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.