Presence of concurrent sarcoid-like granulomas indicates better survival in cancer patients: a retrospective cohort study

Abstract

IntroductionAn increased risk of sarcoidosis and sarcoid-like reactions in subjects with a history of malignancy has been suggested. We assessed the incidence and clinical characteristics of cancer patients with biopsies containing sarcoid-like granulomas on cancer metastasis and patient survival.MethodsThis is a retrospective, multicentre, observational study involving endobronchial ultrasound transbronchial needle aspiration and a melanoma patient dataset at the University of Miami, USA, and a sarcoidosis patient database at Chiba University, Japan. Subjects with a confirmed diagnosis of cancer and who subsequently developed granulomas in different organs were enrolled. The study was registered at Clinicaltrials.gov (NCT03844698).Results133 patients met the study's criteria. The most common primary cancer sites were the skin (22.5%), breast (20.3%) and lymph node (12.8%). 24 (18%) patients developed sarcoid-like granulomas within 1 year of cancer diagnosis, 54 (40.6%) between 1 and 5 years and 49 (36.8%) after 5 years. Imaging showed possible sarcoid-like granulomas in lymph nodes in 51 cases (38.3%) and lung tissue and mediastinal lymph nodes in 73 cases (54.9%); some parenchymal reticular opacity and fibrosis was found in 5 (3.7%) and significant parenchymal fibrosis in 2 (1.5%) subjects. According to logistic regression analysis, the frequency of metastatic cancer was significantly lower in patients with sarcoid-like granulomas than in controls. Moreover, multivariate Cox proportional hazard analysis showed a significant survival advantage in those with sarcoid-like granuloma.ConclusionSarcoid-like granulomas are uncommon pathology findings in cancer patients. There is a significant association between the presence of granulomas and reduced metastasis and increased survival. Further study is warranted to understand the protective mechanism involved.

Sarcoidosis-Like Cancer-Associated Granulomatosis: Characteristics and a Case-Control Comparison with Sarcoidosis

“…On the other hand, and strikingly, most cancers observed in our series had a very limited baseline extension and a high 5-year remission rate. This is in keeping with previous studies showing a better prognosis of cancer when associated with granulomatous reactions [ 12 , 13 , 14 , 15 ] and arguing for a role of these granulomatous reactions in tumor control. Large prospective case control studies are needed to address the very interesting issue of pathogeny and role of granulomas in cancer patients.…”

“…This point is not trivial since it might have a strong impact on both the prognosis and management of these conditions. Indeed, some studies have underlined the positive impact of sarcoid-like reactions on tumor prognosis [ 12 , 13 , 14 , 15 ]. Clinicians should therefore be very cautious in not overtreating these patients, as immunosuppressants used to control the granulomatous inflammation might also result in a decreased tumor control.…”

Hepatocellular carcinoma with regional lymphadenopathy caused by sarcoid-like reaction: a case report

“…Previously reported cases of SLR had bilateral enlargement of mediastinal and/or hilar lymph nodes, and FDG uptake was detected [ 11 ]. Such cases can be more easily suspected not only for metastasis, but also for SLR.…”

Clinical significance of sarcoid‐like reaction in lymph nodes of gastric cancer patients

“…Our results also indicate that SR may be a factor predictive of a favorable prognosis for tumor immunity. Recently, Murthi et al 18 reported that patients with a SR in solid malignancies had a significantly better survival rate than did the control group. Dagaonkar et al, 19 in their study investigating the survival rate of 19 patients with lung cancer with SR, reported that the 3‐year survival rate of patients with SR was 21% versus 6% for those without SR. Also, several case reports show that advanced gastric cancer with the formation of SR has a favorable prognosis 6,7 .…”