Original article
General thoracic
Performance at Preoperative Stair-Climbing Test Is Associated With Prognosis After Pulmonary Resection in Stage I Non-Small Cell Lung Cancer

Presented at the Poster Session of the Forty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–Feb 1, 2012.
https://doi.org/10.1016/j.athoracsur.2012.02.068Get rights and content

Background

This investigation evaluated whether the performance at a preoperative symptom-limited stair-climbing test was a prognostic factor in resected pathologic stage I non-small cell lung cancer (NSCLC).

Methods

Observational analysis was performed on a prospective database that included 296 patients who underwent pulmonary lobectomy for pathologic stage T1 N0 or T2 N0 NSCLC (2000 to 2008). Patients who received induction chemotherapy were excluded. Survival was calculated by the Kaplan-Meyer method. The log-rank test was used to assess differences in survival between groups. The relationships between survival and baseline and clinical variables were determined by Cox multivariate analyses.

Results

Median follow-up was 43 months. The best cutoff associated with prognosis was an 18-meter stair climb. Median (months) survival and 5-year survival of patients who climbed more than 18 meters were significantly longer than those who climbed less than 18 meters (97 vs 74; 77% vs 54%, p = 0.001). Cox regression model (hazard ratio) showed that climbing more than 18 meters (0.5; p = 0.003), diffusion capacity of the lung for carbon monoxide (0.98; p = 0.02), and pT stage (1.8; p = 0.02) were independent prognostic factors. Patients who climbed less than 18 meters had increased deaths from cancer (24% vs 15%, p = 0.1) or other causes (19% vs 9%, p = 0.02).

Conclusions

Preoperative cardiopulmonary fitness is a significant prognostic factor in patients after resection for early-stage NSCLC. Interventions aimed at improving exercise tolerance can be useful to improve long-term prognosis after NSCLC operations.

Section snippets

Patients and Methods

This was an observational analysis performed on a prospective database. The study was approved by the local Institutional Review Board. All patients gave their informed consent to participate in the institutional prospective database and for the use of their data for research and clinical purposes. A total of 296 consecutive patients undergoing pulmonary lobectomy and systematic lymph node dissection [13] for pathologic stage I (pT1 or pT2-N0 only) NSCLC and with complete follow-up were

Results

Patient characteristics are summarized in Table 1. Median follow-up was 43 months. The average altitude reached at preoperative stair climb test was 20 meters. Testing for a threshold effect showed that 18 meters was the best cutoff associated with long-term survival. Compared with patients who climbed less than 18 meters, patients who climbed more than 18 meters had significantly longer median survival of 97 (95% CI, 89 to 105) months vs 74 (95% CI, 63 to 85) months and 5-year survival of 77%

Comment

The association between exercise tolerance and prognosis in cancer survivors has been rarely reported. Regular moderate-intensity exercise is known to be associated with a 30% to 50% reduction in the risk of cancer-specific mortality and all-cause mortality after a diagnosis of early breast or colorectal cancer [19, 20, 21, 22]. Two studies have evaluated the prognostic importance of exercise tolerance in lung cancer. Kasymjanova and colleagues [6] assessed the prognostic value of the 6-minute

References (29)

  • E. Lim et al.

    Guidelines on the radical management of patients with lung cancer

    Thorax

    (2010)
  • L. Kohman et al.

    CALGB 140803—Association between cardiorespiratory fitness and overall survival in operable lung cancer patients: ancillary analysis of protocol 9238

    J Clin Oncol

    (2009)
  • A. Bobbio et al.

    Preoperative pulmonary rehabilitation in patients undergoing lung resection for non-small cell lung cancer

    Eur J Cardiothorac Surg

    (2008)
  • H. Riesenberg et al.

    In-patient rehabilitation of lung cancer patients—a prospective study

    Support Care Cancer

    (2010)
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