Sharma Kavita, Gilmour Adam, Jones Georgina, O'Donoghue Joseph M, Clemens Mark W
The Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, UK.
Leeds Beckett University, United Kingdom.
JPRAS Open. 2022 Sep 23;34:178-188. doi: 10.1016/j.jpra.2022.08.008. eCollection 2022 Dec.
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has increasingly become a significant concern for patients. Focus thus far has been on understanding pathogenesis and establishing treatment pathways. There has been less attention on the assessment of long-term treatment outcomes. The purpose of this study was to perform a systematic review to assess published data on treatment outcomes for BIA-ALCL.
Using PRISMA guidelines, a systematic search of the literature was carried out from January 1997 to January 2021 using the Web of Science (PubMed) and Ovid Medline. Included in the review were any studies on the management and follow-up of patients, including disease status at a minimum of 18 months following treatment.
A total of 39 articles matched the inclusion criteria. However, 94% of patients were managed with explantation and capsulectomy. Then, 39% of patients had adjuvant chemotherapy, 19% radiotherapy, 6% autologous stem cell transplant, and 4% immunotherapy. The mean follow-up was 19 months (range 3-36 months), and 69% of patients were reported to be alive at 18 months. The mainstay of treatment was surgical - en bloc capsulectomy with adjuvant treatment for advanced disease.
Robust survival data based on high-level evidence are challenging to establish in BIA-ALCL. Early diagnosis and en bloc capsulectomy with negative margins, whilst considering the need for adjuvant treatment, particularly targeted immune therapy in advanced disease represents the consistent forms of treatment. National databases, prospective studies, and treatment of patients in tertiary centres are all recommended to improve the quality of the research available in the management of BIA-ALCL.
乳房植入物相关间变性大细胞淋巴瘤（BIA-ALCL）日益成为患者关注的重要问题。迄今为止，重点一直放在了解发病机制和建立治疗途径上。对长期治疗结果的评估关注较少。本研究的目的是进行系统评价，以评估已发表的关于BIA-ALCL治疗结果的数据。
按照PRISMA指南，于1997年1月至2021年1月使用科学网（PubMed）和Ovid Medline对文献进行系统检索。纳入评价的是关于患者管理和随访的任何研究，包括治疗后至少18个月的疾病状态。
共有39篇文章符合纳入标准。然而，94%的患者接受了取出植入物和包膜切除术治疗。然后，39%的患者接受了辅助化疗，19%接受了放疗，6%接受了自体干细胞移植，4%接受了免疫治疗。平均随访时间为19个月（范围3 - 36个月），据报告69%的患者在18个月时存活。治疗的主要方法是手术——整块包膜切除术并对晚期疾病进行辅助治疗。
在BIA-ALCL中，基于高级别证据建立可靠的生存数据具有挑战性。早期诊断和切缘阴性的整块包膜切除术，同时考虑辅助治疗的必要性，特别是对晚期疾病进行靶向免疫治疗，是一致的治疗形式。建议建立国家数据库、开展前瞻性研究以及在三级中心对患者进行治疗，以提高BIA-ALCL管理方面现有研究的质量。
