Tang Zhuang-Li, Chi Chao-Cheng, Tang Zhen-Wei, Li Xia-Wei, Man Xiao-Yong
Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Front Med (Lausanne). 2023 Jun 8;10:1200804. doi: 10.3389/fmed.2023.1200804. eCollection 2023.
To describe the demographics and phenotypes of malignancies-associated dermatomyositis (MADM) in east China and pinpoint potential factors indicative of malignancies in patients with dermatomyositis and establish a predictive model.
We retrospectively analyzed clinical data from 134 patients with adult-onset dermatomyositis hospitalized between January 2019 and May 2022 in one comprehensive hospital. Clinical data including disease course, initial symptoms and signs, and demographic information were retrieved from the Electronic Medical Records System. Other parameters including myositis-specific autoantibodies profiles, ferritin, sedimentation, etc. were all referable. Multivariable multinomial logistic regression was employed to simulate a model to predict cancer risks. Receiver operating characteristic curve was adopted to evaluate the potency of the model.
134 patients with adult-onset dermatomyositis were aptly enrolled in this study based on inclusive and exclusive criteria: 12 (8.96%) with malignancies, 57 (42.53%) with aberrant tumor biomarkers but no malignancies, 65 (48.51%) with neither malignancies nor abnormal tumor biomarkers. Senior diagnostic age, higher LDH, higher ferritin, positive anti-TIF1γ and anti-Mi2 rather than anti-NXP2 autoantibodies were positive indicators of malignancies. Additionally, neither initial complaints nor signs were found to be correlated to a tendency towards malignancies. Digestive system, nasopharyngeal, and lung malignancies were mostly documented in east China. One multivariable multinomial logistic regression model was established to predict the phenotypes of dermatomyositis on the basis of potential malignancies and the overall sensitivity and specificity was satisfactory.
Positivity of anti-TIF1γ and anti-Mi2 autoantibodies are highly indicative of malignancies while the role of anti-NXP2 autoantibody in MADM in the Chinese population remains unclear. The phenotypes of malignancies can be predicted through the model and the predictive power is sufficient. More attention should be paid to malignancies screening in patients with aberrant tumor biomarkers but no malignancies, particularly digestive system, nasopharyngeal, and lung malignancies in patients with dermatomyositis but without malignancies.
描述中国东部地区恶性肿瘤相关性皮肌炎（MADM）的人口统计学特征和表型，确定皮肌炎患者中提示恶性肿瘤的潜在因素，并建立预测模型。
我们回顾性分析了2019年1月至2022年5月期间在一家综合医院住院的134例成人起病皮肌炎患者的临床资料。从电子病历系统中检索临床资料，包括病程、初始症状和体征以及人口统计学信息。其他参数，包括肌炎特异性自身抗体谱、铁蛋白、血沉等均可供参考。采用多变量多项逻辑回归来模拟预测癌症风险的模型。采用受试者工作特征曲线来评估模型的效能。
根据纳入和排除标准，本研究恰当纳入了134例成人起病皮肌炎患者：12例（8.96%）患有恶性肿瘤，57例（42.53%）肿瘤生物标志物异常但无恶性肿瘤，65例（48.51%）既无恶性肿瘤也无肿瘤生物标志物异常。诊断年龄较大、乳酸脱氢酶较高、铁蛋白较高、抗TIF1γ和抗Mi2抗体阳性而非抗NXP2自身抗体阳性是恶性肿瘤的阳性指标。此外，未发现初始症状和体征与恶性肿瘤倾向相关。在中国东部地区，消化系统、鼻咽癌和肺癌恶性肿瘤最为常见。建立了一个多变量多项逻辑回归模型，以根据潜在恶性肿瘤预测皮肌炎的表型，总体敏感性和特异性令人满意。
抗TIF1γ和抗Mi2自身抗体阳性高度提示恶性肿瘤，而抗NXP2自身抗体在中国人群MADM中的作用仍不清楚。通过该模型可以预测恶性肿瘤的表型，且预测能力足够。对于肿瘤生物标志物异常但无恶性肿瘤的患者，尤其是皮肌炎但无恶性肿瘤的患者，应更加关注消化系统、鼻咽癌和肺癌恶性肿瘤的筛查。
