Rheumatology International

, Volume 39, Issue 10, pp 1733–1739 | Cite as

Clinical characteristics and prognosis of polymyositis and dermatomyositis associated with malignancy: a 25-year retrospective study

  • Kyoko Motomura
  • Hiroyuki YamashitaEmail author
  • Saeko Yamada
  • Yuko Takahashi
  • Hiroshi Kaneko


The objective of this study was to identify factors predictive of malignancy in patients with polymyositis (PM) and dermatomyositis (DM) in Japan. We conducted a retrospective study of PM and DM patients who were admitted to our hospital between January 1992 and September 2017. Among 134 patients, 29 (21.6%) were diagnosed with cancer in the 3 years prior to and 3 years after the initial diagnosis of PM or DM. According to multivariate analyses, male sex [odds ratio (OR) = 3.65, p = 0.03], old age (OR = 1.05, p = 0.02), and a past history of diabetes mellitus (OR = 10.4, p = 0.005) were associated with an increased risk of malignancy. The absence of interstitial lung disease (ILD) (OR = 0.25, p = 0.03) was also associated with an increased risk of malignancy. Diabetes mellitus was observed in 28.6% of PM and DM patients with malignancy, but in only 7.3% of those with malignancy. Survival was significantly lower in patients with malignancy than in those without malignancy (p < 0.001). Independent factors associated with malignancies in patients with PM or DM were male sex, old age, the absence of ILD, and, especially, a past history of diabetes mellitus.


Polymyositis Dermatomyositis Malignancy Diabetes mellitus 



This work was supported in part by Grants-in-Aid for Research from the National Center for Global Health and Medicine (29-2001). The authors would like to thank Dr. Tsuneyo Mimori at the Kyoto University for the measurement of myositis-specific autoantibodies.

Author contributions

KM designed the study, wrote the initial draft of the manuscript and analyzed date. HY contributed to analysis and interpretation of data, and assisted in the preparation of the manuscript. SY, YT and HK, members of the Division of Rheumatic Diseases, National Center for Global Health and Medicine have contributed to data collection and interpretation, and critically reviewed the manuscript. All authors approved the final version of the manuscript, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Compliance with ethical standards

Conflict of interest

None of the authors, including Kyoko Motomura, Hiroyuki Yamashita, Saeko Yamada, Yuko Takahashi and Hiroshi Kaneko have any conflicts of interest associated with this article.

Ethical approval

This study complied with the principles of the Declaration of Helsinki and was approved by the Ethics Committee at the National Center for Global Health and Medicine (2018-5-11/NCGM-G-002515-00).


