{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T06:19:50Z","timestamp":1789021190369,"version":"build-2803163510"},"reference-count":28,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ARM"],"abstract":"<jats:p>Background: Elderly-onset sarcoidosis &gt; 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\u2013control study. Material and Methods: A retrospective study analyzed newly diagnosed sarcoidosis patients in the Loewenstein Lung Center, Baden-W\u00fcrttemberg, Germany, categorizing them into younger-onset (&lt;65 years) and elderly-onset (\u226565 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\u201363] years), compared to 69 (69 [65\u201384] years), p \u2264 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\u20133.5, 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\u201315.8), p \u2264 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\u20131.12), 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.<\/jats:p>","DOI":"10.3390\/arm94010003","type":"journal-article","created":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T12:23:44Z","timestamp":1767356624000},"page":"3","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Exploring the Risk: Investigating the Association Between Elderly-Onset Sarcoidosis (EOS) and Malignancy"],"prefix":"10.3390","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4217-6712","authenticated-orcid":false,"given":"Ahmed","family":"Ehab","sequence":"first","affiliation":[{"name":"Pulmonary Medicine Department, SLK Lung Center Loewenstein, 74245 Loewenstein, Germany"},{"name":"Pulmonary Medicine Department, Mansoura University, Mansoura 35516, Egypt"},{"name":"DGD Lung Center Hemer, 58675 Hemer, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel T.","family":"Kempa","sequence":"additional","affiliation":[{"name":"Pulmonary Medicine Department, SLK Lung Center Loewenstein, 74245 Loewenstein, Germany"},{"name":"Pulmonary Medicine Department, Robert Bosch Hospital, 70173 Stuttgart, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Shalabi","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Mainz University Hospital, Johannes Gutenberg University Mainz, 55116 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noha","family":"Elkateb","sequence":"additional","affiliation":[{"name":"Clinic for Internal Medicine, Rheumatology and Immunology, Medius Klinik, 73230 Kirchheim unter Teck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nesrine Saad","family":"Farrag","sequence":"additional","affiliation":[{"name":"Community Medicine Department, Port Said University, Port Said 31111, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heba Wagih","family":"Abdelwahab","sequence":"additional","affiliation":[{"name":"Pulmonary Medicine Department, Mansoura University, Mansoura 35516, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1001\/jama.2011.10","article-title":"Sarcoidosis: Clinical Presentation, Immunopathogenesis, and Therapeutics","volume":"305","author":"Iannuzzi","year":"2011","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/S2213-2600(18)30064-X","article-title":"Pulmonary sarcoidosis","volume":"6","author":"Spagnolo","year":"2018","journal-title":"Lancet Respir. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1378\/chest.14-1475","article-title":"Sarcoidosis and Cancer Risk: Systematic Review and Meta-analysis of Observational Studies","volume":"147","author":"Bonifazi","year":"2015","journal-title":"Chest"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1513\/AnnalsATS.201511-760OC","article-title":"Sarcoidosis in America. Analysis Based on Health Care Use","volume":"13","author":"Baughman","year":"2016","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1097\/MCP.0000000000000715","article-title":"Sarcoidosis epidemiology: Recent estimates of incidence, prevalence and risk factors","volume":"26","author":"Arkema","year":"2020","journal-title":"Curr. Opin. Pulm. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1016\/0002-9343(74)90160-0","article-title":"Course and prognosis of sarcoidosis around the world","volume":"57","author":"Siltzbach","year":"1974","journal-title":"Am. J. Med."},{"key":"ref_7","first-page":"525","article-title":"Prognostic factors predicting the outcome of sarcoidosis: An analysis of 818 patients","volume":"52","author":"Neville","year":"1983","journal-title":"Q. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/0002-9343(63)90165-7","article-title":"Manifestations of sarcoidosis. Analysis of 145 patients, with a review of nine series selected from the literature","volume":"35","author":"Mayock","year":"1963","journal-title":"Am. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1885","DOI":"10.1164\/ajrccm.164.10.2104046","article-title":"Clinical characteristics of patients in a case control study of sarcoidosis","volume":"164","author":"Baughman","year":"2001","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1183\/09031936.00075307","article-title":"Epidemiology of sarcoidosis in Japan","volume":"31","author":"Morimoto","year":"2008","journal-title":"Eur. Respir. J."