Che Weng Ian, Kuja-Halkola Ralf, Hellgren Karin, Lundberg Ingrid E, Westerlind Helga, Baecklund Fredrik, Holmqvist Marie
Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau SAR, China.
Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
J Intern Med. 2024 Oct;296(4):336-349. doi: 10.1111/joim.20003. Epub 2024 Aug 2.
Patients with idiopathic inflammatory myopathies (IIM) have an increased risk of cancer, but their cancer-related disease burden remains unclear.
To explore how cancer might impact the mortality of patients with IIM and examine the associated prognostic factors for cancer and death.
We identified patients with IIM diagnosed between 1998 and 2020 and ascertained their cancer and death records via linkage to the Swedish healthcare and population registers. Transition hazards from IIM diagnosis to cancer and death were estimated in multistate models using flexible parametric methods. We then predicted the probability of having cancer or death, and the duration of staying alive at a given time from IIM and cancer diagnoses from a crude model. We also explored prognostic factors for progression to cancer and death in a multivariable model.
Of 1826 IIM patients, 310 (17%) were diagnosed with cancer before and 306 (17%) after IIM diagnosis. In patients diagnosed with cancer after IIM, the 5-year probability of death from cancer and from other causes was 31% and 18%, respectively, compared to 7% and 15% in patients without cancer after IIM. We reported several factors associated with risk of progression to cancer and death. Specifically, patients with first cancer after IIM who were older at IIM diagnosis, had cancer history, dermatomyositis and a cancer diagnosis within 1 year following IIM faced a greater cancer-specific mortality.
We observed a substantial increase in mortality from cancer, compared to before, rather than other causes after a cancer diagnosis following IIM, suggesting an unmet medical need for effective cancer management in IIM patients. This finding, along with the identified prognostic factors, provides useful insight into future research directions for improving cancer management in IIM patients.
特发性炎性肌病（IIM）患者患癌风险增加，但其癌症相关疾病负担尚不清楚。
探讨癌症如何影响IIM患者的死亡率，并研究癌症和死亡的相关预后因素。
我们确定了1998年至2020年间诊断为IIM的患者，并通过与瑞典医疗保健和人口登记系统的关联确定了他们的癌症和死亡记录。使用灵活的参数方法在多状态模型中估计从IIM诊断到癌症和死亡的转移风险。然后，我们从一个粗略模型预测患癌症或死亡的概率，以及从IIM和癌症诊断开始在给定时间存活的持续时间。我们还在多变量模型中探索了进展为癌症和死亡的预后因素。
在1826例IIM患者中，310例（17%）在IIM诊断之前被诊断出患有癌症，306例（17%）在IIM诊断之后被诊断出患有癌症。在IIM诊断后被诊断出患有癌症的患者中，因癌症和其他原因死亡的5年概率分别为31%和18%，而IIM诊断后未患癌症的患者中这一概率分别为7%和15%。我们报告了几个与进展为癌症和死亡风险相关的因素。具体而言，IIM诊断时年龄较大、有癌症病史、患皮肌炎且在IIM诊断后1年内被诊断出患有癌症的IIM后首次患癌患者面临更高的癌症特异性死亡率。
我们观察到，与IIM诊断后未患癌症的患者相比，IIM诊断后患癌症的患者因癌症导致的死亡率大幅上升，而非其他原因导致的死亡率上升，这表明IIM患者对有效的癌症管理存在未满足的医疗需求。这一发现以及确定的预后因素为改善IIM患者癌症管理的未来研究方向提供了有用的见解。
