title: Preoperative Peak Oxygen Uptake in Lung Cancer Subjects With Neoadjuvant Chemotherapy: A Cross-Sectional Study.
abstract: 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 (r(2) = 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.
authors.affiliation: Division of Pulmonary Medicine, Geneva Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland. Division of Pulmonary Medicine, Hôpital de La Tour, Geneva, Switzerland. isabelle.fresard@latour.ch.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Fresard
authors.affiliation: Division of Anaesthesiology, Geneva Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Licker
authors.affiliation: Division of Pulmonary Medicine, Geneva Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Dan
authors.initials: D
authors.lastname: Adler
authors.affiliation: Division of Pulmonary Medicine, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Alban
authors.initials: A
authors.lastname: Lovis
authors.affiliation: Division of Thoracic Surgery, Hôpital de La Tour, Geneva, Switzerland.
authors.forename: John
authors.initials: J
authors.lastname: Robert
authors.affiliation: Division of Thoracic and Endocrine Surgery, Geneva Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Wolfram
authors.initials: W
authors.lastname: Karenovics
authors.affiliation: Division of Anaesthesiology, Geneva Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: John
authors.initials: J
authors.lastname: Diaper
authors.affiliation: Division of Pulmonary Medicine, Geneva Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Janssens
authors.affiliation: Division of Thoracic and Endocrine Surgery, Geneva Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Frederic
authors.initials: F
authors.lastname: Triponez
authors.affiliation: Division of Pulmonary Medicine, Geneva Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Frederic
authors.initials: F
authors.lastname: Lador
authors.affiliation: Division of Pulmonary Medicine, Geneva Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Thierry
authors.initials: T
authors.lastname: Rochat
authors.affiliation: Division of Pulmonary Medicine, Geneva Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Vicente
authors.initials: V
authors.lastname: Espinosa
authors.affiliation: Division of Pulmonary Medicine, Geneva Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Chetna
authors.initials: C
authors.lastname: Bhatia
authors.affiliation: Institute of Sport Sciences and Department of Physiology, University of Lausanne, Lausanne, Switzerland and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: Bengt
authors.initials: B
authors.lastname: Kayser
authors.affiliation: Division of Pulmonary Medicine, Geneva Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland. Division of Pulmonary Medicine, Hôpital du Valais, Sion, Switzerland.
authors.forename: Pierre-Olivier
authors.initials: PO
authors.lastname: Bridevaux
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D003430:Cross-Sectional Studies; D005080:Exercise Test; D017079:Exercise Tolerance / Q000187:drug effects; D005260:Female; D006801:Humans; D007320:Inspiratory Capacity / Q000187:drug effects*; D016015:Logistic Models; D008168:Lung / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000009:adverse effects* / Q000379:methods; D009367:Neoplasm Staging; D010101:Oxygen Consumption / Q000187:drug effects*; D057234:Preoperative Period; D011659:Pulmonary Gas Exchange / Q000187:drug effects*; D016896:Treatment Outcome
keywords: cardio-pulmonary exercise tests; chemotherapy; lung cancer; lung surgery; peak oxygen uptake; post operative complications; training