RT Journal Article
SR Electronic
T1 Preoperative Peak Oxygen Uptake in Lung Cancer Subjects With Neoadjuvant Chemotherapy: A Cross-Sectional Study
JF Respiratory Care
FD American Association for Respiratory Care
SP respcare.04299
DO 10.4187/respcare.04299
A1 Isabelle Fresard
A1 Marc Licker
A1 Dan Adler
A1 Alban Lovis
A1 John Robert
A1 Wolfram Karenovics
A1 John Diaper
A1 Jean-Paul Janssens
A1 Frederic Triponez
A1 Frederic Lador
A1 Thierry Rochat
A1 Vicente Espinosa
A1 Chetna Bhatia
A1 Bengt Kayser
A1 Pierre-Olivier Bridevaux
YR 2016
UL http://rc.rcjournal.com/content/early/2016/05/10/respcare.04299.abstract
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.