Retrospective Analysis Of The Clinical Features Of Castleman’s Disease And Review Of The Literature

Objective To study the clinical characteristics of Castleman disease(CD)patients,including clinical manifestations,laboratory indicators,treatment strategies,and prognosis,through a retrospective analysis of 300 cases of CD.The aim is to enhance the awareness of CD among clinicians and assist in clinical management.Methods Clinical data of 72 patients diagnosed with Castleman disease by pathological histology,who were treated at Gansu Provincial People’s Hospital and Gansu Provincial Cancer Hospital from April 2009 to October 2022,were collected.Additionally,clinical information of 228 CD patients from the past decade,published and available on CNKI and Wanfang databases,was collected and statistically analyzed.The clinical characteristics,treatment strategies,and factors related to the prognosis of the disease were summarized.Results Among the 300 patients,216(72%)had unicentric Castleman disease(UCD),and84(28%)had multicentric Castleman disease(MCD),with UCD being more common than MCD.In UCD patients,there were 90 males(41.66%)and 126 females(58.33%),while in MCD patients,there were 47 males(55.95%)and 37 females(44.05%).There was a statistically significant difference in gender between the two groups(P=0.026,P<0.05).The average age of onset was 40.97±16.74 years in UCD patients and 46.87±16.30 years in MCD patients,with a slightly higher age of onset in MCD patients.The occurrence rate of mixed type in MCD was much higher than that in UCD.MCD patients had more abnormal laboratory test results,systemic symptoms,and signs than UCD patients.The survival rate of UCD patients was better than that of MCD patients,and the difference was statistically significant(P<0.0001).Poor prognosis was observed in plasma cell type CD compared to hyaline vascular type and mixed type(P=0.0129,P<0.05).Poor prognosis was also associated with anemia,renal dysfunction,abnormal coagulation function,and elevated LDH levels in CD patients(P<0.0001).Conclusion UCD has a higher proportion of female patients,while MCD has a higher proportion of male patients.MCD patients have a higher age of onset compared to UCD patients,and the age of onset is higher in plasma cell-associated CD patients compared to hyaline vascular-associated CD and mixed-type CD patients.UCD patients have fewer clinical symptoms and signs than MCD patients,as MCD often involves multiple systems in the body.Significant differences are observed in the histopathology of CD,with the hyaline vascular type being predominant in UCD.In contrast,plasma cell type is more common in MCD,and the occurrence rate of the mixed type is much higher in MCD than in UCD.UCD patients generally have a favorable prognosis after surgical resection.In contrast,MCD patients still have a poorer prognosis even after multi-modal treatments,primarily due to the severity of systemic symptoms in MCD patients.