Predicting factors of malignancy in dermatomyositis and polymyositis: a case-control study
Predicting factors of malignancy in dermatomyositis and polymyositis: a case-control study
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DOI：
10.1046/j.1365-2133.2001.04140.x
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发表时间：
2001-04-01
影响因子：
10.3
通讯作者：
Shen, JL
中科院分区：
文献类型：
--
作者：
Chen, YJ;Wu, CY;Shen, JL
背景皮肌炎（DM）/多发性肌炎（PM）与恶性肿瘤之间的相关性在文献中已被广泛报道。几十年来，对这些患者进行广泛的恶性肿瘤评估的有效性也受到质疑。只有有限的文件，关于恶性肿瘤的迹象和预后因素在DM/PM已经reported. ObjectiveTo确定潜在的危险因素，伴随肿瘤性疾病的患者诊断为有DM/PM.Methods从1983年4月1日至1999年6月30日，147例患者被诊断为可能或明确的DM/PM在荣民总医院，台中，台湾。我们排除了4例在DM/PM之前诊断为肿瘤性疾病的患者，然后回顾性分析了其余143例患者的数据，并将这些病例分为4种主要类型：原发性特发性DM、原发性特发性PM、青少年DM/PM和无肌病性DM（ADM）。我们接下来使用逻辑回归进行单变量分析，以评估恶性肿瘤的可能预测因素，例如平均发病年龄、性别、发病时的表现、与其他结缔组织疾病的相关性、初始皮肤表现、并发症和实验室数据。结果143例DM/PM患者中，DM最常见（64%），其次为ADM（14%）、青少年DM/PM（13%）和PM（10%）。总体平均发病年龄为42.4岁。22%的患者存在其他结缔组织疾病，尤其是PM（50%）和青少年DM/PM患者（28%）。13%的患者存在内部恶性肿瘤，并且大多数与DM相关，鼻咽癌（NPC）是最常见的肿瘤。原发性特发性糖尿病患者，发病年龄较大，血清肌酸磷酸激酶水平较高，男性，有更多的机会发展为伴随恶性肿瘤。那些与并发症，特别是间质性肺疾病，有相关的肿瘤的风险较低。多因素分析显示，发病年龄大（OR 9.10）和男性（OR 4.06）是DM/PM患者发生恶性肿瘤的危险因素。结论发病年龄大（> 45岁）和男性是DM/PM患者发生恶性肿瘤的独立预测因素（P < 0.05）。原发性特发性糖尿病组发生内部恶性肿瘤的风险较高，尤其是鼻咽癌。然而，在多变量分析中，这并不是伴随肿瘤疾病的独立预测因素。此外，并发间质性肺病的患者恶性肿瘤的发生率显著降低（P < 0.001）。
Background An association between dermatomyositis (DM)/polymyositis (PM) and malignancies has been widely reported in the literature. The validity of extensive evaluation for malignancies in those patients has also been questioned for decades. Only limited papers regarding the signs of malignancy and the prognostic factors in DM/PM have been reported.Objectives To define the potential risk factors of concomitant neoplastic diseases in patients diagnosed as having DM/PM.Methods From 1 April 1983 to 30 June 1999, 147 patients were diagnosed as having probable or definite DM/PM at the Veterans General Hospital, Taichung, Taiwan. We excluded four patients who had preceding neoplastic diseases diagnosed before DM/PM, then retrospectively reviewed the data of the remaining 143 patients and subgrouped the cases as four main types: primary idiopathic DM, primary idiopathic PM, juvenile DM/PM and amyopathic DM (ADM). We next performed univariate analysis using logistic regression to evaluate the possible predictive factors for malignancies, such as mean age at onset, gender, manifestations at onset, association with other connective tissue diseases, initial skin presentations, complications and laboratory data. Then we chose the significant factors for multivariate analysis by logistic regression, to determine the independent risk factors of malignancies in DM/PM patients.Results Among the 143 patients, DM was the most common type (64%), followed by ADM (14%), juvenile DM/PM (13%) and PM (10%). The mean age at onset overall was 42.4 years. Other connective tissue diseases were present in 22% of all patients, especially PM (50%) and juvenile DM/PM patients (28%). Internal malignancies were present in 13% of patients, and most were associated with DM, Nasopharyngeal carcinomas (NPCs) were the most common tumours. Patients with primary idiopathic DM, with an older age at onset, higher serum creatine phosphokinase levels and male gender, had more chance of developing concomitant malignancies. Those associated with complications, especially interstitial lung diseases, had a lower risk of associated neoplasia. In multivariate analysis, an older age at onset (odds ratio 9.10) and male gender (odds ratio 4.06) were associated with greater risk of developing malignancies.Conclusions The two independent predictive factors for malignancy (P < 0.05) in patients with DM/PM were an older age at onset (> 45 years) and male gender. The primary idiopathic DM group was shown to have higher risk of developing internal malignancies, especially NPC. However, this was not identified as an independent predictive factor for concomitant neoplastic diseases in multivariate analysis. In addition, patients who had the complication of interstitial lung disease had a significantly lower frequency of malignancies (P < 0.001).