Clinical and prognostic analysis of unicentric mediastinal Castleman disease: a 10-year retrospective series study.
- 1Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China.
Abstract
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. 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. The most frequent anatomical involvement occurred in station 3A lymph nodes (12 cases, 24.5%), followed by station 10 (11 cases, 22.3%) and station 4 (8 cases, 16.3%). Mean tumor size was 6.25±3.09 cm (intraoperative measurement). Histopathological subtypes included hyaline vascular variant (43 cases, 87.7%), plasma cell variant (4 cases, 8.2%), and mixed-type (2 cases, 4.1%). Compared to thoracotomy, VATS demonstrated shorter operative duration (P<0.05), reduced intraoperative blood loss (P<0.05), and shorter postoperative chest tube retention (3±2.81 vs. 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%. 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.
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BibTeX
@article{wang2026clinical,
title = {{Clinical and prognostic analysis of unicentric mediastinal Castleman disease: a 10-year retrospective series study.}},
author = {Zhijie Wang and Xiaobin Wang and Yongshi Liu and Xiangbin Xin and Yucheng Wang and Jin Liu and Guang Yang},
journal = {Journal of thoracic disease},
year = {2026},
month = oct,
doi = {10.21037/jtd-2026-1831},
url = {https://europepmc.org/article/MED/42996955},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Clinical and prognostic analysis of unicentric mediastinal Castleman disease: a 10-year retrospective series study.
AU - Zhijie Wang
AU - Xiaobin Wang
AU - Yongshi Liu
AU - Xiangbin Xin
AU - Yucheng Wang
AU - Jin Liu
AU - Guang Yang
PY - 2026
DA - 2026/10/23
JO - Journal of thoracic disease
DO - 10.21037/jtd-2026-1831
UR - https://europepmc.org/article/MED/42996955
AB - 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. 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. The most frequent anatomical involvement occurred in station 3A lymph nodes (12 cases, 24.5%), followed by station 10 (11 cases, 22.3%) and station 4 (8 cases, 16.3%). Mean tumor size was 6.25±3.09 cm (intraoperative measurement). Histopathological subtypes included hyaline vascular variant (43 cases, 87.7%), plasma cell variant (4 cases, 8.2%), and mixed-type (2 cases, 4.1%). Compared to thoracotomy, VATS demonstrated shorter operative duration (P<0.05), reduced intraoperative blood loss (P<0.05), and shorter postoperative chest tube retention (3±2.81 vs. 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%. 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.
SN - 2072-1439
SN - 2077-6624
ER -