  1. 1.
    Stertz G (1916) Polymyositis. Berl Klin Wochenschr 53:489Google Scholar
  2. 2.
    Antiochos BB, Brown LA, Li Z, Tosteson TD, Wortmann RL, Rigby WF (2009) Malignancy is associated with dermatomyositis but not polymyositis in Northern New England, USA. J Rheumatol 36:2704–2710CrossRefGoogle Scholar
  3. 3.
    András C, Ponyi A, Constantin T, Csiki Z, Szekanecz E, Szodoray P et al (2008) Dermatomyositis and Polymyositis associated with malignancy: a 21-year retrospective study. J Rheumatol 35:438–444Google Scholar
  4. 4.
    So MW, Koo BS, Kim YG, Lee CK, Yoo B (2011) Idiopathic inflammatory myopathy associated with malignancy: a retrospective cohort of 151 Korean patients with dermatomyositis and polymyositis. J Rheumatol 38(11):2432–2435CrossRefGoogle Scholar
  5. 5.
    Fang YF, Wu YJ, Kuo CF, Luo SF, Yu KH (2016) Malignancy in dermatomyositis and polymyositis: analysis of 192 patients. Clin Rheumatol 35(8):1977–1984CrossRefGoogle Scholar
  6. 6.
    Wang J, Guo G, Chen G, Wu B, Lu L, Bao L (2013) Meta-analysis of the association of dermatomyositis and polymyositis with cancer. Br J Dermatol 169:838–847CrossRefGoogle Scholar
  7. 7.
    Ponyi A, Constantin T, Garami M, András C, Tállai B, Váncsa A et al (2005) Cancer-associated myositis:clinical features and prognostic signs. Ann N Y Acad Sci 1051:64–71CrossRefGoogle Scholar
  8. 8.
    Fardet L, Dupuy A, Gain M, Kettaneh A, Chérin P, Bachelez H et al (2009) Factors associated with underlying malignancy in a retrospective cohort of 121 patients with dermatomyositis. Medicine (Baltimore). 88(2):91–97CrossRefGoogle Scholar
  9. 9.
    Lu X, Yang H, Shu X, Chen F, Zhang Y, Zhang S et al (2014) Factors predicting malignancy in patients with polymyositis and dermatomyositis: a systematic review and meta-analysis. PLoS One 9(4):e94128CrossRefGoogle Scholar
  10. 10.
    Zantos D, Zhang Y, Felson D (1994) The overall and temporal association of cancer with polymyositis and dermatomyositis. J Rheumatol 21:1855–1859Google Scholar
  11. 11.
    Hill CL, Zhang Y, Sigurgiersson B, Pukkala E, Mellemkjaer L, Airio A et al (2001) Frequency of specific cancer types in dermatomyositis and polymyositis: a population-based study. Lancet 357:96–100CrossRefGoogle Scholar
  12. 12.
    Buchbinder R, Forbes A, Hall S, Dennett X, Giles G (2001) Incidence of malignant disease in biopsy-proven inflammatory myopathy. A population-based cohort study. Ann Intern Med 134:1087–1095CrossRefGoogle Scholar
  13. 13.
    Stockton D, Doherty VR, Brewster DH (2001) Risk of cancer in patients with dermatomyositis or polymyositis, and follow-up implications: a Scottish population-based cohort study. Br J Cancer 85:41–45CrossRefGoogle Scholar
  14. 14.
    Bohan A, Peter JB (1975) Polymyositis and dermatomyositis. N Engl J Med 292:344–347CrossRefGoogle Scholar
  15. 15.
    Torres C, Belmonte R, Carmona L, Gómez-Reino FJ, Galindo M, Ramos B et al (2006) Survival, mortality and causes of death in inflammatory myopathies. Autoimmunity 39:205–215CrossRefGoogle Scholar
  16. 16.
    Kuo CF, See LC, Yu KH, Chou IJ, Chang HC, Chiou MJ et al (2011) Incidence, cancer risk and mortality of dermatomyositis and polymyositis in Taiwan: a nationwide population study. Br J Dermatol 165:1273–1279CrossRefGoogle Scholar
  17. 17.
    Sigurgerisson B, Lindelof B, Edhag O, Allander E (1992) Risk of cancer in patients with dermatomyositis or polymyositis. A population-based study. N Engl J Med 326:363–367CrossRefGoogle Scholar
  18. 18.
    Liu WC, Ho M, Koh WP, Tan AW, Ng PP, Chua SH et al (2010) An 11-year review of dermatomyositis in Asian patients. Ann Acad Med Singap 39:843–847Google Scholar
  19. 19.
    Marie I, Hachulla E, Hatron PY, Hellot MF, Levesque H, Devulder B et al (2001) Polymyositis and dermatomyositis: short term and longterm outcome, and predictive factors of prognosis. J Rheumatol 28:2230–2237Google Scholar
  20. 20.
    Wakata N, Kurihara T, Saito E, Kinoshita M (2002) Polymyositis and dermatomyositis associated with malignancy: a 30-year retrospective study. Int J Dermatol 41:729–734CrossRefGoogle Scholar
  21. 21.
    Maoz CR, Langevitz P, Livneh A, Blumstein Z, Sadeh M, Bank I et al (1998) High incidence of malignancies in patients with dermatomyositis and polymyositis: an 11-year analysis. Semin Arthritis Rheum 27:319–324CrossRefGoogle Scholar
  22. 22.
    Airio A, Kautiainen H, Hakala M (2006) Prognosis and mortality of polymyositis and dermatomyositis patients. Clin Rheumatol 25:234–239CrossRefGoogle Scholar
  23. 23.
    Tiniakou Eleni, Mammen Andrew L (2017) Idiopathic Inflammatory myopathies and malignancy: a comprehensive review. Clin Rev Allerg Immunol 52:20–33CrossRefGoogle Scholar
  24. 24.
    Yang Z, Lin F, Qin B, Liang Y, Zhong R (2015) Polymyositis/dermatomyositis and malignancy risk: a metaanalysis study. J Rheumatol 42(2):282–291CrossRefGoogle Scholar
  25. 25.
    Sparsa A, Liozon E, Hermann F, Ly K, Lebrun V, Soria P et al (2002) Routine vs extensive malignancy search for adult dermatomyositis and polymyositis: a study of 40 patients. Arch Dermatol 138:885–890CrossRefGoogle Scholar
  26. 26.
    Inoue M, Iwasaki M, Otani T, Sasazuki S, Noda M, Tsugane S (2006) Diabetes mellitus and the risk of cancer: results from a large-scale population-based cohort study in Japan. Arch Intern Med 166:1871–1877CrossRefGoogle Scholar
  27. 27.
    Fiorentino DF, Kuo K, Chung L, Zaba L, Li S, Casciola-Rosen L (2015) Distinctive cutaneous and systemic features associated with antitranscriptional intermediary factor-1γ anti-bodies in adults with dermatomyositis. J Am Acad Dermatol 72:449–455CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Rheumatic DiseasesNational Center for Global Health and MedicineTokyoJapan

Personalised recommendations