Clinical and prognostic analysis of unicentric mediastinal Castleman’s disease: a 10-year retrospective series study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Castleman disease (CD) is a rare lymphoproliferative disorder, and unicentric mediastinal CD (UMCD) represents an uncommon thoracic manifestation for which surgical resection remains the mainstay of treatment.This study aims to: (I) characterize the anatomical distribution of UMCD in a single-center cohort; (II) evaluate the efficacy of video-assisted thoracoscopic surgery (VATS) for UMCD resection and identify preoperative predictors of thoracotomy; (III) analyze prognostic outcomes in surgically managed UMCD patients. Methods: A retrospective analysis was conducted on 49 consecutive UMCD patients (26 males, 23 females; mean age 37.27±15.27 years) undergoing surgical resection at the department of thoracic surgery (Tangdu Hospital, Fourth Military Medical University) between May 2014 and October 2024. Demographic characteristics, anatomical distributions, and perioperative outcomes were systematically analyzed. Comparative analysis between VATS and thoracotomy groups was performed using independent samples t-tests. Univariate and multivariate logistic regression identified predictors of thoracotomy, with diagnostic performance evaluated via receiver operating characteristic (ROC) curve analysis. Survival outcomes were assessed using Kaplan-Meier methodology. Results: 5.52±3.54 days, P<0.05). Multivariate analysis identified tumor diameter >6.6 cm (P<0.05) and arterial-phase contrast-enhanced computed tomography (CT) attenuation >102 Hounsfield units (HU) (P<0.05) as independent predictors of thoracotomy. ROC analysis revealed an area under the curve (AUC) of 0.875 for the combined diagnostic model. With a median follow-up duration of 52 months, the VATS group maintained 100% recurrence-free survival. In the thoracotomy group, three patients succumbed to disease (two from local recurrence refractory to conservative therapy, one from postoperative pneumonia with respiratory failure following pneumonectomy). The overall survival (OS) rate for the cohort was 91.83%. Conclusions: Station 3A lymph nodes represent the predominant anatomical site of UMCD involvement. VATS resection confers significant advantages over thoracotomy, including reduced operative time, blood loss, and postoperative recovery duration. The diameter >6.6 cm and arterial-phase CT attenuation >102 HU of tumors serve as reliable preoperative indicators for thoracotomy. Early surgical intervention correlates with favorable prognosis, while postoperative complications and local recurrence demonstrate significant association with mortality.
Source: Journal of Thoracic Disease
Institutions: Tang Du Hospital, Air Force Medical University
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7224122849