摘要
Immune checkpoint inhibitors (ICIs) have significantly transformed cancer treatment and are increasingly used as adjuvant therapy to reduce the risk of recurrence. However, this shift has led to the occurrence of immune-related adverse events (irAEs) in patients who would otherwise be clinically cured after primary treatment. Sarcoidosis-like reaction (SLR) is a rare but significant irAE characterized by non-necrotizing granulomatous inflammation. In the context of adjuvant therapy, SLR can closely mimic the symptoms of recurrence on monitoring images, potentially leading to unnecessary diagnostic procedures, treatment interruptions, or additional medical interventions. This review summarizes current research on SLR associated with ICI use, with a focus on adjuvant immunotherapy, where practical guidance is still limited. We combine data from clinical trials, real-world studies, and case reports to discuss the incidence of SLR, proposed immunological mechanisms, clinical and radiological manifestations, pathology, differential diagnosis, and management strategies. Special attention is paid to distinguishing SLR from cancer recurrence, determining when tissue confirmation is necessary, and how to customize treatment based on the severity of the condition and organ involvement. Common radiological findings include bilateral mediastinal and hilar lymphadenopathy and pulmonary nodules; however, tissue biopsy remains the gold standard for confirmation. Many cases are of low severity and can be managed conservatively. Increased awareness of SLR associated with ICI is essential to prevent misdiagnosis and avoid unnecessary treatments while maintaining the therapeutic benefits of adjuvant immunotherapy.
