Subsets of Idiopathic Inflammatory Myositis Enriched for Contemporaneous Cancer Relative to the General Population

Christopher A. Mecoli*, Tak Igusa, Mengkun Chen, Xing Yao Wang, Jemima Albayda, Julie J. Paik, Eleni Tiniakou, Brittany Adler, Carrie Richardson, Will Kelly, Sonye Danoff, Andrew L. Mammen, Elizabeth A. Platz, Antony Rosen, Lisa Christopher-Stine, Livia Casciola-Rosen, Ami A. Shah

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Objective: This study investigates cancer risk in idiopathic inflammatory myopathy (IIM) relative to the general population. Methods: We conducted a single-center, retrospective cohort study of IIM patients and malignancy. Myositis-specific and -associated autoantibodies were determined by Euroimmun line blot, enzyme-linked immunosorbent assay, and immunoprecipitation. We calculated standardized prevalence ratios (SPRs) and adjusted for calendar year, age, sex, race, and ethnicity by comparing observed cancers in IIM patients versus expected cancers in the general population using the Surveillance, Epidemiology, and End Results registry. Results: Of 1,172 IIM patients, 203 (17%) patients with a cancer history were studied. Over a median follow-up of 5.2 years, the observed number of IIM patients diagnosed with cancer was increased 1.43-fold (SPR 1.43 [95% confidence interval (95% CI) 1.15–1.77]; P = 0.002). Within 3 years of IIM symptom onset, an increased SPR was observed for anti–transcription intermediary factor 1γ (anti-TIF1γ)–positive patients for ovarian and breast cancer (ovarian SPR 18.39 [95% CI 5.01–47.08], P < 0.001; breast SPR 3.84 [95% CI 1.99–6.71], P < 0.001). As expected, anti-TIF1γ positivity was associated with a significantly elevated SPR; however, only 55% (36 of 66) of all cancers within 3 years of dermatomyositis onset were observed in anti-TIF1γ–positive patients. Other myositis-specific autoantibodies, including anti–Mi-2, anti–small ubiquitin-like modifier activating enzyme (SAE), and anti-nuclear matrix protein 2 (NXP-2), accounted for 26% (17 of 66) of cancers diagnosed within 3 years of dermatomyositis onset. No cancer association, positive or negative, was observed for patients with antisynthetase, anti–melanoma differentiation–associated protein 5 (anti–MDA-5), or anti–hydroxymethylglutaryl-coenzyme A reductase (anti-HMGCR) antibodies. Conclusion: In a tertiary referral center population, anti-TIF1γ was most strongly associated with breast and ovarian cancer. Patients with antisynthetase, anti–MDA-5, or anti-HMGCR antibodies had the same cancer risk as the general population. (Figure presented.).

Original languageEnglish (US)
Pages (from-to)620-629
Number of pages10
JournalArthritis and Rheumatology
Volume75
Issue number4
DOIs
StatePublished - Apr 2023

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology

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