PDF(Pubmed)
Abstract：
Morphea is an autoimmune fibrotic skin disease. Eosinophilic fasciitis (EF) is considered to belong to the severe spectrum of morphea. We conducted a scoping review assessing the risk of secondary cancer among morphea/EF patients, paraneoplastic morphea/EF and morphea/EF developing secondary to cancer therapy. The search was conducted using MEDLINE, Embase, Cochrane databases for articles published from inception to September 2022 following the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines with no language or date restrictions. Two hundred and one studies were included. Of these, 32 studies reported on secondary cancer in morphea/EF patients, 45 on paraneoplastic morphea/EF and 125 on cancer-treatment-induced morphea/EF. While the current evidence remains limited, data suggest an increased risk of secondary cutaneous and possibly pancreatic malignancy in morphea patients, particularly the generalized subtype. There were insufficient data for EF. On the other hand, paraneoplastic morphea was anecdotal, whereas several observational studies suggested that ~10% of EF cases may be paraneoplastic, primarily in the context of hematologic malignancies. Radiotherapy-induced morphea is rare, seen in ~0.2% of treated patients and is usually localized to the treatment site, except in patients with pre-existing autoimmunity. While chemotherapy-induced cases are reported, immunotherapy morphea/EF cases are emerging and are preferentially seen with PD-1 and not CTLA-4 inhibitors. This study is limited by the type of articles included (case reports, case series and observational studies), and hence, additional research on this important topic is needed.
摘要：
Morphea是一种自身免疫性纤维化皮肤病。嗜酸性筋膜炎（EF）被认为属于严重的硬皮病谱。我们进行了一项范围审查，评估了硬伤/EF患者的继发性癌症风险。副肿瘤性硬伤/EF和硬伤/EF继发于癌症治疗。搜索是使用MEDLINE进行的，Embase,Cochrane数据库，用于从开始到2022年9月发表的文章，遵循系统评价和范围评价荟萃分析的首选报告项目（PRISMA-ScR）指南，没有语言或日期限制。包括200项研究。其中,32项研究报道了硬伤/EF患者的继发性癌症，副肿瘤性硬伤/EF为45，癌症治疗诱导的硬伤/EF为125。虽然目前的证据仍然有限，数据表明，在硬伤患者中，继发性皮肤和胰腺恶性肿瘤的风险增加，特别是广义子类型。EF的数据不足。另一方面,副肿瘤性角膜是轶事，而一些观察性研究表明，约10%的EF病例可能是副肿瘤，主要在血液系统恶性肿瘤的背景下。放射疗法引起的硬伤很少见，在~0.2%的治疗患者中观察到，通常局限于治疗部位，除了预先存在自身免疫的患者。虽然报道了化疗引起的病例，免疫治疗的硬伤/EF病例正在出现，并且优先使用PD-1而不是CTLA-4抑制剂。这项研究受到所包括文章类型的限制(病例报告，病例系列和观察性研究)，因此，需要对这一重要课题进行更多的研究。
