Advertisement

Rheumatology International

, Volume 33, Issue 4, pp 965–971 | Cite as

The incidence and associations of malignancy in a large cohort of patients with biopsy-determined idiopathic inflammatory myositis

  • Vidya LimayeEmail author
  • Colin Luke
  • Graeme Tucker
  • Catherine Hill
  • Susan Lester
  • Peter Blumbergs
  • Peter Roberts-Thomson
Original Article

Abstract

The South Australian (SA) myositis database has registered all patients with biopsy-proven inflammatory myositis in SA from 1980 to 2009. We determined the incidence and associations of malignancy in myositis by linking this database with the SA cancer registry. Standardized incidence ratios (SIR) for malignancy were determined using the total SA population over the same time period, stratified by age and gender. The SIR for cancer in the myositis population (n = 373) was 1.39, p = 0.047. There was a trend towards an increased SIR in dermatomyositis but no increased risk of malignancy in polymyositis or inclusion body myositis. Malignancies of the lung and prostate were the commonest and 28 % of malignancies occurred within one year of IIM diagnosis. The odds of developing cancer were significantly raised in the presence of a shawl sign, male gender, and in patients with overlap syndrome or rheumatoid arthritis whilst myalgia was a significant protective factor. HLA-A28 allele was overrepresented in patients with malignancy (11 vs 2 %, p = 0.006). Patients in SA with myositis are at modestly increased risk for malignancy. We report clinical and genetic risk factors allowing the identification of patients at greatest risk for malignancy.

Keywords

Polymyositis Dermatomyositis Inclusion body myositis Cancer Standardized incidence ratio Muscle histology 

Notes

Acknowledgments

Vidya Limaye was the recipient of a grant from Arthritis Australia. The authors are grateful to Dr. Sally Cox for her assistance in establishing the South Australian myositis database.

Conflict of interest

The authors have no conflict of interest.

