A systematic review and meta-analysis to inform cancer screening guidelines in idiopathic inflammatory myopathies

被引：92
作者：
Oldroyd, Alexander G. S. [1 ,2 ,3 ,4 ]
Allard, Andrew B. [5 ]
Callen, Jeffrey P. [6 ]
Chinoy, Hector [1 ,2 ,4 ]
Chung, Lorinda [7 ,8 ]
Fiorentino, David [9 ]
George, Michael D. [10 ,11 ]
Gordon, Patrick [12 ]
Kolstad, Kate [9 ]
Kurtzman, Drew J. B. [13 ]
Machado, Pedro M. [14 ,15 ,16 ,17 ]
McHugh, Neil J. [18 ]
Postolova, Anna [19 ]
Selva-O'Callaghan, Albert [20 ]
Schmidt, Jens [21 ]
Tansley, Sarah [5 ,21 ]
Vleugels, Ruth Ann [22 ,23 ]
Werth, Victoria P. [24 ,25 ]
Aggarwal, Rohit [26 ]
机构：
[1] Manchester Univ NHS Fdn Trust, Manchester Biomed Res Ctr, Natl Inst Hlth Res, Manchester, Lancs, England
[2] Univ Manchester, Manchester Acad Hlth Sci Ctr, Ctr Musculoskeletal Res, Manchester, Lancs, England
[3] Univ Manchester, Ctr Epidemiol Versus Arthrit, Manchester, Lancs, England
[4] Salford Royal NHS Fdn Trust, Dept Rheumatol, Salford, Lancs, England
[5] Royal Natl Hosp Rheumat Dis, Royal United Hosp Bath NHS Fdn Trust, Bath, Avon, England
[6] Univ Louisville, Dept Med, Div Med, Louisville, KY USA
[7] Stanford Univ, Dept Med & Dermatol, Div Immunol & Rheumatol, Stanford, CA USA
[8] Palo Alto Hlth Care Syst, Palo Alto, CA USA
[9] Stanford Univ, Sch Med, Dept Dermatol, Stanford, CA USA
[10] Univ Penn, Div Rheumatol, Philadelphia, PA USA
[11] Univ Penn, Div Epidemiol, Philadelphia, PA USA
[12] Kings Coll Hosp NHS Fdn Trust, Dept Rheumatol, London, England
[13] Wright State Univ, Dept Dermatol, Dayton, OH USA
[14] UCL, Ctr Rheumatol, London, England
[15] UCL, Dept Neuromuscular Dis, London, England
[16] Univ Coll London Hosp NHS Trust, Univ Coll London Hosp Biomed Res Ctr, Natl Inst Hlth Res, London, England
[17] London North West Univ Healthcare NHS Trust, Dept Rheumatol, Northwick Pk Hosp, London, England
[18] Univ Bath, Dept Pharm & Pharmacol, Bath, Avon, England
[19] Stanford Hlth Care, Dept Immunol & Rheumatol, Stanford, CA USA
[20] Univ Autonoma Barcelona, Vall Hebron Gen Hosp, Syst Autoimmune Unity, Barcelona, Spain
[21] Neuromuscular Ctr, Dept Neurol, Gottingen, Germany
[22] Harvard Med Sch, Boston, MA 02115 USA
[23] Brigham & Womens Hosp, Dept Dermatol, Boston, MA USA
[24] Univ Penn, Dept Dermatol, Philadelphia, PA 19104 USA
[25] Corporal Michael J Crescenz VA MedicalCtr, Div Dermatol, Philadelphia, PA USA
[26] Univ Pittsburgh, Dept Med, Div Rheumatol & Clin Immunol, Pittsburgh, PA USA
来源：
RHEUMATOLOGY | 2021年 / 60卷 / 06期
关键词：
myositis; muscle; autoantibodies; CT scanning; neoplasia; epidemiology; meta-analysis; MYOSITIS-SPECIFIC AUTOANTIBODIES; AMYOPATHIC DERMATOMYOSITIS; ANTI-TIF1-GAMMA ANTIBODIES; CLINICAL-SIGNIFICANCE; RETROSPECTIVE COHORT; STATISTICAL-ANALYSIS; JAPANESE PATIENTS; ADULT PATIENTS; RISK-FACTORS; POLYMYOSITIS;
D O I：
10.1093/rheumatology/keab166
中图分类号：
R5 [内科学];
学科分类号：
1002 ; 100201 ;
摘要：
Objectives. To identify clinical factors associated with cancer risk in the idiopathic inflammatory myopathies (IIMs) and to systematically review the existing evidence related to cancer screening. Methods. A systematic literature search was carried out on Medline, Embase and Scopus. Cancer risk within the IIM population (i.e. not compared with the general population) was expressed as risk ratios (RR) for binary variables and weighted mean differences (WMD) for continuous variables. Evidence relating to cancer screening practices in the Ms were synthesized via narrative review. Results. Sixty-nine studies were included in the meta-analysis. DM subtype (RR 2.21), older age (WMD 11.19), male sex (RR 1.53), dysphagia (RR 2.09), cutaneous ulceration (RR 2.73) and anti-transcriptional intermediary factor-1 gamma positivity (RR 4.66) were identified as being associated with significantly increased risk of cancer. PM (RR 0.49) and clinically amyopathic DM (RR 0.44) subtypes, Raynaud's phenomenon (RR 0.61), interstitial lung disease (RR 0.49), very high serum creatine kinase (WMD -1189.96) or lactate dehydrogenase (WMD -336.52) levels, and anti-Jo1 (RR 0.45) or anti-EJ (RR 0.17) positivity were identified as being associated with significantly reduced risk of cancer. Nine studies relating to IIM-specific cancer screening were included. CT scanning of the thorax, abdomen and pelvis appeared to be effective in identifying underlying asymptomatic cancers. Conclusion. Cancer risk factors should be evaluated in patients with IIM for risk stratification. Screening evidence is limited but CT scanning could be useful. Prospective studies and consensus guidelines are needed to establish cancer screening strategies in IIM patients.
引用
收藏
页码：2615 / 2628
页数：14
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