Vyas Krishna S, DeCoster Ryan C, Burns Jack C, Rodgers Louis T, Shrout Max A, Mercer James P, Coquillard Cristin, Dugan Adam J, Baratta Michael D, Rinker Brian D, Vasconez Henry C
From the Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN.
Division of Plastic and Reconstructive Surgery.
Ann Plast Surg. 2020 Jun;84(6S Suppl 5):S405-S410. doi: 10.1097/SAP.0000000000002285.
Autologous fat grafting (AFG) is a popular and effective method of breast reconstruction after mastectomy; however, the oncological safety of AFG remains in question. The aim of this study was to determine whether AFG increases the risk of cancer recurrence in the reconstructed breast.
A matched, case-control study was conducted from 2000 to 2017 at the senior author's institution. Inclusion was limited to female patients who underwent mastectomy and breast reconstruction with or without AFG. Data were further subdivided at the breast level. χ analyses were used to test the association between AFG status and oncologic recurrence. A Cox proportional-hazards model was constructed to assess for possible differences in time to oncologic recurrence. The probability of recurrence was determined by Kaplan-Meier analyses and confirmed with log-rank testing.
Overall, 428 breasts met study criteria. Of those, 116 breasts (27.1%) received AFG, whereas 312 (72.9%) did not. No differences in the rates of oncologic recurrence were found between the groups (8.2% vs 9.0%, P < 1.000). Unadjusted (hazard ratio = 1.03, confidence interval = 0.41-2.60, P < 0.957) and adjusted hazard models showed no statistically significant increase in time to oncologic recurrence when comparing AFG to non-AFG. In addition, no statistical differences in disease-free survival were found (P = 0.96 by log rank test).
Autologous fat grafting for breast reconstruction is oncologically safe and does not increase the likelihood of oncologic recurrence. Larger studies (eg, meta analyses) with longer follow-up are needed to further elucidate the long-term safety of AFG as a reconstructive adjunct.
自体脂肪移植（AFG）是乳房切除术后乳房重建的一种常用且有效的方法；然而，AFG的肿瘤学安全性仍存在疑问。本研究的目的是确定AFG是否会增加重建乳房中癌症复发的风险。
2000年至2017年在资深作者所在机构进行了一项匹配的病例对照研究。纳入对象仅限于接受乳房切除术并进行或未进行AFG乳房重建的女性患者。数据在乳房层面进一步细分。采用χ分析来检验AFG状态与肿瘤复发之间的关联。构建Cox比例风险模型以评估肿瘤复发时间的可能差异。通过Kaplan-Meier分析确定复发概率，并通过对数秩检验进行确认。
总体而言，428个乳房符合研究标准。其中，116个乳房（27.1%）接受了AFG，而312个（72.9%）未接受。两组之间肿瘤复发率没有差异（8.2%对9.0%，P<1.000）。未调整（风险比=1.03，置信区间=0.41-2.60，P<0.957）和调整后的风险模型显示，将AFG与非AFG进行比较时，肿瘤复发时间没有统计学上的显著增加。此外，无病生存率没有统计学差异（对数秩检验P=0.96）。
用于乳房重建的自体脂肪移植在肿瘤学上是安全的，不会增加肿瘤复发的可能性。需要更大规模、随访时间更长的研究（如荟萃分析）来进一步阐明AFG作为重建辅助手段的长期安全性。
