The incidence and associations of malignancy in a large cohort of patients with biopsy-determined idiopathic inflammatory myositis
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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.
KeywordsPolymyositis Dermatomyositis Inclusion body myositis Cancer Standardized incidence ratio Muscle histology
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.
- 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
- 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
- 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
- 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.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
- 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.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
- 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