References

  1. 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. Br J Cancer 85(1):41–45PubMedCrossRefGoogle Scholar
  2. 2.
    Buchbinder R, Forbes A, Hall S et al (2001) Incidence of malignant disease in biopsy-proven inflammatory myopathy: a population-based cohort study. Ann Intern Med 134:1087–1095PubMedGoogle Scholar
  3. 3.
    Hill CL, Zhang Y, Sigurgeirsson B, Pukkala E, Mellemkjaer L, Airio A et al (2001) Frequency of specific cancer types in dermatomyositis and polymyositis: a population-based study. Lancet 357:96–100PubMedCrossRefGoogle Scholar
  4. 4.
    Chow WH, Gridley G, Mellemkjaer L, McLaughlin JK, Olsen JH, Fraumeni JF Jr (1995) Cancer risk following polymyositis and dermatomyositis: a nationwide cohort study in Denmark. Cancer Causes Control 6:9–13PubMedCrossRefGoogle Scholar
  5. 5.
    Dankó K, Ponyi A, Molnar AP, András C, Constantin T (2009) Paraneoplastic myopathy. Curr Opin Rheumatol 21(6):594–598PubMedCrossRefGoogle Scholar
  6. 6.
    Casciola-Rosen L, Nagaraju K, Plotz P, Wang K, Levine S, Gabrielson E et al (2005) Enhanced autoantigen expression in regenerating muscle cells in idiopathic inflammatory myopathy. J Exp Med 201(4):591–601PubMedCrossRefGoogle Scholar
  7. 7.
    Levine SM (2006) Cancer and myositis: new insights into an old association. Curr Opin Rheumatol 18(6):620–624PubMedCrossRefGoogle Scholar
  8. 8.
    Peng JC, Sheen TS, Hsu MM (1995) Nasopharyngeal carcinoma with dermatomyositis: analysis of 12 cases. Arch Otolaryngol Head Neck Surg 121:1298–1301PubMedCrossRefGoogle Scholar
  9. 9.
    Chan HL (1985) Dermatomyositis and cancer in Singapore. Int J Dermatol 24:447–450PubMedGoogle Scholar
  10. 10.
    Chen YJ, Wu CY, Shen JL (2001) Predicting factors of malignancy in dermatomyositis and polymyositis: a case-control study. Br J Dermatol 144:825–831PubMedCrossRefGoogle Scholar
  11. 11.
    Airo A, Pukkala E, Isomaki H (1995) Elevated cancer incidence in patients with dermatomyositis: a population-based study. J Rheumatol 22:1300–1303Google Scholar
  12. 12.
    Sigurgeirsson B, Lindelof B, Edhag O, Allander E (1992) Risk of cancer in patients with dermatomyositis or polymyositis. A population-based study. N Engl J Med 326:363–367PubMedCrossRefGoogle Scholar
  13. 13.
    Bohan Bohan A, Peter JB (1975) Polymyositis and dermatomyositis (first of two parts). N Engl J Med 292(7):344–347CrossRefGoogle Scholar
  14. 14.
    Love LA, Leff RL, Fraser DD, Targoff IN, Dalakas M, Plotz PH et al (1999) A new approach to the classification of idiopathic inflammatory myopathy: myositis-specific autoantibodies define useful homogeneous patient groups. Medicine 70:360–374Google Scholar
  15. 15.
    Troyanov Y, Targoff IN, Tremblay JL, Goulet JR, Raymond Y, Senécal JL (2005) Novel classification of idiopathic inflammatory myopathies based on overlap syndrome features and autoantibodies: analysis of 100 French Canadian patients. Medicine (Baltimore) 84(4):231–249CrossRefGoogle Scholar
  16. 16.
    Targoff IN (1993) Humoral immunity in polymyositis/dermatomyositis. J Invest Dermatol 100:116S–123SPubMedCrossRefGoogle Scholar
  17. 17.
    Ghirardello A, Zampieri S, Tarricone E, Iaccarino L, Bendo R, Briani C et al (2006) Clinical implications of autoantibody screening in patients with autoimmune myositis. Autoimmunity 39:217–221PubMedCrossRefGoogle Scholar
  18. 18.
    Koenig M, Fritzler MJ, Targoff IN, Troyanov Y, Senécal JL (2007) Heterogeneity of autoantibodies in 100 patients with autoimmune myositis: insights into clinical features and outcomes. Arthritis Res Ther 9(4):R78PubMedCrossRefGoogle Scholar
  19. 19.
    Gunawardena H, Betteridge ZE, McHugh NJ (2008) Newly identified autoantibodies: relationship to idiopathic inflammatory myopathy subsets and pathogenesis. Curr Opin Rheumatol 20(6):675–680PubMedCrossRefGoogle Scholar
  20. 20.
    Chinoy H, Fertig N, Oddis CV, Ollier WER, Cooper RG (2007) The diagnostic utility of myositis autoantibody testing for predicting the risk of cancer-associated myositis. Ann Rheum Dis 66:1345–1349PubMedCrossRefGoogle Scholar
  21. 21.
    Limaye V, Hakendorf P, Woodman RJ, Blumbergs P, Roberts-Thomson P (2010) Mortality and its predominant causes in a large cohort of patients with biopsy-determined inflammatory myositis. Int Med J. doi: 10.1111/j.1445-5994.2010.02406.x
  22. 22.
    Trallero-Araguás E, Labrador-Horrillo M, Selva-O’Callaghan A, Martínez MA, Martínez-Gómez X, Palou E et al (2010) Cancer-associated myositis and anti-p155 autoantibody in a series of 85 patients with idiopathic inflammatory myopathy. Medicine (Baltimore) 89(1):47–52CrossRefGoogle Scholar
  23. 23.
    O’Hanlon TP, Carrick DM, Targoff IN, Arnett FC, Reveille JD, Carrington M et al (2006) Immunogenetic risk and protective factors for the idiopathic inflammatory myopathies: distinct HLA-A, -B, -Cw, -DRB1 and -DQA1 allelic profiles distinguish European American patients with different myositis autoantibodies. Medicine (Baltimore) 85(2):111–127CrossRefGoogle Scholar
