Valid treatment effect inference in survival studies is fundamental yet challenging when the treatment assignments and outcomes are confounded by many baseline covariates. To this end, in this paper we propose a high-dimensional survival causal inference (HSCI) framework that delivers valid inference under a sparse high-dimensional Cox proportional hazards outcome model and a high-dimensional logistic propensity score working model. To mitigate the nuisance estimation bias, we develop a Neyman near-orthogonal score for the treatment effect and implement it with cross-fitting. Under doubly robust nuisance-rate conditions, we establish the root-n asymptotic normality and consistent variance estimation. We also extend the framework to inference on high-dimensional survival covariate effects. Simulation examples confirm that HSCI reduces sharply the bias relative to the regularized Cox estimators and maintains valid confidence interval coverage across different dimensionality, censoring, and misspecified propensity-model settings. An application to diffuse large-B-cell lymphoma data further showcases its value for high-dimensional biomedical survival studies.

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