Routine chest X-ray measure may predict lung surgery outcomes

A measurement taken from routine chest X-rays may help predict long-term outcomes after lung cancer surgery, according to research published in the International Journal of Clinical Oncology.

The study evaluated diaphragmatic dome height, an imaging-based marker of diaphragmatic function. Lower height may reflect diaphragmatic dysfunction, which can affect breathing efficiency and recovery after surgery.

Researchers retrospectively reviewed 302 patients with lung cancer and obstructive ventilatory disorder who underwent lobectomy between 2017 and 2024. Diaphragmatic dome height was measured on chest radiographs acquired 1 month before surgery.

Patients were divided into low and high diaphragmatic dome height groups using a cutoff of 18.8 mm. The study assessed associations with 3-year overall survival and disease-specific survival related to respiratory deaths.

Lower diaphragmatic dome height was associated with worse outcomes. The low-height group had 70% 3-year overall survival, compared with 85% in the high-height group. Disease-specific survival was 80% versus 92%, respectively.

Respiratory-related deaths were also more common in the low-height group. The 3-year cumulative incidence of postoperative respiratory-related death was 20% in patients with low diaphragmatic dome height, compared with 5% in those with higher measurements.

The measurement remained an independent prognostic factor after accounting for established predictors, including tumor stage, pulmonary function, and surgical approach, the authors reported.

Chest radiography is already a standard part of preoperative assessment in patients with lung cancer, the authors noted. That could make diaphragmatic dome height a practical marker for risk stratification without adding another imaging exam.

Further multicenter and prospective studies are needed to validate the measurement and assess how it could be incorporated into preoperative risk models, according to the study.