Pulmonary artery enlargement as a predictor of long-term prognosis in patients with resected early-stage non-small cell lung cancer

Objectives: Although several studies have highlighted the potential prognostic value of computed tomography-measured pulmonary artery enlargement in various respiratory diseases, the long-term outcomes following lung cancer surgery remain unexplored. This study aimed to assess the predictive value of pulmonary artery enlargement for overall survival in patients with completely resected non- small cell lung cancer. Methods: We retrospectively identified patients with pathological Tis-1cN0M0 non-small cell lung cancer who underwent complete resection between 2013 and 2018 in our hospital. We reviewed the routine preoperative computed tomography images and measured the pulmonary artery diameter at the bifurcation (PA) and the ascending aorta diameter (A) to calculate the PA/A ratio. Based on a PA/A threshold of 0.8, patients were categorized into high- and low-ratio groups, and their overall survival and cumulative incidence of cause-specific deaths were compared after propensity score matching. Results: Of the 319 included patients, 116 were categorized into the high-ratio group and 203 into the low-ratio group. After propensity score matching, overall survival was significantly worse in the high-ratio group than in the low-ratio group (5-year overall survival: 89.4% vs 96.2%; P 1/4 .006). The high-ratio group had a significantly higher incidence of death not related to lung cancer than the low-ratio group (P 1/4 .01). Conclusions: In patients with resected early-stage non-small cell lung cancer, those with preoperatively pulmonary artery enlargement had a poorer overall survival than those without, possibly attributed to a higher non-lung cancer-related death incidence. Measuring the preoperative PA/A ratio might be a useful tool for risk stratification, and selecting sublobar resection for these patients could improve the long-term prognosis. (JTCVS Open 2025;23:266-75)