PT  - JOURNAL ARTICLE
AU  - Isabelle Fresard
AU  - Marc Licker
AU  - Dan Adler
AU  - Alban Lovis
AU  - John Robert
AU  - Wolfram Karenovics
AU  - John Diaper
AU  - Jean-Paul Janssens
AU  - Frederic Triponez
AU  - Frederic Lador
AU  - Thierry Rochat
AU  - Vicente Espinosa
AU  - Chetna Bhatia
AU  - Bengt Kayser
AU  - Pierre-Olivier Bridevaux
TI  - Preoperative Peak Oxygen Uptake in Lung Cancer Subjects With Neoadjuvant Chemotherapy: A Cross-Sectional Study
AID  - 10.4187/respcare.04299
DP  - 2016 May 10
TA  - Respiratory Care
PG  - respcare.04299
4099  - http://rc.rcjournal.com/content/early/2016/05/10/respcare.04299.short
4100  - http://rc.rcjournal.com/content/early/2016/05/10/respcare.04299.full
AB  - 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.