From the Division of Plastic Surgery, Duke University; Division of Plastic Surgery and Biomedical Library, Perelman School of Medicine, University of Pennsylvania; Plastic Surgery Foundation; and Plastic and Reconstructive Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center.
Plast Reconstr Surg. 2022 Oct 1;150(4):762-769. doi: 10.1097/PRS.0000000000009538. Epub 2022 Jul 22.
Although guidelines have been published on treatment of breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL), there has been no comprehensive analysis of BIA-ALCL treatment variation based on the available literature. The authors sought to assess current treatment strategies of BIA-ALCL relative to current guidelines.
Database searches were conducted in June of 2020. Included articles were case reports and case series with patient-level data. Collected variables included clinicopathologic features, implant characteristics, diagnostic tests, ALCL characteristics, treatment, and details of follow-up and outcome. Treatment data from before and after 2017 were compared with National Cancer Center Network guidelines.
A total of 89 publications were included and 178 cases of BIA-ALCL were identified. Most patients presented with seroma ( n = 114, 70.4 percent), followed by a mass ( n = 14, 8.6 percent), or both ( n = 23, 14.2 percent). Treatment included en bloc capsulectomy of the affected implant in 122 out of 126 cases with treatment details provided (96.8 percent). Radiation therapy was given in 38 cases (30.2 percent) and chemotherapy was given in 71 cases (56.3 percent). Practitioners used less chemotherapy for local disease after treatment guideline publication in 2017 ( p < 0.001), whereas treatment for advanced disease remained unchanged ( p = 0.3). There were 10 recurrences and eight fatalities attributable to BIA-ALCL, which were associated with advanced presentation (29 versus 2.1 percent; OR, 19.4; 95 percent CI, 3.9 to 96.3; p < 0.001).
BIA-ALCL remains a morbid but treatable condition. Current guidelines focus treatment for local disease and reduce nonsurgical interventions with radiation or chemotherapy. Patients presenting with advanced BIA-ALCL experience higher rates of recurrence and mortality.
尽管已经发布了关于乳房植入物相关间变性大细胞淋巴瘤（BIA-ALCL）治疗的指南，但基于现有文献，尚未对 BIA-ALCL 治疗的变化进行全面分析。作者旨在评估 BIA-ALCL 的当前治疗策略与当前指南的相关性。
作者于 2020 年 6 月进行了数据库检索。纳入的文章为具有患者水平数据的病例报告和病例系列。收集的变量包括临床病理特征、植入物特征、诊断性检查、ALCL 特征、治疗以及随访和结局的详细信息。将 2017 年前后的治疗数据与国家癌症中心网络指南进行了比较。
共纳入 89 篇文献，确定了 178 例 BIA-ALCL 病例。大多数患者表现为血清肿（n = 114，70.4%），其次是肿块（n = 14，8.6%），或两者均有（n = 23，14.2%）。126 例治疗详情提供的病例中，122 例（96.8%）接受了受累植入物整块包膜切除术。38 例（30.2%）接受了放射治疗，71 例（56.3%）接受了化疗。2017 年治疗指南发布后，医生对局部疾病的化疗使用减少（p < 0.001），而晚期疾病的治疗保持不变（p = 0.3）。BIA-ALCL 复发 10 例，死亡 8 例，与晚期表现相关（29%与 2.1%；OR，19.4；95%CI，3.9 至 96.3；p < 0.001）。
BIA-ALCL 仍然是一种严重但可治疗的疾病。当前指南侧重于局部疾病的治疗，并减少了放射或化疗等非手术干预。晚期 BIA-ALCL 患者的复发和死亡率更高。
