Meta-Analysis

. 2021 Jun 18;60(6):2615-2628.

doi: 10.1093/rheumatology/keab166.

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

Alexander G S Oldroyd^{1

2

3

4}, Andrew B Allard⁵, Jeffrey P Callen⁶, Hector Chinoy^{1

2

4}, Lorinda Chung^{7

8}, David Fiorentino⁹, Michael D George^{10

11}, Patrick Gordon¹², Kate Kolstad⁹, Drew J B Kurtzman¹³, Pedro M Machado^{14

15

16}, Neil J McHugh¹⁷, Anna Postolova¹⁸, Albert Selva-O'Callaghan¹⁹, Jens Schmidt²⁰, Sarah Tansley^{5

20}, Ruth Ann Vleugels^{21

22}, Victoria P Werth^{23

24}, Rohit Aggarwal²⁵

Affiliations

¹ National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK.
² Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
³ Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK.
⁴ Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK.
⁵ Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.
⁶ Division of Medicine, Department of Medicine, University of Louisville, Louisville, KY, USA.
⁷ Division of Immunology and Rheumatology, Department of Medicine and Dermatology, Stanford University, Stanford, USA.
⁸ Palo Alto Health Care System, Palo Alto, USA.
⁹ Department of Dermatology, School of Medicine, Stanford University, Stanford, CA, USA.
¹⁰ Division of Rheumatology, Philadelphia, PA, USA.
¹¹ Division of Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
¹² Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK.
¹³ Department of Dermatology, Wright State University, Dayton, OH, USA.
¹⁴ Centre for Rheumatology and Department of Neuromuscular Diseases, University College London, London, UK.
¹⁵ National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Trust, London, UK.
¹⁶ Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.
¹⁷ Department of Pharmacy and Pharmacology, University of Bath, Bath, UK.
¹⁸ Department of Immunology and Rheumatology, Stanford Health Care, Stanford, CA, USA.
¹⁹ Systemic Autoimmune Unity, Vall D'Hebron General Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain.
²⁰ Department of Neurology, Neuromuscular Centre, Göttingen, Germany.
²¹ Harvard Medical School, Boston, MA, USA.
²² Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.
²³ Department of Dermatology, University of Pennsylvania, Philadelphia, USA.
²⁴ Division of Dermatology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, USA.
²⁵ Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.

PMID: 33599244
PMCID: PMC8213426
DOI: 10.1093/rheumatology/keab166

Meta-Analysis

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

Alexander G S Oldroyd et al. Rheumatology (Oxford). 2021.

. 2021 Jun 18;60(6):2615-2628.

doi: 10.1093/rheumatology/keab166.

Authors

Affiliations

¹ National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK.
² Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
³ Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK.
⁴ Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK.
⁵ Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.
⁶ Division of Medicine, Department of Medicine, University of Louisville, Louisville, KY, USA.
⁷ Division of Immunology and Rheumatology, Department of Medicine and Dermatology, Stanford University, Stanford, USA.
⁸ Palo Alto Health Care System, Palo Alto, USA.
⁹ Department of Dermatology, School of Medicine, Stanford University, Stanford, CA, USA.
¹⁰ Division of Rheumatology, Philadelphia, PA, USA.
¹¹ Division of Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
¹² Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK.
¹³ Department of Dermatology, Wright State University, Dayton, OH, USA.
¹⁴ Centre for Rheumatology and Department of Neuromuscular Diseases, University College London, London, UK.
¹⁵ National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Trust, London, UK.
¹⁶ Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.
¹⁷ Department of Pharmacy and Pharmacology, University of Bath, Bath, UK.
¹⁸ Department of Immunology and Rheumatology, Stanford Health Care, Stanford, CA, USA.
¹⁹ Systemic Autoimmune Unity, Vall D'Hebron General Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain.
²⁰ Department of Neurology, Neuromuscular Centre, Göttingen, Germany.
²¹ Harvard Medical School, Boston, MA, USA.
²² Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.
²³ Department of Dermatology, University of Pennsylvania, Philadelphia, USA.
²⁴ Division of Dermatology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, USA.
²⁵ Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.

PMID: 33599244
PMCID: PMC8213426
DOI: 10.1093/rheumatology/keab166

Erratum in

Corrigendum to: A systematic review and meta-analysis to inform cancer screening guidelines in idiopathic inflammatory myopathies.
Oldroyd AGS, Allard AB, Callen JP, Chinoy H, Chung L, Fiorentino D, George MD, Gordon P, Kolstad K, Kurtzman DJB, Machado PM, McHugh NJ, Postolova A, Selva-O'Callaghan A, Schmidt J, Tansley S, Vleugels RA, Werth VP, Aggarwal R. Oldroyd AGS, et al. Rheumatology (Oxford). 2021 Nov 3;60(11):5483. doi: 10.1093/rheumatology/keab616. Rheumatology (Oxford). 2021. PMID: 34689208 Free PMC article. No abstract available.

Abstract

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 IIMs 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.

Keywords: CT scanning; autoantibodies; epidemiology; meta-analysis; muscle; myositis; neoplasia.

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Figures

<sc>Fig</sc>. 1 — **Fig. 1**
PRISMA flow diagram

See this image and copyright information in PMC

Comment in

Risk-Based Screening for Cancer in Patients With Dermatomyositis: Toward a More Individualized Approach.
Vaughan H, Rugo HS, Haemel A. Vaughan H, et al. JAMA Dermatol. 2022 Mar 1;158(3):244-247. doi: 10.1001/jamadermatol.2021.5841. JAMA Dermatol. 2022. PMID: 35107570 No abstract available.

References

1. Oldroyd A, Lilleker J, Chinoy H.. Idiopathic inflammatory myopathies - a guide to subtypes, diagnostic approach and treatment. Clin Med (Northfield IL) 2017;17:322–8. - PMC - PubMed
1. Chinoy H, Cooper RG.. Polymyositis and dermatomyositis. In: Chinoy H and Cooper RG, eds. Oxford Textbook of Rheumatology. Oxford: Oxford University Press, 2013:1009–20.
1. Qiang JK, Kim WB, Baibergenova A, Alhusayen R.. Risk of malignancy in dermatomyositis and polymyositis: a systematic review and meta-analysis. J Cutan Med Surg 2017;21:131–6. - PubMed
1. Dobloug GC, Garen T, Brunborg C, Gran JT, Molberg Ø.. Survival and cancer risk in an unselected and complete Norwegian idiopathic inflammatory myopathy cohort. Semin Arthritis Rheum 2015;45:301–8. - PubMed
1. Nuño-Nuño L, Joven BE, Carreira PE. et al. Mortality and prognostic factors in idiopathic inflammatory myositis: a retrospective analysis of a large multicenter cohort of Spain. Rheumatol Int 2017;37:1853–61. - PubMed

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

Affiliations

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

Authors

Affiliations

Erratum in

Abstract

Figures

Comment in

References

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Supplementary concepts

Grants and funding

LinkOut - more resources

Full Text Sources

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Medical