Preoperative Peak Oxygen Uptake in Lung Cancer Subjects With Neoadjuvant Chemotherapy: A Cross-Sectional Study

BACKGROUND: In non-small-cell lung cancer patients, high peak oxygen uptake (peak V (over dot)(O2)) predicts lower rates of postoperative complications and better long-term survival. Neoadjuvant chemotherapy (NAC) may negatively impact peak V. O2. 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 V (over dot)(O2) 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 (D-LCO) (P = .035) and hemoglobin concentrations (P < .001). D-LCO was strongly correlated with peak V (over dot)(O2) (r(2) = 0.56). Adjustment for D-LCO reduced the effect of NAC on peak V (over dot)(O2) without suppressing it. CONCLUSIONS: NAC was associated with lower preoperative peak V (over dot)(O2) 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.