Prevalence of Neoplasm in patients with Sarcoidosis - a monocentric observational study

ABSTRACT Background: Sarcoidosis is a systemic inflammatory disease characterized by the presence of non-caseating granulomas. It can affect any organ or tissue in the body. The disease primarily occurs in the fourth and fifth decades of life, with a slight prevalence in females. Several studies have identified a higher prevalence of neoplasms in patients with sarcoidosis; however, a causal association between the two conditions has not yet been established. Further research is needed to clarify the association and its clinical implications. Aim of the study: This retrospective observational single-centre study analyses a cohort of patients to evaluate the prevalence of neoplasms in patients with sarcoidosis. Furthermore, the study evaluates whether neoplasms arise before, concurrently with, or after the diagnosis of sarcoidosis and identifies any differences in treatment between patients with and without malignancies by analysing the treatments received by patients. Materials and methods: In this retrospective observational study, 210 patients diagnosed with sarcoidosis were enrolled. Demographic, clinical, and radiological data were collected for the entire cohort from the beginning of 2015 to the last follow-up visit, which was in January 2025. Of these 210 patients, 36 had a malignancy. Demographic, clinical, and treatment data were compared between patients with sarcoidosis alone and patients with sarcoidosis and neoplasm. The temporal relationship between the diagnosis of sarcoidosis and neoplasm was also compared. Results: We identified 36 patients (17.14%) out of 210 with both sarcoidosis and malignancy, of whom 5 had a dual diagnosis of neoplasm. Analyzing the temporal relationship between the two diagnoses, we found that in 12 of the 36 patients, sarcoidosis was diagnosed before neoplasm; in 4 of the 36 cases the diagnoses were concomitant, with a temporal interval of 12 months between the two diagnoses; and in 20 of the 36 patients, the neoplasm was diagnosed before sarcoidosis. We observed a higher prevalence of both hematological malignancies (8 out of 41, 19.51%) and solid tumors, particularly skin cancer, with 8 cases of melanoma (19.51%) and 3 cases of non-melanoma skin cancer (7.32%). In the cohort of patients with sarcoidosis, we found a high incidence of splenic involvement (12.9%, p = 0.026), with one-third of these patients also affected by malignancy. We observed that patients with both neoplasm and sarcoidosis require less steroid and second-line therapy than those with sarcoidosis alone, and that in patients with neoplasm, the diagnosis of sarcoidosis occurs at a more advanced age (54 years vs. 49 years, p = 0.015) and with milder symptoms (44% vs. 76%, p < 0.001). Conclusions: In conclusion, our study confirms the association between sarcoidosis and neoplasms, particularly haematological malignancies, and melanomas. Regarding solid tumours, this relationship remains of uncertain significance, and further studies are necessary to evaluate its nature and underlying mechanisms. We also found a lower need for steroid therapy and second-line treatments in patients with malignancy and sarcoidosis, compared to those with sarcoidosis alone. Additionally, we observed an onset of sarcoidosis at an older age and milder symptoms in patients with cancer and sarcoidosis, suggesting that sarcoidosis may be modulated by the immunosuppressive effects of the neoplasm or oncological therapies.