  24. 24.
    Hohlfeld R (2002) Polymyositis and dermatomyositis. In: Karpati G (ed) Structural and molecular basis of skeletal muscle diseases. ISN Neuropath Press, Switzerland, pp 221–227Google Scholar
  25. 25.
    Dalakas MC (2011) Pathophysiology of inflammatory and autoimmune myopathies. Presse Med 40:e237–e247PubMedCrossRefGoogle Scholar
  26. 26.
    Chahin N, Engel AG (2008) Correlation of muscle biopsy, clinical course, and outcome in PM and sporadic IBM. Neurology 70:418–424PubMedCrossRefGoogle Scholar
  27. 27.
    Mastaglia FL, Philips VA (2002) Idiopathic inflammatory myopathies, epidemiology, classification and diagnostic criteria. Rheum Dis Clin North Am 28:723–741PubMedCrossRefGoogle Scholar
  28. 28.
    NE Breslow, NE Day Statistical methods in cancer research: vol II–The design and analysis of cohort studies. IARC Scientific Publications (International Agency for Research on Cancer), pp 49–51Google Scholar
  29. 29.
    Limaye VS, Lester S, Bardy P, Thompson P, Cox S, Blumbergs P, Roberts-Thomson P (2012) A three-way interplay of DR4, autoantibodies and synovitis in biopsy-proven idiopathic inflammatory myositis. Rheumatol Int 32(3):611–619Google Scholar
  30. 30.
    Buchbinder R, Hill CL (2002) Malignancy in patients with inflammatory myopathy. Curr Rheumatol Rep 4:415–426PubMedCrossRefGoogle Scholar
  31. 31.
    Chen YJ, Wu CY, Huang YL, Wang CB, Shen JL, Chang YT (2010) Cancer risks of dermatomyositis and polymyositis: a nationwide cohort study in Taiwan. Arthritis Res Ther 12:R70PubMedCrossRefGoogle Scholar
  32. 32.
    Maoz CR, Langevitz P, Livneh A, Blumstein Z, Sadeh M, Bank I et al (1998) High incidence of malignancies in patients with dermatomyositis and polymyositis: an 11-year analysis. Semin Arthritis Rheum 27:319–324PubMedCrossRefGoogle Scholar
  33. 33.
    Antiochos BB, Brown LA, Li Z, Tosteson TD, Wortmann RL, Rigby WFC (2009) Malignancy is associated with dermatomyositis but not polymyositis in Northern New England. USA J Rheumatol 36:2704–2710CrossRefGoogle Scholar
  34. 34.
    Zhang W, Jiang SP, Huang L (2009) Dermatomyositis and malignancy: a retrospective study of 115 cases. Eur Rev Med Pharmacol Sci 13(2):77–80PubMedGoogle Scholar
  35. 35.
    Lakhanpal S, Bunch TW, Ilstrup DM, Melton LJ 3rd (1986) Polymyositis-dermatomyositis and malignant lesions: does an association exist? Mayo Clin Proc 61:645–653PubMedCrossRefGoogle Scholar
  36. 36.
    Andras C, Ponyi A, Constantin T, Csiki Z, Szekanecz E, Szodoray P et al (2008) Dermatomyositis and polymyositis associated with malignancy: a 21-year retrospective study. J Rheumatol 35:438–444PubMedGoogle Scholar
  37. 37.
    Barona P, Sierrasesumaga L, Antillon F, Villa-Elizaga I (1993) Study of HLA antigens in patients with osteosarcoma. Hum Hered 43(5):311–314PubMedCrossRefGoogle Scholar
  38. 38.
    Abrahamova J, Majsky A, Koutecky J (1981) HLA-antigens in germ cell tumours of various sites. Onkologie 4(1):19–20PubMedCrossRefGoogle Scholar
  39. 39.
    Hornmark-Stenstam B, Landberg T, Low B (1978) HLA antigens in Hodgkin’s disease of very long survival. Acta Radiol Oncol Radiat Phys Biol 17(4):283–288PubMedCrossRefGoogle Scholar
  40. 40.
    Paul SM, Bacharach B, Goepp C (1987) A genetic influence on alveolar cell carcinoma. J Surg Oncol 36(4):249–252PubMedCrossRefGoogle Scholar
  41. 41.
    Illeni MT, Pasquali M, La Monica G, Bohm S, Rovini D, Di Re E (1985) HLA antigens in ovarian adenocarcinoma patients. Eur J Gynaecol Oncol 6(2):121–125PubMedGoogle Scholar
  42. 42.
    Sosman JA, Unger JM, Liu PY, Flaherty LE, Park MS, Kempf RA et al (2002) Southwest oncology group. Adjuvant immunotherapy of resected, intermediate-thickness, node-negative melanoma with an allogeneic tumour vaccine: impact of HLA Class I antigen expression on outcome. J Clin Oncol 20(8):2067–2075PubMedCrossRefGoogle Scholar
  43. 43.
    Luboldt HJ, Kubens BS, Rubben H, Grosse-Wilde H (1996) Selective loss of human leukocyte antigen class I allele expression in advanced renal cell carcinoma. Cancer Res 56(4):826–830PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Vidya Limaye
    • 1
    • 2
    Email author
  • Colin Luke
    • 3
  • Graeme Tucker
    • 4
  • Catherine Hill
    • 5
  • Susan Lester
    • 5
  • Peter Blumbergs
    • 6
  • Peter Roberts-Thomson
    • 7
  1. 1.Department of RheumatologyRoyal Adelaide HospitalAdelaideAustralia
  2. 2.Department of MedicineUniversity of AdelaideAdelaideAustralia
  3. 3.Epidemiology BranchSouth Australian Department of HealthAdelaideAustralia
  4. 4.Epidemiology Branch Health System Information and Performance Operations DivisionSA HealthAdelaideAustralia
  5. 5.Department of RheumatologyThe Queen Elizabeth HospitalAdelaideAustralia
  6. 6.Neuropathology Department, Hanson InstituteInstitute of Medical and Veterinary ScienceAdelaideAustralia
  7. 7.SA PathologyDepartment of HealthAdelaideAustralia

Personalised recommendations