Inhibidores del factor de necrosis tumoral y riesgo de cáncer anorrectal en pacientes con enfermedad inflamatoria intestinal: ¿es acaso una relación constante y peligrosa?
DOI:
https://doi.org/10.22516/25007440.1303Palabras clave:
Inhibidores del factor de necrosis tumoral, Enfermedades inflamatorias del intestino, enfermedades del recto, neoplasias, diagnóstico, terapiaResumen
Introducción: se ha venido explorando la relación del uso de inhibidores del factor de necrosis tumoral (anti-TNF) y malignidad en pacientes con enfermedad inflamatoria intestinal (EII). Se plantea como objetivo revisar el estado del arte acerca de esta relación desde distintos puntos de vista con lo descrito hasta la fecha actual.
Metodología: revisión de la literatura de los metabuscadores PubMed, Science Direct, Embase, SciELO, Cochrane y Medline, sin límites en el período de tiempo. Se seleccionaron fuentes bibliográficas coherentes con el objetivo planteado.
Resultados: su definición no es clara. La infección por virus del papiloma humano y la enfermedad fistulizante perianal de larga evolución son los principales factores de riesgo. El principal mecanismo fisiopatológico es la inducción de apoptosis de células T. Su presentación clínica puede solaparse con la actividad de la EII. El diagnóstico debe apoyarse en imágenes avanzadas, anoscopia de alta resolución (AAR) y estudios histopatológicos. En cuanto a su manejo, se requiere considerar la relación riesgo-beneficio de la continuación del anti-TNF. La presentación de enfermedad local se asocia a recurrencia y riesgos de complicaciones bajos.
Conclusiones: existe información acerca de relación entre los inhibidores del TNF y malignidad en pacientes con EII, que puede extrapolarse hasta cierto punto. La mayor parte de la evidencia apoya un rol protector. Sin embargo, cuando se evalúa el cáncer de ano y del margen anal tipo escamocelular en forma independiente hay recomendaciones a favor de considerar estos pacientes en un grupo de factor de riesgo y deberían entrar en un programa de vigilancia.
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