Rheumatology Division, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Clinical Epidemiology Division, Departement of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
Semin Arthritis Rheum. 2021 Feb;51(1):331-337. doi: 10.1016/j.semarthrit.2020.12.009. Epub 2020 Dec 24.
To examine the association between idiopathic inflammatory myopathy (IIM) and cancer before and after IIM diagnosis.
We used prospectively collected nationwide register data to design a case-control study to investigate the occurrence of cancer before IIM, and a cohort study to investigate the occurrence of cancer after IIM. Patients diagnosed with IIM between 2002 and 2016 in Sweden, were compared to the general population. The association between cancer and IIM was estimated before and after IIM diagnosis via logistic regression and Cox regression models, respectively.
We included 1419 patients with IIM and 7045 individuals from the general population. The overall odds of cancer before IIM diagnosis were increased in IIM compared to the general population, adjusted odds ratio (AOR) 1.5, 95% confidence interval (CI) 1.3-1.8. This association was also noted after IIM diagnosis, adjusted hazard ratio (AHR) 1.7 (95% CI 1.4-2.0), or one additional cancer in every 125 IIM patients per year. Colorectal (AOR 2.1), lung (AOR 5.4) and ovarian (AOR 7.0) cancers were associated with IIM before diagnosis. Oropharyngeal (AHR 9.1) and cervical (AHR 3.8) cancers, malignant melanoma (AHR 3.2) and non-melanoma skin cancer (AHR 3.1) were associated with IIM after diagnosis. Adenocarcinomas were associated with dermatomyositis before diagnosis and squamous cell cancers after IIM diagnosis. Lymphatic hematopoietic cancers were associated with IIM both before and after diagnosis.
The cancer types that occur before IIM diagnosis differ from the ones that occur after diagnosis. This may have an impact on screening decisions for IIM.
研究特发性炎性肌病（IIM）在诊断前后与癌症的相关性。
我们使用前瞻性收集的全国性登记数据设计了病例对照研究来调查 IIM 之前癌症的发生情况，以及队列研究来调查 IIM 之后癌症的发生情况。在瑞典，2002 年至 2016 年间诊断为 IIM 的患者与普通人群进行了比较。使用逻辑回归和 Cox 回归模型分别估计 IIM 前后癌症与 IIM 之间的关联。
我们纳入了 1419 名 IIM 患者和 7045 名普通人群。与普通人群相比，在 IIM 诊断前，癌症的总体发生几率增加，调整后的优势比（AOR）为 1.5，95%置信区间（CI）为 1.3-1.8。在 IIM 诊断后也观察到了这种关联，调整后的风险比（AHR）为 1.7（95%CI 1.4-2.0），即每 125 名 IIM 患者每年增加一例癌症。在诊断前，结直肠癌（AOR 2.1）、肺癌（AOR 5.4）和卵巢癌（AOR 7.0）与 IIM 相关。在诊断后，口咽癌（AHR 9.1）和宫颈癌（AHR 3.8）、恶性黑色素瘤（AHR 3.2）和非黑色素瘤皮肤癌（AHR 3.1）与 IIM 相关。在诊断前，腺癌与皮肌炎相关，而在 IIM 诊断后，鳞状细胞癌与 IIM 相关。淋巴血液系统癌症与 IIM 前后均相关。
在 IIM 诊断前发生的癌症类型与诊断后发生的癌症类型不同。这可能会对 IIM 的筛查决策产生影响。
