Mazur Sławomir, Zołocińska Aleksandra, Siennicka Katarzyna, Janik-Kosacka Karolina, Chrapusta Anna, Pojda Zygmunt
Department of Breast Cancer and Reconstructive Surgery, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warszawa, Poland.
Department of Regenerative Medicine, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warszawa, Poland.
Adv Clin Exp Med. 2018 Aug;27(8):1085-1090. doi: 10.17219/acem/70798.
Progress in breast cancer surgery results in a decreased frequency of mastectomy, in the early phases of cancer replaced by breast conserving therapy (lumpectomy). Increased popularity of breast reconstruction by fat or adipose stem cells (ASC)-enriched fat transfer raised uncertainty about the possible risk of increased cancer recurrence. In vitro studies suggest that locally secreted cytokines and reconstructed local blood vessels may stimulate cancer expansion or cancer de novo induction from glandular tissue remaining after lumpectomy.
The purpose of the study was to evaluate the risk of cancer recurrence in breast cancer patients related to the stromal vascular fraction (SVF) augmentation during autologous fat grafting for breast reconstruction.
The tumor recurrence ratio in 56 patients having the breast reconstructed with autologous ASC (transplanted as the subpopulation present in SVF) was compared with the frequency of tumor recurrence in 252 matched patients treated in clinics without subsequent breast reconstruction. Adipose tissue was collected by the Coleman technique and split into 2 portions: one was used for breast reconstruction, the other was enzymatically digested, and isolated cells were used for the augmentation of fat implanted into the breast area. Cancer recurrence in the experimental and matched control group was evaluated following 3-year-long observation time, and the statistical significance of difference in cancer recurrence between the experimental and control group was evaluated.
Cancer recurrence in the group of patients treated with ASC-enriched fat for breast reconstruction was 3.7% and did not differ significantly from the control group data (4.13%). No adverse effects of therapy were observed.
Our study does not produce any data suggesting increased cancer risk following breast reconstruction after a mastectomy or a lumpectomy combined with local radiotherapy. It may be concluded that an autologous transplantation of fat augmented with ASC is a safe and efficient procedure. Longer observation time and the observation of larger numbers of patients would be useful for strengthening the conclusion.
乳腺癌手术的进展导致乳房切除术的频率降低，在癌症早期，乳房保留疗法（肿块切除术）取而代之。通过脂肪或富含脂肪干细胞（ASC）的脂肪移植进行乳房重建越来越受欢迎，这增加了癌症复发风险可能升高的不确定性。体外研究表明，局部分泌的细胞因子和重建的局部血管可能会刺激癌症扩展或从肿块切除术后残留的腺组织中重新诱发癌症。
本研究的目的是评估在乳腺癌患者自体脂肪移植进行乳房重建过程中，与基质血管成分（SVF）增加相关的癌症复发风险。
将56例接受自体ASC乳房重建（作为SVF中的亚群进行移植）患者的肿瘤复发率与252例在诊所接受治疗且未进行后续乳房重建的匹配患者的肿瘤复发频率进行比较。采用科尔曼技术收集脂肪组织并分成两部分：一部分用于乳房重建，另一部分进行酶消化，分离出的细胞用于增加植入乳房区域的脂肪。在3年的观察期后评估实验组和匹配对照组的癌症复发情况，并评估实验组和对照组之间癌症复发差异的统计学显著性。
接受富含ASC脂肪进行乳房重建的患者组中癌症复发率为3.7%，与对照组数据（4.13%）无显著差异。未观察到治疗的不良反应。
我们的研究未产生任何数据表明乳房切除术后或肿块切除术后联合局部放疗进行乳房重建后癌症风险增加。可以得出结论，自体移植富含ASC的脂肪是一种安全有效的方法。更长的观察时间和对更多患者的观察将有助于加强这一结论。
