Risk factors for cancer‐associated myositis: A large‐scale multicenter cohort study

Abstract

Aim: The aim of this study was to identify the risk factors and prognosis of patients with cancer-associated myositis (CAM). Method: Four hundred and eighty-seven patients with dermatomyositis (DM), clinical amyopathic dermatomyositis (CADM) and polymyositis (PM) from 3 clinical centers were enrolled retrospectively in this study. Clinical and laboratory data of CAM and non-CAM patients were compared. Logistic regression analysis was used to identify risk factors of CAM. Results: Out of the 487 patients with DM/CADM/PM, 7.0% (34/487) of patients were classified as CAM. Older age (53.91 ± 13.32 vs. 48.76 ± 14.34 years), heliotrope rash (61.8% vs. 41.9%), shawl sign (41.2% vs. 22.1%), V sign (58.8% vs. 38.6%) were observed significantly more commonly in patients with CAM than those without CAM (all P < .05). Fever (17.7% vs. 37.8%), arthralgia/arthritis (23.5% vs. 45.7%), interstitial lung disease (ILD, 38.2% vs 68.9%) were significantly less common in the CAM group than the non-CAM group. Age at onset (odds ratio [OR] 1.036, 95% CI 1.001-1.072, P = .042), shawl sign (OR 2.748, 95% CI 1.107-6.822, P = .029), anti-transition initiation factor (TIF)-1γ antibody (OR 4.012, 95% CI 1.268-12.687, P = .018) were identified as the initial risk factors for the onset of CAM, and ILD was identified as a protective factor for CAM (OR 0.292, 95% CI 0.115-0.739, P = .009). All-cause mortality was significantly higher in CAM patients compared with non-CAM patients (P = .001). Conclusion: The mortality of patients with CAM was higher than DM/CADM/PM patients without cancer. Malignancy should be screened in DM/CADM/PM patients especially with risk factors, including older age, shawl sign, anti-TIF-1γ antibody, and lack of ILD.

Anti-OJ (Anti-isoleucyl-tRNA Synthetase) Autoantibody- Positive Anti-synthetase Syndrome: a Case Report

“…The association between PM/DM and malignant diseases has been reported and con rmed [10]. Studies have found that ASS and interstitial pneumonia have a negative correlation with cancer-associated myositis [11][12][13], but there are also cases of various ASS-related diseases combined with malignant tumours [14][15]. In this case, myositis, arthritis and fever were manifestations of paraneoplastic syndrome.…”

Update on Malignancy in Myositis—Well-Established Association with Unmet Needs

“…The newest population-based studies confirm that the majority of malignancies occur in the temporal association with the onset of myopathy. Most of the cancer cases emerge within a year of IIM diagnosis, and the risk of malignancy decreases over time [ 15 , 16 , 17 ]. The temporal coincidence and the disappearance of muscle symptoms after tumor removal enabled us to conclude that CAM may be a paraneoplastic syndrome [ 9 ].…”

Machine Learning Algorithms Identify Clinical Subtypes and Cancer in Anti-TIF1γ+ Myositis: A Longitudinal Study of 87 Patients

“…Our anti-TIF1g+ myositis patients in cluster 2 with the highest risk of cancer were more often males, had higher CRP levels, and more frequent shawl sign and V-neck sign. These clinical characteristics were proven to be related factors for CAM (9,(19)(20)(21)(22). For example, a meta-analysis including 69 studies concluded that DM subtype, older age, male gender, dysphagia, cutaneous ulceration, and anti-TIF1g positivity were associated with increased cancer risk (21).…”

“…For example, a meta-analysis including 69 studies concluded that DM subtype, older age, male gender, dysphagia, cutaneous ulceration, and anti-TIF1γ positivity were associated with increased cancer risk ( 21 ). Another large-scale multicenter cohort study found CAM patients had more common older age, heliotrope rash, shawl sign, and V sign ( 22 ). In fact, anti-TIF1γ+ myositis patients with cancer account for nearly half of the CAM cases, that is why they exhibit large clinical similarities ( 15 , 17 ).…”