El paradigma de la gastrectomía total profiláctica en el cáncer gástrico: antecedentes para evaluar su alcance terapéutico
Resumen
El cáncer gástrico (CG) es el quinto cáncer más común a nivel mundial y es la primera causa de mortalidad en Chile en el sexo masculino relacionada a cáncer. Su etiología aún permanece desconocida, de momento solo existen factores de riesgo, destacando la infección por Helicobacter Pylori (HP) y los antecedentes familiares de CG. Dentro del espectro de cáncer gástrico hereditario (CGH) resalta el Cáncer Gástrico Difuso Hereditario (CGDH), donde la mutación de CDH1 ha sido ampliamente estudiada. Se sabe que la gastrectomía total profiláctica (GTP) es la mejor alternativa preventiva y terapéutica para el CGDH causado por esta mutación. Sin embargo, su recomendación ha sido limitada únicamente a pacientes con mutaciones CDH1. No obstante, recientemente se estableció la primera estimación de riesgo acumulado de desarrollar CGDH en pacientes portadores de mutaciones de CTNNA1 y se ha planteado también la posibilidad de realizar GTP. En paralelo, se han descrito otras múltiples variantes genéticas patogénicas y factores como la ascendencia amerindia que en relación con HP elevan considerablemente el riesgo de desarrollar CG. Los objetivos de esta revisión son describir las principales causas genéticas del CG y CGH, centrado en el CGDH y exponer la evidencia que sustente la utilización de la GTP en pacientes asintomáticos portadores de mutaciones distintas a CDH1, tal como CTNNA1 o que presenten un alto riesgo acumulado debido a la interacción CTNNA1 u otras variantes genéticas patógenas con la infección por HP y/o el potencial riesgo de su ascendencia, incentivando el desarrollo de futuras investigaciones que promuevan esta indicación.
Palabras clave:
Cáncer gástrico, Cáncer gástrico hereditario, Helicobacter Pylori, Gastrectomía total profilácticaReferencias
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