目的:分析皮肌炎（dermatomyositis,DM）合并妇科恶性肿瘤患者的临床特征及诊断和治疗,并进行短期随访,为DM患者的早期肿瘤诊断和干预提供参考资料。方法:收集我院自2015年至2020年收治的11例DM合并妇科恶性肿瘤患者的临床资料,分析患者临床特征及短期随访结局。结果:11例DM合并妇科恶性肿瘤患者,涉及3种妇科恶性肿瘤,其中子宫内膜癌4例（4/11）,宫颈癌2例（2/11）,卵巢癌5例（5/11）。根据2020年国际妇产科联盟（International Federation of Gynecology and Obstetrics,FIGO）妇科肿瘤分期标准,Ⅲ~Ⅳ期的妇科恶性肿瘤患者为8例。10例患者先确诊DM,在DM确诊之后,即接受了影像学和肿瘤指标的筛查,从而确诊了妇科恶性肿瘤,间隔时间为1周到1年不等;另1例患者初诊DM后筛查肿瘤指标及影像学检查（盆腔及腹腔CT）,未发现恶性肿瘤,但在DM随访过程中,发现癌抗原12-5（cancer antigen 12-5,CA12-5）升高,在诊断DM后第21个月确诊卵巢癌。8例患者在初诊DM时行血清抗转录中介因子1-γ（transcriptional intermediary factor 1-γ,TIF1-γ）抗体检测,6例为阳性。11例患者中,除1例宫颈癌患者直接接受根治性放疗和化疗外,10例患者均接受了妇科肿瘤手术治疗。本研究的随访时间为2个月~2年,患者总生存率为100%,随访中无妇科恶性肿瘤复发, 但2例DM复发。结论:对于确诊的DM患者,如初筛未发现明显妇科恶性肿瘤征象,仍需重视随访及筛查,注意动态随访血清肿瘤标志物;DM合并妇科恶性肿瘤患者其肿瘤分期往往较晚,多为Ⅲ~Ⅳ期;对于DM合并妇科恶性肿瘤的患者,治疗可仍以妇科恶性肿瘤治疗原则为主。

Objective: To analyze the clinical characteristics, diagnosis and treatment of dermatomyositis (DM) accompanied with gynecological malignant tumor to provide evidence for early detection and intervention of the disease. Methods: The clinical data of 11 DM patients with gynecological malignant tumor treated in our hospital from 2015 to 2020 were enrolled, and the clinical characteristics and treatment protocols were analyzed. Results: In eleven patients diagnosed DM accompanied with gynecological malignant tumor, three types of cancer were identified, including endometrial cancer (4/11), cervical cancer (2/11), and ovarian cancer (5/11). Eightout of 11 patients were diagnosed stage Ⅲ-Ⅳ gynecological cancer according to 2020 FIGO(International Federation of Gynecology and Obstetrics) gynecological tumor staging. Ten patients were screened for gynecological cancer by imaging and tumor biomarkers,and diagnosed gynecological cancer after being confirmed as DM 1 week to 21 months. The other one patient was found to have ovarian cancer at 21^st month after diagnosis of DM because of the increased level of CA12-5 (carbohydrate antigen12-5) during the follow-up, however, her CT imaging of the pelvic and abdominal cavity and tumor biomarkers were normal in initial screening. The anti-TIF1-γ antibodies in 8 DM patients were tested, and 6 of them were positive. Except one patient with cervical cancer receiving directly radical radiotherapy and chemotherapy, the other 10 patients received gynecological tumor resection. The overall survival rate was 100% during the follow-up of 2 months to 2 years. There was no tumor recurrence duringthe follow-up, but the DM recurrence appeared in 2patients. Conclusions: For the DM patients lacking signs of malignant tumor in the initial screening, the continuing follow-upand screening for tumor biomarkers should get more attention.The DM patients accompanied gynecological malignant tumor often showed late-stage cancer (Ⅲ-Ⅳ staging) and the treatment should be mainly focused on the gynecological tumor.