},{"key":"ref_11","first-page":"46","article-title":"Sarcoidosis in Denmark 1980\u20131994. A registry-based incidence study comprising 5536 patients","volume":"20","author":"Byg","year":"2003","journal-title":"Sarcoidosis Vasc. Diffuse Lung Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1007\/s40266-013-0125-5","article-title":"Elderly-onset sarcoidosis: Prevalence, clinical course, and treatment","volume":"30","author":"Jamilloux","year":"2013","journal-title":"Drugs Aging"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1111\/j.1447-0594.2006.00341.x","article-title":"Reviewing the definition of \u201celderly\u201d","volume":"6","author":"Orimo","year":"2006","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.rmed.2019.03.013","article-title":"Elderly sarcoidosis: A comparative study from a 42-year single-centre experience","volume":"152","author":"Corbella","year":"2019","journal-title":"Respir. Med."},{"key":"ref_15","first-page":"e20443","article-title":"Elderly Onset Sarcoidosis: A Case Report","volume":"13","author":"Ramachandran","year":"2021","journal-title":"Cureus"},{"key":"ref_16","first-page":"e2021016","article-title":"Retrospective study of elderly onset sarcoidosis in Tunisian patients","volume":"38","author":"Chebbi","year":"2021","journal-title":"Sarcoidosis Vasc. Diffuse Lung Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1038\/bjc.1974.64","article-title":"The incidence of malignant tumours in patients with respiratory sarcoidosis","volume":"29","author":"Brincker","year":"1974","journal-title":"Br. J. Cancer"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"El Jammal, T., Pavic, M., Gerfaud-Valentin, M., Jamilloux, Y., and S\u00e8ve, P. (2020). Sarcoidosis and Cancer: A Complex Relationship. Front. Med., 7.","DOI":"10.3389\/fmed.2020.594118"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1183\/09031936.98.12040906","article-title":"Sarcoidosis and cancer revisited: A long-term follow-up study of 555 Danish sarcoidosis patients","volume":"12","author":"Hommelgaard","year":"1998","journal-title":"Eur. Respir. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1038\/nature07205","article-title":"Cancer-related inflammation","volume":"454","author":"Mantovani","year":"1683","journal-title":"Nature"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1038\/bjc.1972.18","article-title":"Sarcoid Reactions and Sarcoidosis in Hodgkin\u2019s Disease and Other Malignant Lymphomata","volume":"26","author":"Brincker","year":"1972","journal-title":"Br. J. Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1038\/bjc.1986.199","article-title":"The sarcoidosis-lymphoma syndrome","volume":"54","author":"Brincker","year":"1986","journal-title":"Br. J. Cancer"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1159\/000455877","article-title":"Characteristics of Sarcoidosis in Patients with Previous Malignancy: Causality or Coincidence?","volume":"93","author":"Arish","year":"2017","journal-title":"Respiration"},{"key":"ref_24","first-page":"101565","article-title":"Case series of concurrent occurrence of sarcoidosis and breast cancer\u2014A diagnostic dilemma","volume":"35","author":"Mehta","year":"2022","journal-title":"Respir. Med. Case Rep."},{"key":"ref_25","first-page":"47","article-title":"Sarcoidosis of the breast: A rare case report and a review","volume":"10","author":"Fiorucci","year":"2006","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1111\/joim.12991","article-title":"Drug-induced sarcoidosis: An overview of the WHO pharmacovigilance database","volume":"288","author":"Lhote","year":"2020","journal-title":"J. Intern. Med."},{"key":"ref_27","first-page":"235","article-title":"Elderly-onset Sarcoidosis: A Single Center Comparative Study","volume":"16","author":"Kobak","year":"2020","journal-title":"Reumatol. Cl\u00ednica (Engl. Ed.)"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.ejim.2019.08.025","article-title":"Systemic phenotype of sarcoidosis associated with radiological stages. Analysis of 1230 patients","volume":"69","author":"Kostov","year":"2019","journal-title":"Eur. J. Intern. Med."}],"container-title":["Advances in Respiratory Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2543-6031\/94\/1\/3\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T12:52:39Z","timestamp":1767358359000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2543-6031\/94\/1\/3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,2]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["arm94010003"],"URL":"https:\/\/doi.org\/10.3390\/arm94010003","relation":{},"ISSN":["2543-6031"],"issn-type":[{"value":"2543-6031","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,2]]}}}