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Peak oxygen consumption and long‐term all‐cause mortality in nonsmall cell lung cancer
Author(s) -
Jones Lee W.,
Watson Dorothy,
Herndon James E.,
Eves Neil D.,
Haithcock Benjamin E.,
Loewen Gregory,
Kohman Leslie
Publication year - 2010
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.25396
Subject(s) - medicine , hazard ratio , cardiorespiratory fitness , lung cancer , confidence interval , vo2 max , proportional hazards model , prospective cohort study , gastroenterology , cardiology , heart rate , blood pressure
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. Cancer 2010. © 2010 American Cancer Society.