CT-defined pulmonary emphysema severity independently predicts long-term outcomes after curative gastrectomy for gastric cancer.

BACKGROUND: Respiratory dysfunction has been reported as a prognostic factor in gastric cancer. In contrast, pulmonary emphysema evaluated by CT may reflect systemic vulnerability beyond airflow limitation and has been implicated in cancer-related outcomes; however, its prognostic relevance in gastric cancer remains unclear. METHODS: This study included patients with pathological stage I-III gastric cancer who underwent curative gastrectomy between July 2014 and August 2025. Pulmonary emphysema was assessed on preoperative chest CT using the Goddard scoring system. Prognostic factors for disease-free survival and overall survival were evaluated using univariate and multivariate Cox proportional hazards regression analyses. RESULTS: A total of 226 patients were analyzed, of whom 62 (27%) had a high Goddard score (≥6). Kaplan-Meier analysis demonstrated significantly poorer survival in the high-score group, with 3-year disease-free survival, disease-specific survival, and overall survival rates of 56.3%, 61.8%, and 47.4%, respectively, compared with 88.4%, 89.2%, and 79.6% in the low-score group (all P < 0.01). On multivariate analysis, a high Goddard score independently predicted poorer disease-free survival (hazard ratio 4.13, 95% confidence interval 2.25-7.59; P < 0.01), together with pathological stage II-III disease (P < 0.01). For overall survival, a high Goddard score (hazard ratio 3.38, 95% confidence interval 2.10-5.44; P < 0.01), pathological stage II-III disease (P < 0.01), and postoperative complications (P < 0.01) were identified as independent prognostic factors. CONCLUSIONS: CT-defined pulmonary emphysema severity, quantified by the Goddard score, is independently associated with long-term outcomes after curative gastrectomy for gastric cancer.