Risk factors for cancer-associated myositis: A large-scale multicenter cohort study
Risk factors for cancer-associated myositis: A large-scale multicenter cohort study
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DOI：
10.1111/1756-185x.14046
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发表时间：
2020-12-26
影响因子：
2.5
通讯作者：
He, Jing
中科院分区：
文献类型：
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作者：
Li, Yimin;Jia, Xiaohui;He, Jing
目的探讨癌症相关性肌炎（CAM）患者的危险因素及预后。方法回顾性分析3个临床中心487例DM、临床无肌病性皮肌炎（CADM）和多发性肌炎（PM）患者的临床资料。比较CAM和非CAM患者的临床和实验室数据。结果487例DM/CADM/PM患者中，CAM发生率为7.0%（34/487）。老年（53.91 +/- 13.32 vs. 48.76 +/- 14.34岁）、天芥菜皮疹（61.8% vs. 41.9%）、披肩征（41.2% vs. 22.1%）、V征（58.8% vs. 38.6%）在CAM患者中的发生率显著高于无CAM患者（均P <0.05）。CAM组中发热（17.7% vs. 37.8%）、关节痛/关节炎（23.5% vs. 45.7%）、间质性肺病（ILD，38.2% vs. 68.9%）的发生率显著低于非CAM组。发病年龄（比值比[OR] 1.036，95% CI 1.001-1.072，P = .042），披肩征（OR 2.748，95% CI 1.107-6.822，P = .029），抗转换起始因子（TIF）-1 γ抗体（OR 4.012，95%CI 1.268-12.687，P = .018）被确定为CAM发病的初始危险因素，ILD被确定为CAM的保护因素（OR 0.292，95%CI 0.115-0.739，P = .009）。CAM患者的全因死亡率显著高于非CAM患者（P = .001）。结论CAM患者的死亡率高于非癌症的DM/CADM/PM患者。在DM/CADM/PM患者中，尤其是有风险因素的患者，包括年龄较大、披肩征、抗TIF-1 γ抗体和缺乏ILD，应筛查抗TIF-1。
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)-1 gamma 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-1 gamma antibody, and lack of ILD.