Acta Dermato-Venereologica 99-3CompleteContent | Page 6

256 REVIEW ARTICLE Use of Anti-transcriptional Intermediary Factor-1 Gamma Autoantibody in Identifying Adult Dermatomyositis Patients with Cancer: A Systematic Review and Meta-analysis Marion BEST 1 , Nicolas MOLINARI 2 , François CHASSET 3 , Thierry VINCENT 4 , Nadège CORDEL 5# and Didier BESSIS 1,6# Department of Dermatology, Saint-Eloi Hospital and Montpellier University Hospital, 2 Institut Montpelliérain Alexander Grothendieck, CNRS, and Department of Statistics, Montpellier University Hospital, Montpellier, 3 Department of Dermatology and Allergology, Tenon Hospital, AP-HP, Paris, 4 Department of Immunology, Saint Eloi Hospital, and Montpellier University Hospital, Montpellier, 5 Dermatology and Internal Medicine Unit, Guadeloupe University Hospital and Inserm, U1234, Normandie University, UNIROUEN, IRIB, Rouen, and 6 Institut National de la Santé et de la Recherche Médicale (INSERM) U1058, Montpellier, France 1 # These authors both contributed equally to this work. Anti-transcriptional intermediary factor-1γ (TIF-1γ) autoantibody may be associated with cancer in adult patients with dermatomyositis. The aim of this study was to evaluate the risk of cancer in the presence of anti-TIF-1γ autoantibody in adult dermatomyositis. A comprehensive database search of EMBASE, MEDLINE and the Cochrane Library up to May 2018 was perfor- med using the main key words “dermatomyositis”, “”myositis”, “inflammatory myopathies” and “anti- TIF-1”. Eighteen studies, with a total of 1,962 der- matomyositides, were included in the meta-analysis. The pooled prevalence of cancer-associated derma- tomyositis in patients with anti-TIF-1γ autoantibody was 0.41 (95% confidence interval (CI) 0.36–0.45). In the presence of anti-TIF-1γ autoantibody, the over- all diagnostic odds ratio of cancer was 9.37 (95% CI 5.37–16.34) with low heterogeneity (Cochran’s Q: 14.88 (df = 17, p  = 0.604); I 2  = 0%). The results of this systematic review confirm that detection of anti-TIF- 1γ autoantibody is a valuable tool to identify a subset of adult dermatomyositis patients with higher risk of cancer. Key words: anti-transcriptional intermediary factor-1γ autoan- tibody; cancer; dermatomyositis; meta-analysis. Accepted Nov 20, 2018; E-published Nov 21, 2018 Acta Derm Venereol 2019; 99: 256–262. Corr: Didier Bessis, Department of Dermatology, Saint-Eloi Hospital, CHU Montpellier, 80 avenue Augustin Fliche, FR-34295 Montpellier cedex, France. E-mail: [email protected] T he risk of cancer in adults with dermatomyositis (DM) has been reported extensively in the lite- rature (1–6). Various clinical findings and laboratory markers, including tumour markers, muscle enzymes and myositis-specific autoantibodies (MSA), have been studied to screen and identify adult patients with DM at risk for cancer (7–12). Anti-transcriptional intermediary factor-1gamma (TIF-1γ) autoantibody was identified in 2006 by Targoff et al. (13) as a novel autoantibody directed against a 155-kDa protein in a large series of myositides. Initially referred to as anti-p155, the auto- antigen was then identified as a member of the TIF-1 gene family involved in transforming the growth factor doi: 10.2340/00015555-3091 Acta Derm Venereol 2019; 99: 256–262 SIGNIFICANCE The risk of cancer in adults with dermatomyositis has been reported extensively in the literature, with a global malig- nancy rate ranging from 6.7% to 32%. Identifying adult patients with dermatomyositis at high risk for cancer is a challenge for clinicians. In this systematic review and me- ta-analysis of all relevant published studies the myositis- specific autoantibody anti-Tif1gamma has been confirmed to be a valuable tool to identify a subset of adult DM pa- tients with higher risk (9.37 fold) of cancer. (TGF)-β) signalling pathway (14, 15). The relationship between anti-TIF-1γ autoantibody and cancer-associated DM (CAD) was first noted in a series of 45 adult DM with an odds ratio (OR) for CAD in the presence of anti-TIF-1γ autoantibody of 48.18 (95% confidence intervals (95% CI): 2.46–943.31) (13). Multiple cohort studies (16–35) then continued to investigate the risk of CAD in the presence of anti-TIF-1γ autoantibody, but mostly in limited series. Two meta-analyses performed on 6 (312 patients) (13, 16–20) and 8 (408 patients) (13, 16–21, 25) cohort studies, respectively, found a pooled OR for CAD of 27.26 (95% CI 6.59–118.82) (36) and a relative risk (RR) for CAD of 5.57 (95% CI 2.91–10.65) in the presence of anti-TIF-1γ autoantibody (12). Since then, numerous large studies (24, 26–29, 31, 32, 34, 35) with cohort series of up to 376 patients (24) have been published, sometimes showing a less pronounced as- sociation between anti-TIF-1γ autoantibody and cancer (27, 28, 34). Therefore, to better assess the relationship between anti-TIF-1γ autoantibody and cancer in adults with DM, a systematic review and meta-analysis of all relevant published studies was performed. MATERIALS AND METHODS Search strategy The main investigators (MB and DB) searched EMBASE, MED- LINE and the Cochrane Database of Systematic Reviews up to December 2017 with update for original articles up to May 2018. Searches were restricted to articles written in English. The search This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica.