Association between preoperative diaphragmatic dome height for overall survival in patients with lung cancer and obstructive ventilatory disorder.

BACKGROUND

To investigate the relationship between preoperative diaphragmatic dome height (DDH), measured on chest radiographs, and postoperative overall survival (OS) and disease-specific survival (DSS) due to respiratory-related deaths in patients with lung cancer and obstructive ventilatory disorder (OVD).

METHODS

This single-center retrospective study included 302 patients with lung cancer and OVD who underwent lobectomy between 2017 and 2024. DDH was measured on chest radiographs 1 month preoperatively, and the patients were divided into the low DDH (lower than the first quartile, 18.8 mm) and high DDH (≥ 18.8 mm) groups. The associations of DDH with OS and DSS were evaluated using Cox proportional hazards models and Fine-Gray competing risk analysis, respectively. Kaplan-Meier curves and log-rank tests were used for survival comparisons.

RESULTS

Overall, 65 patients (21%) died postoperatively. Cox proportional hazards and Fine-Gray analyses indicated that DDH (hazard ratio: 2.10, 95% confidence interval [CI]: 1.22-3.61, p < 0.01; subdistribution hazard ratio: 2.50, 95% CI: 1.14-5.45, p < 0.05) was an independent prognostic factor for 3-year OS and DSS. Furthermore, survival curve analysis demonstrated that the low DDH group had significantly lower 3-year OS (70% vs 85%, p < 0.01) and 3-year DSS (80% vs 92%, p < 0.01) compared with the high DDH group.

CONCLUSIONS

DDH is an independent prognostic factor for OS and DSS in patients with lung cancer and OVD, suggesting that it can serve as a novel physiological marker for long-term prognosis.