TY - JOUR
T1 - Cancer and immune-mediated necrotizing myopathy
T2 - a longitudinal referral case-controlled outcomes evaluation
AU - Shelly, Shahar
AU - Beecher, Grayson
AU - Milone, Margherita
AU - Liewluck, Teerin
AU - Ernste, Floranne
AU - Triplett, James
AU - Naddaf, Elie
AU - Zekeridou, Anastasia
AU - McKeon, Andrew
AU - Pittock, Sean J.
AU - Dubey, Divyanshu
AU - Mills, John R.
AU - Mandrekar, Jay
AU - Klein, Christopher J.
N1 - Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.
PY - 2023/1/1
Y1 - 2023/1/1
N2 - Objectives: To investigate immune-mediated necrotizing myopathy (IMNM) association with cancer and its clinical implications. Methods: IMNM cases were identified 1 January 2000 to 31 December 2020 matching sex and age controls (4:1). Results: A total of 152 patients with IMNM were identified and among serologically tested, 60% (83/140) were HMGCR-IgG+, 14% (20/140) were SRP-IgG+ and 26% (37/140) were seronegative. Cancer rates were not significantly different between serological subgroups; 18.1% (15/83) HMGCR-IgG+, 25% (5/20) SRP-IgG+ and 30% (11/37) seronegative (P = 0.34). Cancer screening was performed within 12 months from IMNM diagnosis in 88% (134/152) (whole-body CT plus FDG-PET CT in 53, CT alone in 72 and FDG-PET alone in 9). FDG-PET/CT was positive in 73% (25/34) of cancers. Increasing age was the only risk associated with cancer (P = 0.02). The odds of developing cancer at ±3 or ±5 years from IMNM diagnosis was not higher than controls (OR = 0.49; CI: 0.325-0.76). Lifetime IMNM diagnosis of cancer was less compared with controls (OR = 0.5 CI: 0.33-0.78, P = 0.002). Most patients responded to treatment (137/147, P < 0.001). Death and treatment response did not significantly differ between cancer [23% (8/34); 88% (29/33)] and non-cancer patients [19% (23/118); 92% (108/118)]. In total, 13% (20/152) of patients died during follow-up compared with 14% (41/290) of medicine and 16% (46/290) of neurology controls (P = 0.8). Seropositives had greater life expectancy than seronegatives (P = 0.01). Conclusions: Greater cancer risk is not observed in IMNM vs controls. Cancer screening in IMNM should be individualized based on age-personal and family history, including consideration of FDG-PET/CT. Immune-treatment response did not differ with cancer.
AB - Objectives: To investigate immune-mediated necrotizing myopathy (IMNM) association with cancer and its clinical implications. Methods: IMNM cases were identified 1 January 2000 to 31 December 2020 matching sex and age controls (4:1). Results: A total of 152 patients with IMNM were identified and among serologically tested, 60% (83/140) were HMGCR-IgG+, 14% (20/140) were SRP-IgG+ and 26% (37/140) were seronegative. Cancer rates were not significantly different between serological subgroups; 18.1% (15/83) HMGCR-IgG+, 25% (5/20) SRP-IgG+ and 30% (11/37) seronegative (P = 0.34). Cancer screening was performed within 12 months from IMNM diagnosis in 88% (134/152) (whole-body CT plus FDG-PET CT in 53, CT alone in 72 and FDG-PET alone in 9). FDG-PET/CT was positive in 73% (25/34) of cancers. Increasing age was the only risk associated with cancer (P = 0.02). The odds of developing cancer at ±3 or ±5 years from IMNM diagnosis was not higher than controls (OR = 0.49; CI: 0.325-0.76). Lifetime IMNM diagnosis of cancer was less compared with controls (OR = 0.5 CI: 0.33-0.78, P = 0.002). Most patients responded to treatment (137/147, P < 0.001). Death and treatment response did not significantly differ between cancer [23% (8/34); 88% (29/33)] and non-cancer patients [19% (23/118); 92% (108/118)]. In total, 13% (20/152) of patients died during follow-up compared with 14% (41/290) of medicine and 16% (46/290) of neurology controls (P = 0.8). Seropositives had greater life expectancy than seronegatives (P = 0.01). Conclusions: Greater cancer risk is not observed in IMNM vs controls. Cancer screening in IMNM should be individualized based on age-personal and family history, including consideration of FDG-PET/CT. Immune-treatment response did not differ with cancer.
KW - HMGCR
KW - SRP54
KW - cancer
KW - myopathy
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UR - http://www.scopus.com/inward/citedby.url?scp=85144637749&partnerID=8YFLogxK
U2 - 10.1093/rheumatology/keac144
DO - 10.1093/rheumatology/keac144
M3 - Article
C2 - 35285492
AN - SCOPUS:85144637749
SN - 1462-0324
VL - 62
SP - 281
EP - 289
JO - Rheumatology (United Kingdom)
JF - Rheumatology (United Kingdom)
IS - 1
ER -