TY - JOUR T1 - Preoperative Peak Oxygen Uptake in Lung Cancer Subjects With Neoadjuvant Chemotherapy: A Cross-Sectional Study JF - Respiratory Care SP - 1059 LP - 1066 DO - 10.4187/respcare.04299 VL - 61 IS - 8 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 Y1 - 2016/08/01 UR - http://rc.rcjournal.com/content/61/8/1059.abstract N2 - 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. ER -