Abstract
BACKGROUND: In non-small-cell lung cancer patients, high peak oxygen uptake (peak V̇O2) predicts lower rates of postoperative complications and better long-term survival. Neoadjuvant chemotherapy (NAC) may negatively impact peak V̇O2.
METHODS: Cardiopulmonary exercise testing (CPET) was performed in 34 consecutive stage IIIA/IIIB non-small-cell lung cancer subjects scheduled for elective lung surgery. Using multivariate linear regression adjusted for potential confounders, we compared CPET results in subjects receiving or not receiving NAC (NAC+, n = 19; NAC–, n = 15).
RESULTS: Adjusted peak V̇O2 was lower in NAC + compared with NAC– subjects (–5.3 mL/min/kg [95% CI –8.3 to –2.2], P = .01). Likewise, oxygen pulse, maximal work load, and ventilatory threshold were also lower in NAC+ subjects, whereas peak heart rate and breathing reserve were similar. NAC+ subjects presented lower values of diffusion capacity for carbon monoxide (DLCO) (P = .035) and hemoglobin concentrations (P < .001). DLCO was strongly correlated with peak V̇O2 (r2 = 0.56). Adjustment for DLCO reduced the effect of NAC on peak V̇O2 without suppressing it.
CONCLUSIONS: NAC was associated with lower preoperative peak V̇O2 in subjects with non-small-cell lung cancer. This lower aerobic fitness may result from NAC-induced reduction in pulmonary gas exchange or heart toxicity. Since lower fitness is linked to poorer outcome, the decision for NAC may have to be balanced with its possible toxicity.
- chemotherapy
- peak oxygen uptake
- cardio-pulmonary exercise tests
- lung cancer
- lung surgery
- training
- post operative complications
Footnotes
- Correspondence: Isabelle Fresard, University Hospitals of Geneva, Division of Pulmonary Medicine, Hopital de La Tour, Av J.-D. Maillard 3, 1217 Meyrin, Switzerland. E-mail: isabelle.fresard{at}latour.ch.
The authors have disclosed no conflicts of interest.
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