The diagnostic utility of myositis autoantibody testing for predicting the risk of cancer-associated myositis
The diagnostic utility of myositis autoantibody testing for predicting the risk of cancer-associated myositis
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DOI：
10.1136/ard.2006.068502
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发表时间：
2007-10-01
影响因子：
27.4
通讯作者：
Cooper, Robert G.
中科院分区：
文献类型：
--
作者：
Chinoy, Hector;Fertig, Noreen;Cooper, Robert G.
目的：已知肌炎和癌症之间存在关联。尽管目前尚无可靠的方法来预测特定肌炎患者的癌症风险，但皮肌炎 (DM) 的风险高于多发性肌炎 (PM)。本研究旨在确定是否可以通过抗体分析来预测肌炎患癌症的风险。方法：对患有 PM (n = 109)、DM (n = 103) 和结缔组织疾病重叠（肌炎/CTD 重叠，n = 70）的英国白人成年人进行横断面研究。对患者进行了全面的肌炎特异性/相关自身抗体检测。进行敏感性和特异性分析，以最佳地识别癌症风险。结果：16 名患者患有癌症相关肌炎 (CAM)（15 名 DM，1 名肌炎/CTD 重叠）。 CAM 患者发病时年龄较大，“常规”实验室检测中没有肌炎特异性/相关自身抗体的患者（抗 Jo-1、抗 PM-Scl、抗 U1-RNP、抗 U3-RNP、抗 Ku 抗体阴性）患 CAM 的风险显着增加。拥有针对 155 kDa 和 140 kDa 蛋白质特异性的抗体（抗 155/140 抗体）代表了抗 155/140 抗体阳性结果被证明具有高度特异性、中等敏感性，对 CAM 具有高阴性预测值。“阴性常规肌炎抗体组”结果具有高度敏感性，对 CAM 具有高阴性预测值。这两种方法的结合灵敏度为 94%，可检测 16 种 CAM 中的 15 种，在 DM 中具有 100% 的灵敏度和阴性预测价值。结论：这些结果可能有助于临床医生预测哪些肌炎患者患癌症的风险更大，从而确定那些在肌炎发作和随访时需要积极诊断评估和强化癌症监测的患者。
Objectives: There is a known association between myositis and cancer. The risk is greater in dermatomyositis (DM) than polymyositis ( PM), although reliable methods to predict cancer risk in specific patients with myositis are not presently available. This study was undertaken to determine whether risk of developing cancer in myositis can be predicted by antibody profiling.Methods: A cross-sectional study of UK Caucasian adults with PM (n = 109), DM ( n = 103) and connective tissue disease overlap (myositis/CTD-overlap, n = 70). Patients were tested for a comprehensive range of myositis-specific/associated autoantibodies. Sensitivity and specificity analyses were performed for the optimal identification of cancer risk.Results: Sixteen patients had cancer-associated myositis ( CAM) ( 15 DM, 1 myositis/CTD-overlap). CAM patients were older at disease onset, and patients without myositis-specific/associated autoantibodies on "routine'' laboratory testing ( negative for anti-Jo-1, anti-PM-Scl, anti-U1-RNP, anti-U3-RNP, anti-Ku antibodies) had a significantly increased risk of CAM. Possession of the antibody against 155 kDa and 140 kDa protein specificities (anti-155/140 antibody) represented a significant risk factor for CAM, and was found exclusively in DM. A positive anti-155/140 antibody result proved highly specific, moderately sensitive, with high negative predictive value for CAM. A "negative routine myositis antibody panel'' result was highly sensitive, with high negative predictive value for CAM. The combination of these two approaches was 94% sensitive, detecting 15 of 16 CAM, with 100% sensitivity and negative predictive value in DM.Conclusions: These results may help clinicians predict which patients with myositis are at greater risk of developing cancer, thus identifying those requiring aggressive diagnostic evaluation and intensive cancer surveillance at myositis onset and follow-up.