Pulmonary artery and aortic enlargement predict postoperative survival outcomes in lung cancer

OBJECTIVES: The pulmonary artery/aorta ratio can predict postoperative outcomes in patients with lung cancer; however, few studies have investigated the effects of individual changes in the pulmonary artery and aortic diameters. This study aimed to analyse the impact of pulmonary artery and aortic enlargement on outcomes following surgery for lung cancer. METHODS: We retrospectively analysed data from 1482 patients with non-small-cell lung cancer who underwent radical surgery at our institution between 2006 and 2022. The maximum diameters of the pulmonary artery and ascending aorta were measured using preoperative computed tomography, and patients were divided according to cutoff values set for the receiver operating characteristic curve. All patients were then stratified into three groups: non-enlarged pulmonary artery and aorta ('normal' group, n = 244), enlargement of either the pulmonary artery or aorta ('either enlargement' group, n = 689) and enlargement of both the pulmonary artery and aorta ('both enlargement' group, n = 549). The preoperative clinical characteristics and postoperative outcomes were analysed in these three groups. RESULTS: Five-year overall survival rates in the 'normal', 'either enlargement' and 'both enlargement' groups were 80.2%, 77.3% and 71.0% (P = 0.002), respectively. Enlargement of both vessels was an independent negative prognostic factor for both overall survival (hazard ratio, 1.56; P = 0.04) and cancer-specific death (hazard ratio, 1.83; P = 0.03). However, this association was not significant for non-cancer-specific deaths (hazard ratio, 1.39; P = 0.35). CONCLUSIONS: Measurement of the pulmonary artery and aortic diameters might be a useful predictor of postoperative survival in patients with lung cancer.