Lim Chong Hong, Tseng Chih-Wei, Lin Ching-Tsai, Huang Wen-Nan, Chen Yi-Hsing, Chen Yi-Ming, Chen Der-Yuan
Rheumatology Unit, Department of Internal Medicine, Hospital Sultanah Bahiyah, Alor Setar, Malaysia.
Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
SAGE Open Med. 2018 Jun 18;6:2050312118781895. doi: 10.1177/2050312118781895. eCollection 2018.
To examine the clinical utility of tumor markers in dermatomyositis/polymyositis patients in Taiwan.
Data were collected retrospectively from the database of Taichung Veterans General Hospital in Taiwan from 1998 to 2014. Patients who fulfilled Bohan and Peter criteria of dermatomyositis/polymyositis were recruited. Serum level of tumor markers including carcinoembryonic antigen, alpha-fetoprotein, carbohydrate antigen 125, carbohydrate antigen 19-9 and carbohydrate antigen 15-3 were measured. The occurrence of malignancies and interstitial lung disease was identified. The association of tumor markers with malignancies and interstitial lung disease was examined using Chi-square test or Fisher's exact test.
Among the enrolled 151 patients, 98 (64.9%) dermatomyositis and 53 (35.1%) polymyositis, a total of 15 malignancies were detected: breast ductal carcinoma (n = 4), bladder transitional cell carcinoma (n = 2), lung adenocarcinoma (n = 2), cervical intraepithelial neoplasia 3 and papillary squamous cell carcinoma (n = 2), colorectal (colon and rectal adenocarcinoma) (n = 2), uterine adenocarcinoma (n = 1), nasopharyngeal carcinoma (n = 1) and hematological malignancy (myelodysplastic with excess blast cells) (n = 1). Among the patients with malignancies, 13 (86.7%) had dermatomyositis, 2 (13.3%) polymyositis and 3 (20%) interstitial lung disease. The mean duration from dermatomyositis/polymyositis diagnosis to the occurrence of malignancies was 6.05 ± 5.69 years. There was no significant association of raised tumor markers with the occurrence of malignancies (p > 0.085), while a significant association was observed between the elevated levels of carbohydrate antigen 15-3 and the presence of interstitial lung disease (p = 0.006).
Tumor markers were not useful in malignancy screening or dermatomyositis/polymyositis patients in this tertiary center. The evaluation of the occurrence of malignancy in dermatomyositis/polymyositis patient should include a multidimensional approach. A raised level of carbohydrate antigen 15-3 may be a potential indicator of the presence of interstitial lung disease in dermatomyositis/polymyositis patients.
探讨肿瘤标志物在台湾皮肌炎/多肌炎患者中的临床应用价值。
回顾性收集台湾台中荣民总医院1998年至2014年数据库中的数据。招募符合皮肌炎/多肌炎博汉和彼得标准的患者。检测血清中癌胚抗原、甲胎蛋白、糖类抗原125、糖类抗原19-9和糖类抗原15-3等肿瘤标志物水平。确定恶性肿瘤和间质性肺病的发生情况。采用卡方检验或费舍尔精确检验分析肿瘤标志物与恶性肿瘤和间质性肺病的相关性。
在纳入的151例患者中，皮肌炎98例（64.9%），多肌炎53例（35.1%），共检测到15例恶性肿瘤：乳腺导管癌（n = 4）、膀胱移行细胞癌（n = 2）、肺腺癌（n = 2）、宫颈上皮内瘤变3级和乳头状鳞状细胞癌（n = 2）、结直肠癌（结肠和直肠腺癌）（n = 2）、子宫腺癌（n = 1）、鼻咽癌（n = 1）和血液系统恶性肿瘤（骨髓增生异常伴原始细胞增多）（n = 1）。在恶性肿瘤患者中，13例（86.7%）患有皮肌炎，2例（13.3%）患有多肌炎，3例（20%）患有间质性肺病。从皮肌炎/多肌炎诊断到发生恶性肿瘤的平均时间为6.05±5.69年。肿瘤标志物升高与恶性肿瘤的发生无显著相关性（p>0.085），而糖类抗原15-3水平升高与间质性肺病的存在有显著相关性（p = 0.006）。
在该三级中心，肿瘤标志物对皮肌炎/多肌炎患者的恶性肿瘤筛查无用。评估皮肌炎/多肌炎患者恶性肿瘤的发生应采用多维度方法。糖类抗原15-3水平升高可能是皮肌炎/多肌炎患者存在间质性肺病的潜在指标。
