Highlights
- •IIA BIA-ALCL-staged patients have a wide variability of prognosis and outcomes.
- •Overall survival analysis shows a different behaviour of IIA-staged BIA-ALCL patients.
- •Chest wall infiltration worsens the prognosis in IIA-staged BIA-ALCL patients.
Abstract
Background
Breast implant–associated anaplastic large-cell lymphoma is a rare disease with a
favourable prognosis if adequately treated. Same staged patients have usually a similar
prognosis and outcomes, but in our experience, IIA-staged patients have a wider prognosis
with outcomes that vary from complete disease response to death. This study aimed
to understand and identify all the factors that could influence the prognosis of this
group of patients and verify if their prognosis matches the stage they belong to.
Material and methods
Patients in stage IIA have been divided into two subgroups: IIAb with lymphoma extension
towards the glandular tissue and IIAcw with tumour extension towards the chest-wall.
The overall survival (OS) and event-free survival (EFS) of 64 BIA-ALCL cases were
evaluated for each staged group.
Results
Significant differences of OS and EFS between IIAb and IIAcw patients (log-rank p = 0.046
and log-rank p = 0.018, respectively) were observed and poor prognosis joined IIAcw-
and IV-staged patients.
Conclusion
Chest-wall infiltration is a critical prognostic factor in BIA-ALCL patients as it
influences the possibility of performing a surgical radical tumour extirpation. Our
results could represent valid assistance for the physicians in choosing the most appropriate
BIA-ALCL prognostic category and treatment and could promote further wider studies
to provide stronger evidence on a possible revision of the MDA TNM classification.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of CancerAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Incidence of anaplastic large cell lymphoma and breast-implant-associated lymphoma-an analysis of a certified tumor registry over 17 years.J Clin Med. 2020; 9: 1247https://doi.org/10.3390/jcm9051247
- Breast implant-associated anaplastic large-cell lymphoma: long-term follow-up of 60 patients.J Clin Oncol. 2014; 32: 114-120
- Anaplastic large cell lymphoma occurring in women with breast implants: analysis of 173 cases.Plast Reconstr Surg. 2015; 135: 695-705
- Breast implant-associated anaplastic large cell lymphoma: a comprehensive review.Canc Treat Rev. 2020; 84 (Epub 2020 Jan 13): 101963
- Characteristics and treatment of advanced breast implant-associated anaplastic large cell lymphoma.Plast Reconstr Surg. 2019; (3S A Review of Breast Implant-Associated Anaplastic Large Cell Lymphoma):41S-50S: 143https://doi.org/10.1097/PRS.0000000000005568
- The crucial role of the surgical treatment on the BIA-ALCL prognosis in early and advanced staged patients.Plast Reconstr Surg. 2020; https://doi.org/10.1097/PRS.0000000000007240
Action undertaken by the Italian Ministry of Health to promote and raise physician awareness on BIA-ALCL issue. https://www.trovanorme.salute.gov.it/norme/renderNormsanPdf?anno=2019&codLeg=68570&parte=1%20&serie=null.
Action undertaken by the Italian Ministry of Health to promote and raise physician awareness on BIA-ALCL issue. https://www.trovanorme.salute.gov.it/norme/renderNormsanPdf?anno=2019&codLeg=69250&parte=1%20&serie=null.
Guidelines on the management and treatment of BIA-ALCL patients in Italy- Expert group at the Italian Ministry of Health. https://www.trovanorme.salute.gov.it/norme/renderNormsanPdf?anno=2019&codLeg=71547&parte=1%20&serie=null.
