Mediastinal Granulomatous Inflammation and Overall Survival in Patients with a History of Malignancy.
BACKGROUND
Investigators have postulated that mediastinal granulomatous inflammation is associated with prolonged overall survival in patients with cancer.


OBJECTIVE
We sought to determine whether mediastinal granulomatous inflammation affects overall survival in patients with a history of treated cancer.


METHODS
Patients with a history of treated cancer who underwent endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) for evaluation of mediastinal or hilar lymphadenopathy were grouped based on whether they had mediastinal granulomatous inflammation or benign mediastinal lymphadenopathy without granulomas. Overall survival from the date of EBUS-TBNA to cancer-related death or to last follow-up in patient groups was compared.


RESULTS
We reviewed the records of 106 patients (44 with mediastinal granulomatous inflammation and 62 with benign mediastinal lymphadenopathy). The 3-year survival rate was 90% overall and 93 and 88% in patients with mediastinal granulomatous inflammation and benign mediastinal lymphadenopathy, respectively (P=0.40). After multivariate adjustment, whether patients had mediastinal granulomatous inflammation or benign mediastinal lymphadenopathy did not significantly affect the risk of cancer death (mediastinal granulomatous inflammation to benign mediastinal lymphadenopathy hazard ratio, 1.27; P=0.76).


CONCLUSIONS
These results suggest that patients who develop mediastinal granulomatous inflammation after cancer treatment do not have an increased overall survival when compared with patients who develop benign mediastinal lymphadenopathy. EBUS-TBNA is warranted for patients with treated cancer who develop mediastinal and/or hilar lymphadenopathy to avoid erroneous upstaging or misdiagnosis of cancer recurrence that would lead to suboptimal management.
Departments of 1 Pulmonary Medicine and.
Horiana B
HB
Grosu
Departments of 1 Pulmonary Medicine and.
David E
DE
Ost
Departments of 1 Pulmonary Medicine and.
Rodolfo C
RC
Morice
Departments of 1 Pulmonary Medicine and.
George A
GA
Eapen
2 Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Liang
L
Li
2 Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Juhee
J
Song
2 Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Xiudong
X
Lei
3 Department of Pulmonary Medicine, Baylor College of Medicine, Houston, Texas; and.
Donald R
DR
Lazarus
4 Department of Pulmonary Medicine, Michael DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas.
Roberto F
RF
Casal
Departments of 1 Pulmonary Medicine and.
Carlos A
CA
Jimenez
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D019160:Endosonography; D005260:Female; D006099:Granuloma / Q000401:mortality* / Q000473:pathology; D006801:Humans; D007249:Inflammation / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology; D008206:Lymphatic Diseases / Q000175:diagnosis* / Q000401:mortality*; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis*; D008482:Mediastinum / Q000473:pathology; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D055815:Young Adult
endobronchial ultrasound–guided fine needle aspiration; granulomatous inflammation; mediastinal lymphadenopathy