Oncological safety of autologous fat grafting for breast reconstruction after mastectomy: a meta-analysis
Bibliographic record
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. Key words: Meta-analysis; Breast neoplasms; Mammaplasty; Autologous fat grafting; Oncological safety
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.019 | 0.037 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.015 | 0.055 |
| Bibliometrics | 0.005 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".