- Achieving reliable diagnosis in late breast implant seromas: from reactive to anaplastic large cell lymphoma.Plast Reconstr Surg. 2019; (3S A Review of Breast Implant-Associated Anaplastic Large Cell Lymphoma):15S-22S.): 143
- The 2016 revision of the World Health Organization classification of lymphoid neoplasms.Blood. 2016; 127: 2375-2390
- Principles of cancer staging. American College of surgeons.(3)in: Amin M.B. AJCC cancer staging manual. 8th ed. 2017https://doi.org/10.1007/978-3-319-40618-3_1
- Complete surgical excision is essential for the management of patients with breast implant-associated anaplastic large-cell lymphoma.J Clin Oncol. 2016; 34: 160-168
- A proposal for pathologic processing of breast implant capsules in patients with suspected breast implant anaplastic large cell lymphoma.Mod Pathol. 2020; 33: 367-379
- NCCN Consensus Guidelines for the diagnosis and management of breast implant associated anaplastic large cell lymphoma.Aesthetic Surg J. 2017; 37: 285-289
- R: a language and environment for statistical computing.R Foundation for Statistical Computing, Vienna, Austria2019 (URL)
- 22 cases of breast implant-associated ALCL: awareness and outcome tracking from the Italian Ministry of Health.Plast Reconstr Surg. 2018; 141: 11e-19ehttps://doi.org/10.1097/PRS.0000000000003916
- Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification.J Clin Oncol. 2014; 32: 3059-3068
- WHO classification of tumours of haematopoietic and lymphoid tissues.4th ed. WHO Press, Geneva, Switzerland2008
- Anaplastic large cell lymphoma associated with breast implants: a report of 13 cases.Am J Surg Pathol. 2012; 36: 1000-1008
- A patient death attributable to implant-related primary anaplastic large cell lymphoma of the breast.Plast Reconstr Surg. 2011; 128: 112e-118e
- Two cases of lymphoma in an implant capsule: A difficult diagnosis, an unknown pathology.Annales de Chirurgie Plastique et Esthetique. 2013; 58 (French. Epub 2013 May 24): 688-693https://doi.org/10.1016/j.anplas.2013.04.003
- Breast implant-associated anaplastic large cell lymphoma: two distinct clinicopathological variants with different outcomes.Ann Oncol. 2016; 27 (Epub 2015 Nov 23): 306-314https://doi.org/10.1093/annonc/mdv575
- Survival signals and targets for therapy in breast implant-associated ALK--anaplastic large cell lymphoma.Clin Canc Res. 2012; 18 (Epub 2012 Jul 12. PMID: 22791880): 4549-4559https://doi.org/10.1158/1078-0432.CCR-12-0101
- Breast implant-associated anaplastic large cell lymphoma in Australia and New Zealand: high-surface-area textured implants are associated with increased risk.Plast Reconstr Surg. 2017; 140: 645-654https://doi.org/10.1097/PRS.0000000000003654
- Breast implant-associated anaplastic large-cell lymphoma: current understanding and recommendations for management.Plast Surg (Oakv). 2020; 28: 117-126https://doi.org/10.1177/2292550320925906.Epub.2020.May.21
- Breast reconstruction following breast implant-associated anaplastic large cell lymphoma.Plast Reconstr Surg. 2019; 143 (3S A Review of Breast Implant-Associated Anaplastic Large Cell Lymphoma): 51S-58S
- How I treat breast implant-associated anaplastic large cell lymphoma.Blood. 2018; 132 (Epub 2018 Sep. 12): 1889-1898https://doi.org/10.1182/blood-2018-03-785972
- Metastatic non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.ESMO Guidelines Working Group Ann Oncol. 2010; 21: v116-v119
- Chest wall tumors in childhood and adolescence.Semin Pediatr Surg. 2008; 17: 173-180
- Chest wall tumors: diagnosis, treatment and reconstruction.Exp Ther Med. 2015; 9: 1807-1812https://doi.org/10.3892/etm.2015.2353.Epub.2015.Mar.13
- Chest wall reconstruction after oncological resections.Scand J Surg. 2013; 102: 9-13
- Long-term survival probabilities for childhood rhabdomyosarcoma. A population-based evaluation.Cancer. 2005; 103: 1475-1483https://doi.org/10.1002/cncr.20929
- Breast implant-associated anaplastic large cell lymphoma in a Li-Fraumeni patient: a case report.Diagn Pathol. 2018; 13: 10
- Breast implant-associated anaplastic large cell lymphoma in a patient with Li-Fraumeni syndrome.Histopathology. 2015; 67: 925-927
- Breast cancer in patients with Li-Fraumeni syndrome – a case-series study and review of literature.Breast Canc (Dove Med Press). 2017; 9: 207-215
Article info
Publication history
Published online: March 23, 2021
Accepted:
January 28,
2021
Received in revised form:
January 19,
2021
Received:
October 27,
2020
Identification
Copyright
© 2021 Elsevier Ltd. All rights reserved.
