title: Tumor antigen markers for the detection of solid cancers in inflammatory myopathies.
abstract: Dermatomyositis and polymyositis patients have an increased risk of developing cancers. We have assessed the diagnostic values of serum tumor markers for the detection of solid cancer in dermatomyositis/polymyositis patients. Serum carcinoembryonic antigen, CA15-3, CA19-9, and CA125 were assayed by immunoradiometric methods in 102 dermatomyositis/polymyositis patients. All the patients had complete physical examination, chest X-ray, echocardiogram, gastrointestinal tract endoscopic explorations, thoracoabdomino-pelvic computed tomography scan, and all women had gynecologic examination and mammogram. Exclusion criteria for study were childhood dermatomyositis, inclusion body myositis, myositis associated with a connective tissue disease, prior history of cancer, and the presence of benign conditions known to elevate serum tumor markers. After a median follow-up of 59 months, 10 (9.8%) patients had a solid cancer. Initial elevation of CA125 was associated with an increased risk of developing solid cancer [P = 0.0001 by Fisher's exact test; odds ratio (OR), 29.7; 95% confidence interval (95% CI), 8.2-106.6]. For CA19-9, there was a trend towards a significant association (P = 00.7; OR, 4.5; 95% CI, 1-18.7, respectively). Diagnostic values of elevated CA125 and CA19-9 at screening increased when the study analysis was restricted to patients who developed a cancer within 1 year (P < 0.0001 and P = 0.018, respectively) or to patients without interstitial lung disease (P = 0.00001; OR, 133; 95% CI, 6.5-2733 and P = 0.027; OR, 9; 95% CI, 1.5-53, respectively). Individual comparisons of the baseline and the second CA125 value showed that three of the eight patients with cancers versus 3 of the 76 patients without, displayed an increase of their CA125 level (P = 0.01 by Fisher's exact test). We conclude that CA125 and CA19-9 assessment could be useful markers of the risk of developing tumors for patients with dermatomyositis and polymyositis and should therefore be included in the search for cancer in dermatomyositis/polymyositis patients, especially for patients without interstitial lung disease.
authors.affiliation: Service de Médecine Interne, Hôpital Pitié-Salpétrière, 47-83 Bd de l'Hôpital, 75013 Paris, France. zahir.amoura@psl.ap-hop-paris.fr
authors.forename: Zahir
authors.initials: Z
authors.lastname: Amoura
authors.forename: Pierre
authors.initials: P
authors.lastname: Duhaut
authors.forename: Du Le Thi
authors.initials: DL
authors.lastname: Huong
authors.forename: Bertrand
authors.initials: B
authors.lastname: Wechsler
authors.forename: Nathalie
authors.initials: N
authors.lastname: Costedoat-Chalumeau
authors.forename: Camille
authors.initials: C
authors.lastname: Francès
authors.forename: Patrice
authors.initials: P
authors.lastname: Cacoub
authors.forename: Thomas
authors.initials: T
authors.lastname: Papo
authors.forename: Sylvie
authors.initials: S
authors.lastname: Cormont
authors.forename: Yvan
authors.initials: Y
authors.lastname: Touitou
authors.forename: Philippe
authors.initials: P
authors.lastname: Grenier
authors.forename: Dominique
authors.initials: D
authors.lastname: Valeyre
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Piette
mesh_terms: D000328:Adult; D000368:Aged; D015295:Antigens, Tumor-Associated, Carbohydrate / Q000097:blood*; D014408:Biomarkers, Tumor / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood*; D015331:Cohort Studies; D003882:Dermatomyositis / Q000175:diagnosis*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015592:Immunoradiometric Assay; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000175:diagnosis* / Q000453:epidemiology; D010257:Paraneoplastic Syndromes / Q000175:diagnosis / Q000453:epidemiology; D017285:Polymyositis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D012307:Risk Factors
chemical_list: D015295:Antigens, Tumor-Associated, Carbohydrate; D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen