TY - JOUR T1 - Presence of concurrent sarcoid-like granulomas indicates better survival in cancer patients: a retrospective cohort study JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00061-2020 VL - 6 IS - 4 SP - 00061-2020 AU - Mukunthan Murthi AU - Keiichiro Yoshioka AU - Jeong Hee Cho AU - Sixto Arias AU - Elio Danna AU - Moe Zaw AU - Greg Holt AU - Koichiro Tatsumi AU - Takeshi Kawasaki AU - Mehdi Mirsaeidi Y1 - 2020/10/01 UR - http://openres.ersjournals.com/content/6/4/00061-2020.abstract N2 - 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, 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).Results 133 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.Conclusion Sarcoid-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.These 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 https://bit.ly/2CNhc9e ER -