Prognostic significance of preoperative exercise tolerance in patients with early-stage lung cancer

OBJECTIVE:To investigate the impact of simple preoperative exercise tests as prognostic factors for early-stage lung cancer. METHODS:This single-institution retrospective study included consecutive patients who underwent pulmonary resection for stage 0-I lung cancer between April 2017 and December 2019. Before surgery, 7 metabolic equivalents (METs) in the double Master's two-step test were loaded into the exercise ECG. The relationship between prognosis and exercise stress test results in terms of availability, symptoms, and saturation of percutaneous oxygen was investigated. RESULTS:This study included 862 patients with pathological stage 0-I lung cancer. Among the 862 patients, 673 patients (78.1%) who were able to complete 7 METs exercise for 3 mins without assistance were classified into the complete group. The 5-year survival of the complete group was significantly better than that of the incomplete group. Multivariable analysis revealed that age (HR, 1.06; p = 0.008), male sex (HR, 2.23; p = 0.011), CEA level > 5 ng/mL (HR, 2.33; p = 0.011), and inability to complete 7 METs exercise (HR, 3.90; p < 0.001) were the prognostic factors. Patients in the older group who had the ability to complete exercise had a better prognosis than those in the younger group without the ability (p = 0.003). CONCLUSIONS:Preoperative exercise ability is a prognostic factor for early-stage lung cancer. Patients who can tolerate an exercise load of 7 METs, even if they are aged ≥ 70 years, have a better prognosis than patients aged < 70 years without exercise tolerance.