Reappraisal of the incidence, various types and risk factors of malignancies in patients with dermatomyositis and polymyositis in Taiwan

Abstract Our study aimed to investigate the incidence, risk factors and time to occurrence of malignancy in patients with dermatomyositis (DM) and polymyositis (PM). The electronic medical records of 1100 patients with DM and 1164 patients with PM were studied between January 2001 and May 2019. Mali...

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Autores principales: Jung-Lung Hsu, Ming-Feng Liao, Chun-Che Chu, Hung-Chou Kuo, Rong-Kuo Lyu, Hong-Shiu Chang, Chiung-Mei Chen, Yih-Ru Wu, Kuo-Hsuan Chang, Yi-Ching Weng, Chun-Wei Chang, Hsing-I. Chiang, Chih-Kuang Cheng, Pai-Wei Lee, Chin-Chang Huang, Long-Sun Ro
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Publicado: Nature Portfolio 2021
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Acceso en línea:https://doaj.org/article/defbc33dadc14e5ea14af2dc71c8cb62
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spelling oai:doaj.org-article:defbc33dadc14e5ea14af2dc71c8cb622021-12-02T13:35:04ZReappraisal of the incidence, various types and risk factors of malignancies in patients with dermatomyositis and polymyositis in Taiwan10.1038/s41598-021-83729-52045-2322https://doaj.org/article/defbc33dadc14e5ea14af2dc71c8cb622021-02-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-83729-5https://doaj.org/toc/2045-2322Abstract Our study aimed to investigate the incidence, risk factors and time to occurrence of malignancy in patients with dermatomyositis (DM) and polymyositis (PM). The electronic medical records of 1100 patients with DM and 1164 patients with PM were studied between January 2001 and May 2019. Malignancies after myositis were diagnosed in 61 (5.55%) patients with DM and 38 (3.26%) patients with PM. The cumulative incidence of malignancies in patients with DM were significantly higher than patients with PM (hazard ratio = 1.78, log-rank p = 0.004). Patients with DM had a greater risk of developing malignancy than those with PM at 40–59 years old (p = 0.01). Most malignancies occurred within 1 year after the initial diagnosis of DM (n = 35; 57.38%). Nasopharyngeal cancer (NPC) was the most common type of malignancy in patients with DM (22.95%), followed by lung, and breast cancers. In patients with PM, colorectal, lung and hepatic malignancies were the top three types of malignancy. The risk factors for malignancy included old age (≥ 45 years old) and low serum levels of creatine phosphokinase (CPK) for patients with DM and male sex and low serum levels of CPK for patients with PM. Low serum levels of CPK in patients with myositis with malignancy represented a low degree of muscle destruction/inflammation, which might be attributed to activation of the PD-L1 pathway by tumor cells, thus inducing T-cell dysfunction mediating immune responses in myofibers. A treatment and follow-up algorithm should explore the occurrence of malignancy in different tissues and organs and suggested annual follow-ups for at least 5.5 years to cover the 80% cumulative incidence of malignancy in patients with DM and PM.Jung-Lung HsuMing-Feng LiaoChun-Che ChuHung-Chou KuoRong-Kuo LyuHong-Shiu ChangChiung-Mei ChenYih-Ru WuKuo-Hsuan ChangYi-Ching WengChun-Wei ChangHsing-I. ChiangChih-Kuang ChengPai-Wei LeeChin-Chang HuangLong-Sun RoNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-11 (2021)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Jung-Lung Hsu
Ming-Feng Liao
Chun-Che Chu
Hung-Chou Kuo
Rong-Kuo Lyu
Hong-Shiu Chang
Chiung-Mei Chen
Yih-Ru Wu
Kuo-Hsuan Chang
Yi-Ching Weng
Chun-Wei Chang
Hsing-I. Chiang
Chih-Kuang Cheng
Pai-Wei Lee
Chin-Chang Huang
Long-Sun Ro
Reappraisal of the incidence, various types and risk factors of malignancies in patients with dermatomyositis and polymyositis in Taiwan
description Abstract Our study aimed to investigate the incidence, risk factors and time to occurrence of malignancy in patients with dermatomyositis (DM) and polymyositis (PM). The electronic medical records of 1100 patients with DM and 1164 patients with PM were studied between January 2001 and May 2019. Malignancies after myositis were diagnosed in 61 (5.55%) patients with DM and 38 (3.26%) patients with PM. The cumulative incidence of malignancies in patients with DM were significantly higher than patients with PM (hazard ratio = 1.78, log-rank p = 0.004). Patients with DM had a greater risk of developing malignancy than those with PM at 40–59 years old (p = 0.01). Most malignancies occurred within 1 year after the initial diagnosis of DM (n = 35; 57.38%). Nasopharyngeal cancer (NPC) was the most common type of malignancy in patients with DM (22.95%), followed by lung, and breast cancers. In patients with PM, colorectal, lung and hepatic malignancies were the top three types of malignancy. The risk factors for malignancy included old age (≥ 45 years old) and low serum levels of creatine phosphokinase (CPK) for patients with DM and male sex and low serum levels of CPK for patients with PM. Low serum levels of CPK in patients with myositis with malignancy represented a low degree of muscle destruction/inflammation, which might be attributed to activation of the PD-L1 pathway by tumor cells, thus inducing T-cell dysfunction mediating immune responses in myofibers. A treatment and follow-up algorithm should explore the occurrence of malignancy in different tissues and organs and suggested annual follow-ups for at least 5.5 years to cover the 80% cumulative incidence of malignancy in patients with DM and PM.
format article
author Jung-Lung Hsu
Ming-Feng Liao
Chun-Che Chu
Hung-Chou Kuo
Rong-Kuo Lyu
Hong-Shiu Chang
Chiung-Mei Chen
Yih-Ru Wu
Kuo-Hsuan Chang
Yi-Ching Weng
Chun-Wei Chang
Hsing-I. Chiang
Chih-Kuang Cheng
Pai-Wei Lee
Chin-Chang Huang
Long-Sun Ro
author_facet Jung-Lung Hsu
Ming-Feng Liao
Chun-Che Chu
Hung-Chou Kuo
Rong-Kuo Lyu
Hong-Shiu Chang
Chiung-Mei Chen
Yih-Ru Wu
Kuo-Hsuan Chang
Yi-Ching Weng
Chun-Wei Chang
Hsing-I. Chiang
Chih-Kuang Cheng
Pai-Wei Lee
Chin-Chang Huang
Long-Sun Ro
author_sort Jung-Lung Hsu
title Reappraisal of the incidence, various types and risk factors of malignancies in patients with dermatomyositis and polymyositis in Taiwan
title_short Reappraisal of the incidence, various types and risk factors of malignancies in patients with dermatomyositis and polymyositis in Taiwan
title_full Reappraisal of the incidence, various types and risk factors of malignancies in patients with dermatomyositis and polymyositis in Taiwan
title_fullStr Reappraisal of the incidence, various types and risk factors of malignancies in patients with dermatomyositis and polymyositis in Taiwan
title_full_unstemmed Reappraisal of the incidence, various types and risk factors of malignancies in patients with dermatomyositis and polymyositis in Taiwan
title_sort reappraisal of the incidence, various types and risk factors of malignancies in patients with dermatomyositis and polymyositis in taiwan
publisher Nature Portfolio
publishDate 2021
url https://doaj.org/article/defbc33dadc14e5ea14af2dc71c8cb62
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