Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2014 Apr 8;9(4):e94128.
doi: 10.1371/journal.pone.0094128. eCollection 2014.

Factors predicting malignancy in patients with polymyositis and dermatomyostis: a systematic review and meta-analysis

Xin Lu  1 , Hanbo Yang  1 , Xiaoming Shu  1 , Fang Chen  1 , Yinli Zhang  1 , Sigong Zhang  1 , Qinglin Peng  1 , Xiaolan Tian  1 , Guochun Wang  1
Affiliations
Meta-Analysis

Factors predicting malignancy in patients with polymyositis and dermatomyostis: a systematic review and meta-analysis

Xin Lu et al. PLoS One. .

Abstract

Objective: To define potential factors that could predict concomitant neoplastic diseases in patients diagnosed with PM/DM, which could inform screening decisions.

Methods: Two researchers independently reviewed articles from Pubmed (MEDLINE), EMBASE, Cochrane Plus Library and ISI Web of Knowledge with no restrictions on study design or language. Given that some of the studies combined PM and DM patients as research subjects while others included only DM patients, data were subjected to meta-analyses for all combined PM/DM studies and studies that included only DM patients to obtain informative results.

Results: For PM/DM patients, the following factors are all associated with an increased risk of malignancy: older age, age greater than 45, male sex, dysphagia, cutaneous necrosis, cutaneous vasculitis, rapid onset of myostis (<4 weeks), elevated CK, higher ESR, higher CRP levels. Several factors were associated with lower-than-average risk, including the presence of ILD, arthritis/arthralgia, Raynaud's syndrome, or anti-Jo-1 antibody. For DM patients, results indicated an increased risk of malignancy with older age, male sex, the presence of cutaneous necrosis, elevated ESR (>35 mm/hr), higher CRP levels, or anti-p155 antibody. In addition, the presence of anti-ENA antibodies seem to be related to reduced risk of malignancy.

Conclusion: Awareness and implementation of early-stage cancer screening in PM/DM patients who have these identified factors--such as being older than 45, male sex, cutaneous necrosis, cutaneous vasculitis--are of crucial importance from public health and clinical perspectives and provide insight into the etiopathogenesis of CAM.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow diagram of the study selection process.
Figure 2
Figure 2. Forest plots generated by random-effects meta-analysis for the significant findings from all studies.
(A) Age. (B) Gender. (C) Dysphagia. (D) Cutaneous necrosis. (E) Rapid onest of myositis. (F) Cutaneous vasculitis. (G) ESR. (H) CK(elevated). (I) CRP. (J) ILD. (K) Arthritis/arthralgia. (L) Raynaud phenomenon. (M) Anti-Jo-1 antibody.
Figure 3
Figure 3. Forest plots generated by random-effects meta-analysis for the significant findings from studies involving DM patients only.
(A) Age. (B) Gender. (C) Cutaneous necrosis. (D) ESR(≥40 mm/h). (E) CRP. (F) Anti-p155 antibody. (G) Anti-ENA antibodies.
See this image and copyright information in PMC

References

    1. Buchbinder R, Forbes A, Hall S, Dennett X, Giles G (2001) Incidence of malignant disease in biopsy-proven inflammatory myopathy. A population-based cohort study. Annals of internal medicine 134: 1087–1095. - PubMed
    1. Hill CL, Zhang Y, Sigurgeirsson B, Pukkala E, Mellemkjaer L, et al. (2001) Frequency of specific cancer types in dermatomyositis and polymyositis: a population-based study. Lancet 357: 96–100. - PubMed
    1. Zampieri S, Valente M, Adami N, Biral D, Ghirardello A, et al. (2010) Polymyositis, dermatomyositis and malignancy: a further intriguing link. Autoimmunity reviews 9: 449–453. - PubMed
    1. Buchbinder R, Hill CL (2002) Malignancy in patients with inflammatory myopathy. Current rheumatology reports 4: 415–426. - PubMed
    1. Stockton D, Doherty VR, Brewster DH (2001) Risk of cancer in patients with dermatomyositis or polymyositis, and follow-up implications: a Scottish population-based cohort study. British journal of cancer 85: 41–45. - PMC - PubMed

Publication types