背景:免疫抑制是癌变的危险因素。硫嘌呤特别有助于此。由于硫嘌呤被更积极地用于治疗IBD,我们可能会看到更多与硫嘌呤相关的恶性肿瘤。
目的:回顾文献,探索免疫抑制,特别是硫嘌呤,可能会导致癌症以及在实践中发生的恶性肿瘤,特别强调IBD队列。
方法:搜索术语包括\'恶性肿瘤\'\'癌症\'\'硫唑嘌呤\'\'巯基嘌呤\'\'硫鸟嘌呤(硫鸟嘌呤)\'\'和\'炎症性肠病\'\'克罗恩病\'\'溃疡性结肠炎\'。我们还搜索了特定的癌症(淋巴瘤,结直肠癌,皮肤癌,宫颈癌),并回顾了检测到的文章的参考列表。
结果:免疫抑制与癌症风险增加有关。硫嘌呤与特定的额外风险相关。在IBD队列中,很少有与硫嘌呤相关的恶性肿瘤被报道。然而,研究表明,淋巴瘤的相对风险为4-5。这仍然转化为低实际风险,(每300-1400年的噻嘌呤治疗中有一个额外的淋巴瘤)。
结论:虽然我们必须意识到这种风险并为患者提供适当的咨询,硫嘌呤仍然是IBD治疗的支柱。我们提出了实用的建议,旨在最大程度地降低患者患恶性肿瘤的风险,同时优化硫嘌呤可以提供的好处。
BACKGROUND: Immunosuppression is a risk factor for carcinogenesis. Thiopurines specifically contribute to this. As thiopurines are used more aggressively in the treatment of IBD, it is likely that we will see more thiopurine-related malignancy.
OBJECTIVE: To
review the literature, exploring how immunosuppression, thiopurines specifically, might cause cancer and which malignancies occur in practice, placing specific emphasis on IBD cohorts.
METHODS: Search terms included \'malignancy\' \'cancer\' \'azathioprine\' \'mercaptopurine\' \'tioguanine (thioguanine)\' \'thiopurine\' and \'inflammatory bowel disease\' \'Crohn\'s disease\' \'ulcerative colitis\'. We also searched for specific cancers (lymphoma, colorectal cancer, skin cancer, cervical cancer) and reviewed the reference lists of the articles detected.
RESULTS: Immunosuppression is associated with an increased risk of cancer. Thiopurines are associated with specific additional risks. In IBD cohorts, very few thiopurine-related malignancies have been reported. However, studies suggest a relative risk of 4-5 for lymphoma. This still translates into a low actual risk, (one extra lymphoma in every 300-1400 years of thiopurine treatment).
CONCLUSIONS: Whilst we must be aware of this risk and counsel our patients appropriately, thiopurines remain a mainstay of IBD therapy. We present practical advice aimed at minimizing our patients\' risk of developing malignancy, whilst optimizing the benefits that thiopurines can provide.