Abstract
PurposeThe accumulation of wound fluid known as seroma in the chest cavity following breast surgery is a common occurrence that can persist for many weeks. While the pro-inflammatory composition of seroma is well established, there has been remarkably little research to determine whether seroma contains pro-oncogenic factors, and whether this is influenced by previous malignant disease.MethodsWe developed a clinical trial in which we obtained post-surgical seroma fluids from women with benign or malignant disease 1 or 2 weeks following lumpectomy or mastectomy. We conducted an analysis of more than 80 different cytokines, chemokines and growth factors.ResultsWe found that surgical cavity seroma from breast cancer patients has a higher expression of key tumor-promoting cytokines and lower expression of important tumor-inhibiting factors when compared to benign lesions from non-cancer patients. Patients with high body mass index also had higher levels of leptin regardless of malignancy.ConclusionsWe conclude that the breast post-surgical tumor cavity contains factors that are pro-inflammatory regardless of malignant or benign disease, but in malignant disease there is significant enrichment of additional pro-oncogenic chemokines, cytokines and growth factors, and reduction in tumor-inhibiting factors. These results are consistent with tumor conditioning of surrounding normal stromal tissue and creation of a pro-oncogenic environment that persists long after surgical removal of the tumor.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-015-1260-8) contains supplementary material, which is available to authorized users.
Highlights
Post-operative accumulation of seroma in the surgical cavity following breast cancer surgery varies in incidence from 2.5 to 51 % of patients (Siegel et al 2015)
Seroma is defined as serous fluid that collects in the dead space of the post-mastectomy skin flap, axilla, or breast following breast-conserving surgery
We investigated whether the differential expression of leptin between the two groups was dependent or independent of body mass index (BMI)
Summary
Post-operative accumulation of seroma in the surgical cavity following breast cancer surgery varies in incidence from 2.5 to 51 % of patients (Siegel et al 2015). Seroma is defined as serous fluid that collects in the dead space of the post-mastectomy skin flap, axilla, or breast following breast-conserving surgery (Agrawal et al.2006). Seroma formation is a common consequence of surgical excision, whereby empty space devoid of breast tissue elicits an inflammatory wound healing response with subcutaneous accumulation of serous fluid (Agrawal et al 2006). There are various mechanisms by which wounding can promote tumor development Among these possibilities, seroma fluid has been shown to possess biological activities such as the ability to increase cancer cell proliferation, migration and invasion (Belletti et al 2008; Tagliabue et al 2003). The cytokines, chemokines and growth factors in seroma fluid that regulate these biological activities, have not been well characterized
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