Presence of concurrent sarcoid-like granulomas indicate better survival in cancer patients

Introduction An 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. Methods This is a retrospective, multicenter, observational study involving patients who underwent Endobronchial Ultrasound (EBUS) at the University of Miami Hospital, Miami Veterans Affairs Medical Center in the USA and Chiba University in Japan. Subjects with a confirmed diagnosis of cancer and who subsequently developed granulomas in different organs were enrolled. The study was registered at Clinicaltrial.gov ( NCT03844698 ). Results One hundred and thirty-three patients met the study’s criteria. The most common primary cancer sites were the skin (22.5%), breast (20.3%), and lymph node (LN) (12.8%). Twenty-four (18%) patients developed sarcoidal 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 sarcoidal 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 were 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 sarcoidal granulomas than in controls. Moreover, multivariate Cox proportional hazard analysis showed a significant survival advantage in those with sarcoidal granuloma. Conclusion Sarcoidal 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. Take home message Our findings suggest that patients with underlying malignancy who develop sarcoidosis and sarcoid-like reactions have a lower risk of stage 4 metastatic disease and better survival compared to patients who do not develop such granulomatous reactions.