Autologous fat transfer after breast cancer surgery: An exact-matching study on the long-term oncological safety |
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| Affiliation: | 1. Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, via G. B. Grassi 74, 20157, Milan, Italy;2. Surgery Department, Breast Unit, Istituti Clinici Scientifici Maugeri IRCCS, via Maugeri 4, 27100, Pavia, Italy;3. Nanomedicine and Molecular Imaging Lab, Istituti Clinici Scientifici Maugeri IRCCS, via Maugeri 4, 27100, Pavia, Italy;1. Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands;2. Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands;3. Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands;1. Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, the Netherlands;2. Department of Orthepedic Surgery, Leiden University Medical Center, the Netherlands;3. Department of Pediatric Orthopedic Surgery, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands;4. Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands;1. Breast & Surgical Oncology, The Poche Centre, 40 Rocklands Rd, North Sydney, NSW, 2060, Australia;2. The University of Sydney, Northern Clinical School, NSW, 2006, Australia;3. The Mater Hospital, North Sydney, NSW, 2060, Australia;4. Royal North Shore Hospital, St Leonards, NSW, 2065, Australia;5. Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia;6. Chris O''Brien Lifehouse, Camperdown, NSW, 2050, Australia;7. Institute of Academic Surgery, Royal Prince Alfred Hospital, NSW, 2050, Australia;8. The University of Sydney, Professional Medical Education, Faculty of Medicine and Health, Camperdown, NSW, 2060, Australia;1. Department of Urolorgy, Hospital General Universitario Gregorio Marañón, Madrid, Spain;2. The Lillian Jean Kaplan Renal Transplant Center and the Miami Transplant Institute, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA;3. Servicio de Urología, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain;4. Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy;5. Department of Urology, University of California, Davis, School of Medicine, Sacramento, CA, USA;6. Servicio de Urología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain;7. USC/Norris Comprehensive Cancer Center, Los Angeles, CA, USA;8. Department of Urology, University of Heidelberg, Heidelberg, Germany;9. Department of Urology, A.O.U. San Giovanni Battista, University of Turin, Turin, Italy;10. Department of Urology and Pediatric Urology, Mainz University Medical Center, Mainz, Germany;11. Department of Urology, New York University Langone School of Medicine, New York, USA;12. Department of Urology, Hospital Universitario La Paz, Madrid, Spain;13. Department of Urology, Emory University, Atlanta, GA, USA;14. Department of Urology, Columbia University College of Physicians and Surgeons, New York, USA;15. Department of Urology, Paracelsus University Hospital (PMU), Nürnberg, Germany;p. Department of Urology, Fundació Puigvert, Barcelona, Spain;q. Department of Urology, UNC at Chapel Hill, Chapel Hill, NC, USA;r. Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA;s. Department of Urology, Weill Cornell Medical Center, New York, USA;t. Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria;u. Department of Urology, Center of Urology/Prostate Cancer Center Hirslanden, Zürich, Switzerland;v. Division of Urology, Maggiore della Carita Hospital, University of Eastern Piedmont, Novara, Italy;w. Hospital Universitario y Politécnico La Fe, Valencia, Spain;x. Department of Urology, Medical University of Graz, Graz, Austria;y. Department of Urology, Emerson Hospital-MGH Cancer Center, Boston, MA, USA;1. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China;2. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China;3. Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangdong, 510060, China;4. Department of Digestive Surgery, St. Mary''s Hospital, University of Perugia, Terni, 05100, Italy;1. Department of Surgery, Institut Paoli-Calmettes, Marseille, France;2. Department of Oncology, Institut Paoli-Calmettes, Marseille, France;3. Department of Radiotherapy, Institut Paoli-Calmettes, Marseille, France;4. Department of Pathology, Institut Paoli-Calmettes, Marseille, France;5. Department of Endoscopy, Institut Paoli-Calmettes, Marseille, France;6. Aix-Marseille University, Institut Paoli-Calmettes, Department of Surgery, CNRS, Inserm, CRCM, Marseille, France |
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| Abstract: | IntroductionAutologous fat transfer (AFT) is widely adopted for breast reconstruction, but its long-term oncologic safety is still not clearly established. The aim of the present study was to compare the 10-year loco-regional recurrence (LRR)-free and distant metastases (DM)-free survival probabilities in AFT vs. control patients, also evaluating the impact of AFT in different intrinsic molecular subtypes of breast cancer.Materials and methods464 AFT patients were exactly matched with a cohort of 3100 control patients treated between 2007 and 2017. A multivariate survival analysis was performed accounting for all variables related to LRR and DM, including adjuvant/neoadjuvant treatments. End-points were analyzed both overall and in each molecular subtype.ResultsLRR occurred in 6.4% of AFT and in 5.0% of control patients (p = 0.42), while DM were observed respectively in 7.7% and 5.4% of cases (p = 0.20). AFT showed no effect on the 10-year LRR-free survival probability (adjusted HR 0.87, 95%CI 0.43–1.76, p = 0.69) or the 10-year DM-free survival probability (adjusted HR 0.82, 95%CI 0.43–1.57, p = 0.55). Luminal A patients treated by AFT showed a decreased LRR-free survival probability (HR 2.38, 95%CI 0.91–6.17, Log-Rank p = 0.07), which was significantly lower than controls after 80 months (Log-Rank p = 0.02). No differences in the 10-year event-free survival probability were found in Luminal B, HER2-positive or triple-negative patients.ConclusionAFT does not increase breast cancer recurrence, with the possible exception of late LRRs for Luminal A patients, but further clinical and preclinical data are required to better clarify this data. The use of AFT should not be discouraged. |
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| Keywords: | Autologous fat transfer Lipofilling Breast cancer Loco-regional recurrence Distant metastasis |
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