Peak oxygen consumption and long‐term all‐cause mortality in nonsmall cell lung cancer |
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| Authors: | Lee W. Jones PhD Dorothy Watson James E. Herndon II PhD Neil D. Eves PhD Benjamin E. Haithcock Gregory Loewen DO Leslie Kohman MD |
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| Affiliation: | 1. Department of Surgery, Duke University Medical Center, Durham, North CarolinaFax: (919) 684‐1282;2. Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina;3. Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada;4. Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;5. Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York;6. Department of Surgery, State University of New York, Health Science Center at Syracuse, Syracuse, New York |
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| 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 [VO2peak]) 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 VO2peak 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 VO2peak 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 VO2peak <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 VO2peak of 0.96 to 1.29 L/min?1, and 0.56 (95% CI, 0.39‐0.80) for a VO2peak of >1.29 L/min?1 (Ptrend = .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 VO2peak category (Ptrend = .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 (Ptrend = .0278). CONCLUSIONS: VO2peak is a strong independent predictor of survival in NSCLC that may complement traditional markers of prognosis to improve risk stratification and prognostication. Cancer 2010. © 2010 American Cancer Society. |
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| Keywords: | exercise lung cancer all‐cause mortality cardiorespiratory fitness prognosis |
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