Systemic Autoimmune Diseases Unit, Medicine Department.
Preventive Medicine and Epidemiology, Vall d'Hebron General Hospital, Universitat Autònoma de Barcelona.
Curr Opin Rheumatol. 2018 Nov;30(6):630-636. doi: 10.1097/BOR.0000000000000535.
Despite the well-recognized association between malignancy and myositis, definite data indicating the best strategy for diagnosing cancer in myositis patients is lacking. In this article, we review the data on cancer screening in patients with myositis, and propose an algorithm for this purpose based on recently published data.
Evidence has recently emerged supporting blind screening in patients with certain myositis phenotypes. In addition to the clinical examination, imaging techniques such as PET/computed tomography scanning and whole-body MRI, and determination of the autoantibody profile beyond anti-TIF1γ antibody, the well known cancer biomarker in dermatomyositis, will help the clinician face this complex clinical situation. Molecules related to the checkpoint inhibitor pathway, specifically soluble programmed death 1, may also have a role in the diagnostic work-up of cancer in myositis. In the future, blood tests analysing circulating DNA will certainly help in detecting patients with cancer-associated myositis (CAM).
A step forward has been achieved in the pathway to establish optimal cancer screening for myositis patients. International consensus guidelines for an effective diagnostic work-up of CAM are in progress and will be of paramount importance to improving the outcome in these patients.
尽管恶性肿瘤与肌炎之间存在明确的相关性，但明确表明肌炎患者最佳癌症诊断策略的数据仍缺乏。本文就肌炎患者的癌症筛查数据进行综述，并基于最新发表的数据提出一种用于该目的的算法。
有证据表明，在某些肌炎表型患者中可进行盲筛。除临床检查外，影像学技术（如 PET/CT 扫描和全身 MRI）以及除抗 TIF1γ 抗体（皮肌炎中著名的癌症生物标志物）之外的自身抗体谱的测定，将有助于临床医生应对这种复杂的临床情况。与检查点抑制剂通路相关的分子，特别是可溶性程序性死亡 1，也可能在肌炎的癌症诊断工作中发挥作用。未来，分析循环 DNA 的血液检测肯定有助于检测出伴癌性肌炎（CAM）的患者。
在确定肌炎患者最佳癌症筛查的途径方面已经取得了进展。正在制定肌炎患者 CAM 有效诊断工作的国际共识指南，这对改善这些患者的预后至关重要。
