title: Peak oxygen consumption and long-term all-cause mortality in nonsmall cell lung cancer.
abstract: BACKGROUND
  Identifying strong markers of prognosis is critical to optimize treatment and survival outcomes in patients with nonsmall cell lung cancer (NSCLC). The authors investigated the prognostic significance of preoperative cardiorespiratory fitness (peak oxygen consumption [VO(2peak)]) among operable candidates with NSCLC.
  
  
  METHODS
  By using a prospective design, 398 patients with potentially resectable NSCLC enrolled in Cancer and Leukemia Group B 9238 were recruited between 1993 and 1998. Participants performed a cardiopulmonary exercise test to assess VO(2peak) and were observed until death or June 2008. Cox proportional models were used to estimate the risk of all-cause mortality according to cardiorespiratory fitness category defined by VO(2peak) tertiles (<0.96 of 0.96-1.29/>1.29 L/min⁻¹) with adjustment for age, sex, and performance status.
  
  
  RESULTS
  Median follow-up was 30.8 months; 294 deaths were reported during this period. Compared with patients achieving a VO(2peak) <0.96 L/min⁻¹, the adjusted hazard ratio (HR) for all-cause mortality was 0.64 (95% confidence interval [CI], 0.46-0.88) for a VO(2peak) of 0.96 to 1.29 L/min⁻¹, and 0.56 (95% CI, 0.39-0.80) for a VO(2peak) of >1.29 L/min⁻¹) (P(trend) = .0037). The corresponding HRs for resected patients were 0.66 (95% CI, 0.46-0.95) and 0.59 (95% CI, 0.40-0.89) relative to the lowest VO(2peak) category (P(trend) = .0247), respectively. For nonresected patients, the HRs were 0.78 (95% CI, 0.34-1.79) and 0.39 (95% CI, 0.16-0.94) relative to the lowest category (P(trend) = .0278).
  
  
  CONCLUSIONS
  VO(2peak) is a strong independent predictor of survival in NSCLC that may complement traditional markers of prognosis to improve risk stratification and prognostication.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA. lee.w.jones@duke.edu
authors.forename: Lee W
authors.initials: LW
authors.lastname: Jones
authors.forename: Dorothy
authors.initials: D
authors.lastname: Watson
authors.forename: James E
authors.initials: JE
authors.lastname: Herndon
authors.forename: Neil D
authors.initials: ND
authors.lastname: Eves
authors.forename: Benjamin E
authors.initials: BE
authors.lastname: Haithcock
authors.forename: Gregory
authors.initials: G
authors.lastname: Loewen
authors.forename: Leslie
authors.initials: L
authors.lastname: Kohman
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000503:physiopathology*; D002423:Cause of Death; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D057234:Preoperative Period