Importance Autologous fat transfer (AFT or fat grafting) has become an invaluable tool for the correction of disfiguring deformities after breast cancer surgery. However, clinical and animal studies have shown conflicting results regarding its oncologic safety. Objective To determine whether exposure to AFT vs conventional breast reconstruction is associated with increased rates of cancer relapse in patients with breast cancer. Design, Setting, and Participants This matched cohort study involved retrospective medical record review to identify all patients in a local patient database receiving AFT between 2006 and 2014. Each AFT case was matched with a nonexposed control patient with similar baseline characteristics. The mean (SD) follow-up of patients receiving AFT was 9.3 (4.9) years including 5.0 (1.7) years following AFT. Control patients were followed up for a mean (SD) of 8.6 (1.8) years from the primary surgery. Patients were identified through the local patient database of the Tergooi Hospital in Hilversum, the Netherlands. A total of 287 patients with breast cancer (300 affected breasts) who received AFT for breast reconstruction after cancer were included in the intervention group. Each AFT case was matched with a respective control patient based on age, type of oncologic surgery, tumor invasiveness, and disease stage. In addition, individual AFT-control pairs were selected to have the same locoregional recurrence-free interval at baseline. Data were analyzed between 2016 and 2017. Exposures Reconstruction with AFT vs conventional breast reconstruction or none. Main Outcomes and Measures Primary end points were the cumulative incidences of oncologic events in AFT and control patients and their respective hazard ratios. Results Of the 587 total patients, all were women and the mean age was 48.1 years for the patients undergoing AFT and 49.4 years for the control patients. Eight locoregional recurrences were observed in the treatment group (287 patients) and 11 among the control group (300 patients), leading to an unadjusted hazard ratio of 0.63 (95% CI, 0.25-1.60; P = .33). No increased locoregional recurrence rates were seen in relevant subgroups based on the type of oncological surgery, tumor invasiveness, or pathological stage. In addition, no increased risks with AFT were detected with respect to distant recurrences or breast cancer-specific mortality. Conclusions and Relevance No significant differences in the locoregional recurrence rates between the AFT and control groups were observed after 5 years of follow-up. These findings confirm the results of previous studies; therefore, clinical evidence suggesting that AFT is associated with increased risk for cancer relapse is still lacking.

中文翻译：

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乳腺癌患者自体脂肪转移与常规乳房重建及与癌症复发的关系的长期随访。

重要性自体脂肪转移（AFT或脂肪移植）已成为纠正乳腺癌手术后的容貌畸形的宝贵工具。但是，临床和动物研究显示出关于其肿瘤安全性的相互矛盾的结果。目的确定乳腺癌患者相对于常规乳房再造术与AFT接触是否与癌症复发率增加相关。设计，背景和参与者这项匹配的队列研究包括回顾性病历审查，以识别2006年至2014年之间接受AFT的本地患者数据库中的所有患者。每例AFT病例均与基线特征相似的未暴露对照患者进行匹配。接受AFT的患者的平均（SD）随访时间为9.3（4.9）年，包括AFT后的5.0（1.7）年。对照患者自初次手术后的平均（SD）随访时间为8.6（1.8）年。通过荷兰希尔弗瑟姆Tergooi医院的本地患者数据库识别患者。干预组共纳入287例乳腺癌患者（300例受累乳房），这些患者在癌症发生后接受了AFT进行乳房再造。根据年龄，肿瘤手术类型，肿瘤侵袭性和疾病阶段，将每例AFT病例与相应的对照患者进行匹配。此外，选择单独的AFT对照对在基线时具有相同的局部无复发间隔。对2016年至2017年之间的数据进行了分析。AFT暴露重建与常规乳房重建或完全不重建。主要结果和措施主要终点是AFT和对照患者的肿瘤事件累积发生率及其各自的危险比。结果在587名患者中，所有患者均为女性，接受AFT的患者的平均年龄为48.1岁，而对照患者的平均年龄为49.4岁。在治疗组中观察到八个局部复发（287例患者），在对照组中观察到11例（300例患者），导致未经调整的危险比为0.63（95％CI，0.25-1.60； P = 0.33）。根据肿瘤手术类型，肿瘤浸润性或病理分期，在相关亚组中未见局部区域复发率增加。此外，在远处复发或乳腺癌特异性死亡率方面，未发现AFT风险增加。结论和相关性随访5年后，AFT组和对照组之间的局部复发率无显着差异。这些发现证实了以前的研究结果。因此，仍然缺乏表明AFT与癌症复发风险增加相关的临床证据。