Abstract
ObjectiveTo define potential factors that could predict concomitant neoplastic diseases in patients diagnosed with PM/DM, which could inform screening decisions.MethodsTwo researchers independently reviewed articles from Pubmed (MEDLINE), EMBASE, Cochrane Plus Library and ISI Web of Knowledge with no restrictions on study design or language. Given that some of the studies combined PM and DM patients as research subjects while others included only DM patients, data were subjected to meta-analyses for all combined PM/DM studies and studies that included only DM patients to obtain informative results.ResultsFor PM/DM patients, the following factors are all associated with an increased risk of malignancy: older age, age greater than 45, male sex, dysphagia, cutaneous necrosis, cutaneous vasculitis, rapid onset of myostis (<4 weeks), elevated CK, higher ESR, higher CRP levels. Several factors were associated with lower-than-average risk, including the presence of ILD, arthritis/arthralgia, Raynaud's syndrome, or anti-Jo-1 antibody. For DM patients, results indicated an increased risk of malignancy with older age, male sex, the presence of cutaneous necrosis, elevated ESR (>35 mm/hr), higher CRP levels, or anti-p155 antibody. In addition, the presence of anti-ENA antibodies seem to be related to reduced risk of malignancy.ConclusionAwareness and implementation of early-stage cancer screening in PM/DM patients who have these identified factors – such as being older than 45, male sex, cutaneous necrosis, cutaneous vasculitis – are of crucial importance from public health and clinical perspectives and provide insight into the etiopathogenesis of CAM.
Highlights
Idiopathic inflammatory myopathies (IIM) are a group of acquired, heterogeneous systemic diseases that mainly affect skeletal muscle
After reviewing the full text of the articles, 28 studies of 22 PM/DM-associated malignancy predictors were included in the final analysis.(diagrammed in Figure 1) In total, data from 27 respective cohorts studies, and one[18] prospective cohorts studies were included in the final analysis
From five of the studies,[24,26,29,34,37] we learned that the risk of malignancy was significantly reduced in PM/DM patients with arthritis/arthralgia (RR, 0.44; 95% confidence intervals (CIs): 0.22 to 0.89)
Summary
Idiopathic inflammatory myopathies (IIM) are a group of acquired, heterogeneous systemic diseases that mainly affect skeletal muscle. The overall malignancy risk in these patients is higher than that in the ageand sex-matched general population. This elevated risk is pronounced in IIM patients within three years of their initial diagnosis[1,2]. The comorbid frequency of malignancy in IIM was reported to range from 3% to 40%[3,4]. Each subtype of IIM has been reported to have an association with malignancy, including PM, DM and IBM[1,2,5]. Of the three IIM subtypes, DM appears to have the strongest association with malignancy. Adenocarcinoma was the most common type of IIM-related cancer[2,6].
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