Liu Shubei, Zhang Zhihong, Yan Shushan, Yang Chunjuan, Wang Bin, Shen Minning, Wang Zhenhua, Xu Donghua
Department of Rheumatology and Immunology, Weifang People's Hospital, Shandong Second Medical University, Weifang, China.
Department of Rheumatology and Immunology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Front Oncol. 2025 Jun 4;15:1503140. doi: 10.3389/fonc.2025.1503140. eCollection 2025.
Dermatomyositis (DM) is an idiopathic inflammatory myopathy with characteristic cutaneous inflammation and heterogeneous systemic involvements, and is strongly associated with risk of malignancy. This review summarizes the incidence of malignancies, risk factors associated with malignancies, and cancer screening methods in DM patients. Large population-based cohort studies and meta-analyses have provided strong evidence for the significantly elevated incidence of malignancies in DM patients. Common malignancies occurring in DM patients mainly include ovarian cancer, lung cancer, breast cancer, pancreatic cancer, stomach cancer, hematologic malignancies, and colorectal cancer. Clinicians should cautiously consider the risk of malignancy in DM patients during diagnosis and treatment, conducting regular screening and monitoring to facilitate early detection and treatment of malignancies. Among myositis-specific antibodies, anti-transcription intermediary factor 1γ antibodies are strongly linked to malignancy risk. Other factors such as older age, male gender, dysphagia, skin necrosis, cutaneous vasculitis, rapid onset of the disease, elevated creatinine kinase, and elevated C-reactive protein are closely associated with the risk of malignancy. DM patients with these features need receive screening for malignant tumors or close monitoring and follow-up. DM patients, especially those within 3 years of onset, have a high risk of cancer and should receive careful cancer screening according to their risk stratification. Conventional screening tools such as imaging examinations and tumor marker tests are not effective in detecting malignancies among DM patients. Current cancer screening workflows available for DM patients largely mirror those used in the general population but may not fully address DM-specific characteristics, and the best strategy for screening cancer in DM patients is still lacking. To facilitate earlier detection and diagnosis of DM-associated cancer and thereby improve outcomes, more effective cancer detection tools and personalized malignancy screening workflows specifically tailored to the features of DM and their individual risk stratification are warranted.
皮肌炎（DM）是一种特发性炎性肌病，具有特征性的皮肤炎症和多系统受累情况，且与恶性肿瘤风险密切相关。本综述总结了DM患者中恶性肿瘤的发病率、与恶性肿瘤相关的危险因素以及癌症筛查方法。基于大人群的队列研究和荟萃分析为DM患者中恶性肿瘤发病率显著升高提供了有力证据。DM患者中常见的恶性肿瘤主要包括卵巢癌、肺癌、乳腺癌、胰腺癌、胃癌、血液系统恶性肿瘤和结直肠癌。临床医生在诊断和治疗DM患者时应谨慎考虑其发生恶性肿瘤的风险，进行定期筛查和监测，以便早期发现和治疗恶性肿瘤。在肌炎特异性抗体中，抗转录中介因子1γ抗体与恶性肿瘤风险密切相关。其他因素如年龄较大、男性、吞咽困难、皮肤坏死、皮肤血管炎、疾病快速起病、肌酸激酶升高和C反应蛋白升高与恶性肿瘤风险密切相关。具有这些特征的DM患者需要接受恶性肿瘤筛查或密切监测及随访。DM患者，尤其是发病3年内的患者，患癌风险较高，应根据其风险分层进行仔细的癌症筛查。影像学检查和肿瘤标志物检测等传统筛查工具在检测DM患者中的恶性肿瘤方面效果不佳。目前可用于DM患者的癌症筛查流程在很大程度上与普通人群使用的流程相似，但可能无法完全解决DM的特异性特征，且仍缺乏针对DM患者筛查癌症的最佳策略。为了促进更早地检测和诊断与DM相关的癌症，从而改善预后，需要更有效的癌症检测工具以及专门针对DM特征及其个体风险分层量身定制的个性化恶性肿瘤筛查流程。
