AUTHOR=Vittorietti Martina , Mazzola Sergio , Costantino Claudio , De Bella Daniele Domenico , Fruscione Santo , Bonaccorso Nicole , Sciortino Martina , Costanza Davide , Belluzzo Miriam , Savatteri Alessandra , Tramuto Fabio , Contiero Paolo , Tagliabue Giovanna , Immordino Palmira , Vitale Francesco , Di Napoli Arianna , Mazzucco Walter 

TITLE=Implant replacement and anaplastic large cell lymphoma associated with breast implants: a quantitative analysis

JOURNAL=Frontiers in Oncology

VOLUME=Volume 13 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2023.1202733

DOI=10.3389/fonc.2023.1202733

ISSN=2234-943X

ABSTRACT=Introduction: Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare form of non-Hodgkin T-cell lymphoma associated with breast reconstruction post-mastectomy or cosmetic-additive mammoplasty. The increasing use of implants for cosmetic purposes is expected to lead to an increase in BIA-ALCL cases. This study investigated the main characteristics of the disease and factors predicting BIA-ALCL onset in patients with and without an implant replacement.
Methods: A quantitative analysis was performed by two independent researchers on cases extracted from 52 primary studies (case report, case series, systematic review) published until April 2022 and searched in PubMed, Scopus and Google-Scholar databases, using “Breast-Implant” AND/OR “Associated” AND/OR “Anaplastic-Large-Cell-Lymphoma”. Statistical significance was verified by Student-T test for continuous variables, while Fisher’s exact test was applied for qualitative variables. Cox model with time-dependent covariates was used to estimate BIA-ALCL’s onset time. Kaplan-Meier model allowed to estimate the probability of survival after therapy according to breast implant exposure time.
Results: Overall, 232 patients with BIA-ALCL were extracted. The mean age at diagnosis was 55 years-old, with a mean time to disease onset from first implant of 10.3 years. Hazard of developing BIA-ALCL in a shorter time resulted significantly higher for patients not having an implant replacement (HR= 0.03; 95%CI: 0.005-0.19; p-value= <0.01). Patients with implant replacement were significantly older than patients without previous replacement at the diagnosis, having a median time to diagnosis since first implant of 13 years (7 years in patients without replacement), anyway the median time to BIA-ALCL occurrence since the last implantation was equal to 5 years.
Discussion: Our findings suggest that in BIA-ALCL patients the implant substitution and/or capsulectomy may delay the disease’s onset, however the risk of reoccurrence in an earlier time should be considered in these patients. Moreover, the time to BIA-ALCL onset slightly increased with age. Selection bias, lack of awareness, misdiagnosis and limited data availability could be identified as limits of our study. An implant replacement should be considered according to a risk-stratification approach to delay the BIA-ALCL occurrence in asymptomatic patients, although a stricter follow up after the implant substitution should be recommended