# Exploring the Risk: Investigating the Association Between Elderly-Onset Sarcoidosis (EOS) and Malignancy

## TL;DR

Older patients with sarcoidosis are more likely to have a history of cancer, suggesting a need for careful evaluation to distinguish sarcoidosis from cancer recurrence.

## Contribution

Identifies age at sarcoidosis diagnosis as an independent predictor of prior malignancy, highlighting the need for age-adjusted risk assessments.

## Key findings

- Elderly-onset sarcoidosis patients had an 8-fold higher odds of prior malignancy compared to younger-onset patients.
- Age at diagnosis was an independent predictor of prior malignancy history, while sex, smoking, and cardiometabolic factors were not.
- Histological confirmation is crucial in elderly sarcoidosis patients with a history of cancer to differentiate from tumor recurrence.

## Abstract

What are the main findings?
Patients with EOS were more frequently female and exhibited a markedly higher prevalence of prior malignancy (OR ≈8.0) compared to younger-onset counterparts. First bullet.Increasing age at sarcoidosis diagnosis was independent predictor of prior malignancy history, whereas sex, smoking history, and cardiometabolic profile did not significantly influence the likelihood of pre-existing neoplasia.

Patients with EOS were more frequently female and exhibited a markedly higher prevalence of prior malignancy (OR ≈8.0) compared to younger-onset counterparts. First bullet.

Increasing age at sarcoidosis diagnosis was independent predictor of prior malignancy history, whereas sex, smoking history, and cardiometabolic profile did not significantly influence the likelihood of pre-existing neoplasia.

What is the implication of the main finding?
In elderly patients with newly diagnosed sarcoidosis—particularly those with a history of malignancy—histological confirmation is crucial to distinguish sarcoidosis from tumor recurrence or metastasis due to overlapping radiological findings.The increased prevalence of malignancy in elderly-onset sarcoidosis appears predominantly age-related rather than EOS-specific, emphasizing the need for age-adjusted risk assessment and cautious consideration of targeted cancer evaluation in future prospective studies.

In elderly patients with newly diagnosed sarcoidosis—particularly those with a history of malignancy—histological confirmation is crucial to distinguish sarcoidosis from tumor recurrence or metastasis due to overlapping radiological findings.

The increased prevalence of malignancy in elderly-onset sarcoidosis appears predominantly age-related rather than EOS-specific, emphasizing the need for age-adjusted risk assessment and cautious consideration of targeted cancer evaluation in future prospective studies.

Background: Elderly-onset sarcoidosis > 65 (EOS) is rare and occurs in patients over 65. Studies on its incidence, clinical features, and treatment are limited, and its link to malignancy remains complex. Objectives: In this study, we aimed to analyze the possible association between malignancy and the occurrence of sarcoidosis in elderly patients over 65 years old. Design: Monocentric, nested retrospective case–control study. Material and Methods: A retrospective study analyzed newly diagnosed sarcoidosis patients in the Loewenstein Lung Center, Baden-Württemberg, Germany, categorizing them into younger-onset (<65 years) and elderly-onset (≥65 years). Demographic data, smoking status, medical history, symptoms, diagnostic methods, and any prior malignancy history were collected. Results: A total of 447 patients were included (365 patients within the group of younger-onset sarcoidosis and 82 patients with EOS). The median age of the younger-onset group was 47 (47 [23–63] years), compared to 69 (69 [65–84] years), p ≤ 0.001. Female patients were more prevalent in the group of elderly-onsets (54.9%) compared to the younger-onset group (35.9%), corresponding to an odds ratio of 2.2 (95% CI: 1.3–3.5, p: 0.002). Regarding the past history of malignancy, patients who had a positive history of malignancy were more prevalent among the elderly-onset group (29.6%) compared to the younger-onset group (5%) [OR (95% CI): 8.1 (4.1–15.8), p ≤ 0.001]. In multivariable logistic regression analysis with malignancy as the outcome, increasing age at sarcoidosis diagnosis was independently associated with a higher likelihood of prior malignancy (adjusted OR 1.08 per year, 95% CI 1.04–1.12), whereas sex, smoking status, and cardiometabolic comorbidity (diabetes and/or hypertension) were not independently associated. Conclusions: Elderly-onset sarcoidosis (EOS) is a less frequent variant of sarcoidosis with limited data regarding the possible risk factors. The increased prevalence of malignancy observed among patients with elderly-onset sarcoidosis appeared to be largely driven by age rather than a distinct EOS-specific effect. Age-adjusted analyses are essential when interpreting malignancy risk in sarcoidosis, and future age-matched prospective studies are needed to clarify potential biological links and guide evidence-based screening strategies.