Malignancy in dermatomyositis

Abstract

Dermatomyositis (DM) is an idiopathic inflammatory myopathy that is closely related to malignant diseases. Our study aims to investigate the incidence and predictive factors for occurrence of malignancy among DM patients from Central China. We performed a retrospective, paired, case–control study of 736 DM patients admitted to the First Affiliated Hospital of Zhengzhou University between 2010 and 2017. We paired the 65 patients with malignancy with age-matched and sex-matched patients without malignancy in a ratio of 1:2. Two hundred two patients were finally enrolled and their clinical and laboratory data were collected. The incidence of malignancy in DM patients was 8.83% (65/736). Most malignancies were detected in the most recent 1 year before (9/65, 13.85%) or within 3 years after (40/65, 61.54%) the onset of DM. Males (35/65, 53.85%) and patients aged between 50 and 69 years (43/65, 66.15%) were prone to develop malignancies. Lung cancer (n = 11, 31.43%) was the most common malignancy in male patients, while for females, thyroid, breast and cervical cancer (n = 4 each, 13.33%) were more prevalent. Adenocarcinoma and squamous cell carcinoma (both 18/65, 27.69%) were the top two most common pathological types. Univariate analysis demonstrated that Gottron's sign ( P = .02), dysphagia ( P = .04), albumin (ALB) reduction ( P = .003), aspartate aminotransferase (AST, P = .03), creatine kinase-MB ( P = .02), absence of fever ( P = .02), arthralgia ( P = .04) and interstitial lung disease (ILD, P = .05) were closely related to the occurrence of malignancy. Multivariate analysis revealed the independent risk factors of ALB reduction (odds ratio = 1.546, P = .04) and the protective factor of ILD (odds ratio = 0.349, P = .003). There was no significant difference in the follow-up period between patients with and without ILD ( P = .38). ALB reduction and the absence of ILD were the risk factors for malignancy in DM patients. The protective mechanism of ILD for DM patients needs further study.

Dermatomyositis: a debilitating paraneoplastic phenomenon following a diagnosis of localised squamous cell carcinoma of the cervix

“…The first reported case of DM as a paraneoplastic phenomen was recognised by Stertz, who reported inflammatory myopathy in a patient with gastric adenocarcinoma 5. Paraneoplastic DM is now better recognised, although evidence to quantify just how many DM cases are associated with malignancy is variable; anything between 6% and 60% 6…”

“…A study of 65 patients with paraneoplastic DM in China, 2020, found only 32% of cancers were diagnosed before the occurrence of DM: 14% were within the most recent 1 year, 17% were within 3 years and 23% within 5 years 6. Another study, published 2001, found only 83 of 198 cases were diagnosed with cancer prior to their diagnosis of DM 2.…”

Anti-EJ antibody-positive interstitial pneumonia with breast cancer improved by combining immunosuppressive therapy and chemotherapy

“…In the present case, IP was detected subsequent to a breast cancer diagnosis, with further evaluation revealing positive anti-EJ antibodies. Although malignancies are common among patients with dermatomyositis [ 2 ], reduced incidence of malignancies has been observed in patients with both IP and dermatomyositis [ 3 ]. Despite documented cases of patients with coexisting ASSD, IP, and breast cancer [ 4 , 5 ], standardized treatment guidelines for those with IP in conjunction with malignancy have yet to be established.…”

Dermatomyositis Immunosuppression in Bacillus Calmette–Guerin-Treated Urothelial Cancer

“…1 DM has been linked with various cancers, including lymphoma, lung, ovary, colorectal, pancreatic, stomach, and breast cancer. 1,4 Urothelial cancer is less common, though it has been reported as the fifth most common cancer type among CAD patients with anti-TIF1-γ positivity. 3 In some such cases, DM manifestation acted as a clinical indicator of TCC recurrence, manifesting prior to cancerrelated symptoms and prompting timely investigation to rule out cancer recurrence.…”

“…Despite this, immunosuppressive therapy is often necessary to control DM symptoms, especially when its manifestation includes dysphagia or causes severe functional limitation. Immunosuppression in CAD poses potential risks, however, in that it may: (1) facilitate malignancy propagation, 1 (2) increase risk of complications from concurrent cancer treatment, or (3) decrease efficacy of cancer therapy. These risks are exemplified by the case presented here, though in each case the benefits of steroids were felt to outweigh the risks after review of the literature.…”