【摘要】 目的评价乳腺癌术后乳房重建患者行自体脂肪移植的肿瘤学安全性。方法检索PubMed、Embase、Cochrane、中国知网、万方及维普数据库,收集截止至2018年5月所有已发表的队列研究,由2位评价员独立完成文献筛选和数据提取,并运用改良纽卡斯尔-渥太华量表(NOS)系统评价文献质量。采用比值比(OR)及95%置信区间(CI)为效应量,使用RevMan 5.3软件进行Meta分析。结果最终纳入符合标准的文献13篇,总样本量8 466例患者,其中乳房重建过程应用脂肪移植者(AFG组)1 963例,未应用脂肪移植者(NFG组)6 503例。NOS评价结果显示,所有纳入文献质量均较高(评分为6～9分)。Meta分析显示:AFG组总复发病例数为88例(4.5%,88/1 963),NFG组总复发病例数为455例(7.0%,455/6 503),AFG组乳腺癌复发率明显低于NFG组(OR=0.73,95%CI:0.57～0.95,P=0.02);脂肪移植对乳腺癌的局部复发率、区域复发率及远处复发率均无显著影响(OR=1.06,95%CI:0.60～1.88,P=0.84;OR=0.89,95%CI:0.32～2.48,P=0.83;OR=0.36,95%CI:0.10～1.28,P=0.11)。亚组分析显示:在DCIS或浸润性癌患者中,脂肪移植对乳腺癌复发率无显著影响(OR=1.16,95%CI:0.05～26.91,P=0.93;OR=0.68,95%CI:0.40～1.16,P=0.16);在行保留乳房术或乳房全切手术的患者中,脂肪移植对乳腺癌复发率亦无显著影响(OR=0.36,95%CI:0.08～1.66,P=0.19;OR=0.64,95%CI:0.33～1.26,P=0.19)。结论基于1965年1月至2018年5月相关临床队列研究的综合分析,自体脂肪移植是安全的,且其乳腺癌复发风险较低。更多还原

【Abstract】 Objective To investigate the oncological safety of autologous fat grafting for breast reconstruction after mastectomy in breast cancer patients. Methods The PubMed, Embase, Cochrane, CNKI, Wanfang and VIP databases were searched for all published relevant cohort studies up to May 2018. According to the Newcastle Ottawa Scale(NOS), the literature screening, data extraction and systematic evaluation were performed by two reviewers independently. A meta-analysis was performed using the RevMan 5.3 software, with odds ratio(OR) and 95% confidence interval(CI) as the effect size.Results Thirteen studies were included, with a sample size of 8 466 patients including 1 963 patients in autologous fat grafting group(AFG group) and 6 503 patients in non-fat grafting group(NFG group). The NOS scores were 6 to 9, indicating high methodological quality. The meta-analysis showed that 455 patients(7.0%,455/6 503) in NFG group had recurrence, while 88 patients(4.5%,88/1 963) in AFG group had recurrence, indicating that the recurrence rate of AFG group was significantly lower than that of NFG group(OR=0.73, 95%CI: 0.57-0.95, P=0.02). Fat grafting had no significant effect on the local recurrence rate, regional recurrence rate and distant recurrence rate(OR=1.06, 95%CI: 0.60-1.88, P=0.84; OR=0.89, 95%CI: 0.32-2.48, P=0.83; OR=0.36, 95%CI: 0.10-1.28, P=0.11). Subgroup analysis showed that fat grafting had no significant effect on the recurrence rate of breast cancer in patients with carcinoma in situ or invasive carcinoma(OR=1.16, 95%CI: 0.05-26.91, P=0.93; OR=0.68, 95%CI: 0.40-1.16, P=0.16). The fat grafting still had no significant effect on the recurrence rate of breast cancer in the patients undergoing breast-conserving surgery or total mastectomy(OR=0.36, 95%CI: 0.08-1.66, P=0.19; OR=0.64, 95%CI: 0.33-1.26, P=0.19). Conclusion Based on our meta-analysis of the cohort studies from January 1965 to May 2018, autologous fat grafting is feasible, with low risk of recurrence.更多还原