Prognostic Impact of Surgical-Side Pulmonary Artery Diameter in Patients with Non-Small Cell Lung Cancer Undergoing Lobectomy

Background A surgical-side pulmonary artery diameter (ssPAD) ≥ 23 mm has been linked to postoperative complications after lobectomy for non-small cell lung cancer (NSCLC), but its prognostic significance remains unclear. This study evaluated whether ssPAD ≥ 23 mm serves as an independent prognostic factor and a useful indicator for preoperative risk assessment.

Methods We retrospectively analyzed 438 patients who underwent lobectomy for NSCLC between 2016 and 2017. Patients were classified by ssPAD: ≥ 23 mm (n = 116) and < 23 mm (n = 322). Survival outcomes and clinicopathological variables were compared. The prognostic performance of ssPAD was assessed using C-statistics against main pulmonary artery diameter (MPAD) ≥ 28 mm and pulmonary artery-to-aorta (PA/A) ratio > 1.

Results The ssPAD ≥ 23 mm group showed lower 5-year recurrence-free survival (61% vs 71%, p = 0.047) and overall survival (69% vs 81%, p = 0.001). Lung cancer–specific mortality (24% vs 13%, p = 0.034) and non-cancer mortality (15% vs 7.1%, p = 0.042) were higher, while adjuvant therapy was less frequent due to dyspnea. In multivariable analysis, ssPAD ≥23 mm remained an independent predictor of overall survival (HR 1.84, 95% CI 1.22–2.79, p=0.004).

Conclusions Preoperative ssPAD ≥ 23 mm may be an independent prognostic marker after lobectomy for NSCLC and a simple CT-based tool for risk stratification.