Pennati Angela, Riggio Egidio, Marano Giuseppe, Biganzoli Elia
Unit of Plastic and Reconstructive Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milano, Italy.
Unit of Plastic and Reconstructive Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milano, Italy.
J Plast Reconstr Aesthet Surg. 2018 Dec;71(12):1723-1729. doi: 10.1016/j.bjps.2018.07.028. Epub 2018 Aug 8.
The regenerative effectiveness of lipoaspirate procedures relies on the presence of mesenchymal stem cells, but the stromal microenvironment and hormonal secretions of the adipose tissue may be involved in cancer growth. Only few oncological outcome studies of fat grafting at the surgical site of malignant neoplasms of mesenchymal origin are available; none of these studies examined a series of sarcoma cases.
We analyzed outcome in terms of local or distant spread and overall survival to investigate the oncological safety of fat grafting in patients with sarcoma.
Sixty consecutive patients who had undergone 143 fat grafting procedures after surgical resection of bone and soft tissue sarcomas of the head, trunk, and limbs with clear resection margins were enrolled from 2004 to 2015 in our tertiary care center. A multidisciplinary sarcoma team administered adjuvant therapies. Patients were recurrence free at fat grafting.
The overall median follow-up was 7.5 years. At follow-up after fat grafting (2.4 years), one patient had distant metastasis and two had local relapse. Kaplan-Meier analysis showed disease-free survival rate of 95.4% (CI: 89.1-100.0) at 24 months. The risk of local recurrence (LR) within 24 months was 4.6% (CI: 0.0-20.9). The probability of not having LR after fat grafting was ≥ 89.1%.
We found no evidence of an increased cancer risk after fat grafting procedures in patients with sarcoma, but a stimulatory role of fat cannot be excluded for bone sarcomas based on the cases reported here, and further studies are therefore needed.
脂肪抽吸术的再生效果依赖于间充质干细胞的存在，但脂肪组织的基质微环境和激素分泌可能与癌症生长有关。目前仅有少数关于间充质起源恶性肿瘤手术部位脂肪移植的肿瘤学结局研究；这些研究均未对一系列肉瘤病例进行检查。
我们分析局部或远处扩散及总生存率方面的结局，以调查肉瘤患者脂肪移植的肿瘤学安全性。
2004年至2015年期间，我们三级医疗中心连续纳入了60例患者，这些患者在接受头、躯干和四肢骨与软组织肉瘤手术切除且切缘清晰后接受了143次脂肪移植手术。多学科肉瘤团队给予辅助治疗。脂肪移植时患者无复发。
总体中位随访时间为7.5年。脂肪移植后随访（2.4年）时，1例患者发生远处转移，2例患者发生局部复发。Kaplan-Meier分析显示，24个月时无病生存率为95.4%（CI：89.1-100.0）。24个月内局部复发（LR）风险为4.6%（CI：0.0-20.9）。脂肪移植后无LR的概率≥89.1%。
我们未发现肉瘤患者脂肪移植术后癌症风险增加的证据，但基于本文报道的病例，不能排除脂肪对骨肉瘤的刺激作用，因此需要进一步研究。
