title: Performance at preoperative stair-climbing test is associated with prognosis after pulmonary resection in stage I non-small cell lung cancer.
abstract: 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.
authors.affiliation: Ospedali Riuniti Ancona, Ancona, Italy. brunellialex@gmail.com
authors.forename: Alessandro
authors.initials: A
authors.lastname: Brunelli
authors.forename: Cecilia
authors.initials: C
authors.lastname: Pompili
authors.forename: Rossana
authors.initials: R
authors.lastname: Berardi
authors.forename: Paola
authors.initials: P
authors.lastname: Mazzanti
authors.forename: Azzurra
authors.initials: A
authors.lastname: Onofri
authors.forename: Michele
authors.initials: M
authors.lastname: Salati
authors.forename: Stefano
authors.initials: S
authors.lastname: Cascinu
authors.forename: Armando
authors.initials: A
authors.lastname: Sabbatini
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002423:Cause of Death; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011300:Preoperative Care; D011379:Prognosis; D016016:Proportional Hazards Models; D015996:Survival Rate