Huh Jin-Young, Moon Do Sik, Song Jin Woo
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Front Med (Lausanne). 2022 Aug 17;9:884386. doi: 10.3389/fmed.2022.884386. eCollection 2022.
The development of non-caseating epithelioid cell granulomas in cancer patients who do not fulfill the systemic sarcoidosis criteria is termed sarcoid-like reaction (SLR). Little is known about this condition's natural course and impact on the prognosis of malignancy. We aimed to investigate the natural course and prognostic value of cancer-associated SLR.
Clinical data were retrospectively analyzed in 32 patients with biopsy-proven cancer-associated SLR. Among patients with non-small cell lung cancer (NSCLC), SLR cases ( = 8) were matched with non-SLR cases ( = 78) for survival analysis.
Among the included patients, the mean age was 59.7 years, and 68.8% were female. The median follow-up period was 35.6 months [interquartile range (IQR): 14.0-61.4 months]. Of all the included malignancies ( = 32), breast cancer (25.0%) and NSCLC (25.0%) were the most common, with stage I being the most frequent tumor stage (59.4%). During follow-up, SLR progression to overt sarcoidosis was not observed. In the 28 patients with available follow-up computed tomography images (median interval: 24.9 months; IQR: 14.4-41.7), 4 patients received corticosteroids ( = 4), resulting to a decrease of SLR lesions. Meanwhile, among those who did not receive treatment ( = 24), the extent of SLR decreased or did not change in 85.7% of them, whereas 3.6% had increased SLR extent. Furthermore, among patients with NSCLC, SLR was not associated with overall survival [hazard ratio (HR) = 1.28, 95% confidence interval (CI): 0.02-67.71, = 0.882] and recurrence of malignancy (HR = 1.27, 95% CI 0.21-7.51, = 0.793) in the Cox proportional hazard regression model.
During the follow-up of cancer-related SLR, we found no further evidence for systemic sarcoidosis, and most of the lesions decreased or did not change. Development of SLR was also not associated with overall survival or disease-free survival in patients with NSCLC.
在不符合系统性结节病标准的癌症患者中出现的非干酪样上皮样细胞肉芽肿被称为结节病样反应（SLR）。关于这种情况的自然病程及其对恶性肿瘤预后的影响，人们了解甚少。我们旨在研究癌症相关SLR的自然病程和预后价值。
对32例经活检证实为癌症相关SLR的患者的临床资料进行回顾性分析。在非小细胞肺癌（NSCLC）患者中，将SLR病例（n = 8）与非SLR病例（n = 78）进行匹配以进行生存分析。
纳入的患者中，平均年龄为59.7岁，68.8%为女性。中位随访期为35.6个月[四分位间距（IQR）：14.0 - 61.4个月]。在所有纳入的恶性肿瘤（n = 32）中，乳腺癌（25.0%）和NSCLC（25.0%）最为常见，I期是最常见的肿瘤分期（59.4%）。随访期间，未观察到SLR进展为明显的结节病。在28例有可用随访计算机断层扫描图像的患者中（中位间隔：24.9个月；IQR：14.4 - 41.7），4例患者接受了皮质类固醇治疗（n = 4），导致SLR病变减少。同时，在未接受治疗的患者中（n = 24），85.7%的患者SLR范围缩小或未改变，而3.6%的患者SLR范围增大。此外，在NSCLC患者中，在Cox比例风险回归模型中，SLR与总生存期[风险比（HR）= 1.28，95%置信区间（CI）：0.02 - 67.71，P = 0.882]和恶性肿瘤复发（HR = 1.27，95% CI 0.21 - 7.51，P = 0.793）无关。
在癌症相关SLR的随访过程中，我们没有发现进一步发展为系统性结节病的证据，并且大多数病变减少或未改变。SLR的发生也与NSCLC患者的总生存期或无病生存期无关。
