The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, 55 Zhenhai Road, Siming District, Xiamen, Fujian, 361003, P. R. China.
The Third Clinical Medical College, Fujian Medical University, Xiamen, Fujian, P. R. China.
World J Surg Oncol. 2023 Apr 17;21(1):133. doi: 10.1186/s12957-023-03010-z.
Cell-assisted lipotransfer (CAL), a technique of autologous adipose transplantation enriched with adipose-derived stem cells (ADSCs), has the potential to improve cosmetic outcomes at irradiated sites. However, many concerns have been raised about the possibility of ADSCs increasing oncological risk in cancer patients. With the increasing demand for CAL reconstruction, there is an urgent need to determine whether CAL treatment could compromise oncological safety after radiotherapy, as well as to evaluate its efficacy in guiding clinical decisions.
A PRISMA-compliant systematic review of the safety and efficacy of CAL in breast cancer patients after radiotherapy was conducted. The PubMed, Ovid, Cochrane Library, and ClinicalTrials.gov databases were comprehensively searched from inception to 31 December 2021.
The search initially yielded 1185 unique studies. Ultimately, seven studies were eligible. Based on the limited outcome evidence, CAL did not increase recurrence risk in breast cancer patients but presented aesthetic improvement and higher volumetric persistence in a long-term follow-up. Although breast reconstruction with CAL also had oncological safety after radiotherapy, these patients needed more adipose tissue and had relatively lower fat graft retention than the non-irradiated patients (P < 0.05).
CAL has oncological safety and does not increase recurrence risk in irradiated patients. Since CAL doubles the amount of adipose required without significantly improving volumetric persistence, clinical decisions for irradiated patients should be made more cautiously to account for the potential costs and aesthetic outcomes. There is limited evidence at present; thus, higher-quality, evidence-based studies are required to establish a consensus on breast reconstruction with CAL after radiotherapy.
细胞辅助脂肪转移（CAL）是一种富含脂肪来源干细胞（ADSCs）的自体脂肪移植技术，有可能改善放射治疗部位的美容效果。然而，人们对 ADSCs 是否会增加癌症患者的肿瘤风险提出了诸多担忧。随着对 CAL 重建需求的增加，迫切需要确定 CAL 治疗是否会影响放射治疗后的肿瘤安全性，并评估其在指导临床决策方面的疗效。
对放射治疗后乳腺癌患者 CAL 的安全性和疗效进行了 PRISMA 一致的系统评价。全面检索了 PubMed、Ovid、Cochrane 图书馆和 ClinicalTrials.gov 数据库，检索时间从建库至 2021 年 12 月 31 日。
最初检索到 1185 项独特的研究。最终，有 7 项研究符合纳入标准。根据有限的结果证据，CAL 并未增加乳腺癌患者的复发风险，但在长期随访中表现出美观改善和更高的体积保持率。尽管 CAL 进行乳房重建在放射治疗后也具有肿瘤安全性，但这些患者需要更多的脂肪组织，并且脂肪移植物的保留率相对低于未接受放射治疗的患者（P<0.05）。
CAL 具有肿瘤安全性，不会增加照射患者的复发风险。由于 CAL 使所需脂肪量增加了一倍，但体积保持率并没有显著提高，因此对于照射患者的临床决策应更加谨慎，以考虑潜在的成本和美学效果。目前证据有限，因此需要进行更高质量的基于证据的研究，以就放射治疗后使用 CAL 进行乳房重建达成共识。
