Factors associated with health-related quality of life in children with pectus deformities: a cross-sectional study of symptoms, pulmonary function, and self–proxy relationships

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Pectus deformities (PDs) may affect physical and psychosocial well-being in children; however, the relative associations of symptom burden and pulmonary function with health-related quality of life (HRQoL) remain unclear. We aimed to evaluate the relationships of HRQoL with PD-related symptoms and spirometric indices and to assess correlations between patient self-reported and parent-proxy reported HRQoL. This prospective cross-sectional study included adolescents (aged 14–18 years) with pectus excavatum (PE) and pectus carinatum (PC). Patients with systemic conditions and recent respiratory tract infections were excluded. A priori power analysis indicated that at least 56 participants were required in each PD group, allowing for 20% potential data loss. HRQoL was assessed using the Nuss Questionnaire (NQmA) for PE, the Pectus Carinatum Body Image Quality of Life Questionnaire (PeCBI-QOL) for PC, and the Pediatric Quality of Life Inventory (PedsQL) for both groups. Patient self-reported and parent-proxy-reported HRQoL scores were compared according to clinical characteristics. Correlation analyses were performed to evaluate the relationship between HRQoL scores and spirometric parameters, and between self-reports and parent-proxy reports. Among 122 adolescents (80.3% male), 65 (53.3%) had PE and 57 (46.7%) had PC. PedsQL scores did not differ according to clinical characteristics (all p > 0.05). In the PC group, patients with back pain had significantly lower self-reported PeCBI-QOL social disadvantage scores than those without back pain ( p = 0.011). In the PE group, chest pain was associated with lower NQmA scores across all domains (all p < 0.001) and remained an independent predictor of poorer HRQoL (β= −16.294, 95%CI: −23.879 to − 8.710; p < 0.001). No significant correlations were found between spirometric parameters and HRQoL scores (all p > 0.05). Self- and parent-proxy reports were moderately to strongly correlated across most HRQoL domains, whereas agreement varied across domains, with intraclass correlation coefficients ranging from − 0.089 for PeCBI-QOL body image to 0.794 for the NQmA total score. In adolescents with PDs, HRQoL was not significantly associated with spirometric parameters, whereas chest pain was independently associated with poorer disease-specific HRQoL in patients with PE. Self- and parent-proxy reports showed variable agreement across HRQoL domains, supporting their complementary use, particularly for subjective domains such as body image. Not applicable