有7例和11例患者复发，DFS率相当，HR = 0.57无统计学意义，95%置信区间（CI）：0.22 - 1.47，P = 0.24。根据亚组生存分析，脂肪填充增加了淋巴结阳性状态（P = 0.035）和高级别肿瘤形成（P = 0.049）女性的复发风险。 结论：脂肪填充组和对照组之间未观察到总体复发风险增加。亚组分析确定高级别肿瘤形成和淋巴结阳性状态是癌症复发的危险因素。已知淋巴结阳性疾病的患者淋巴结中隐匿微转移的风险增加。有必要进一步研究以阐明淋巴结中微转移形式的休眠乳腺癌细胞是否会被脂肪来源干细胞分泌的因子重新激活。
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