Maximal Oxygen Uptake--Risk Predictor of NSCLC Resection in Patients With Comorbid Emphysema: Lessons From NETT

Area of Science:

• Cardiology
• Thoracic Surgery
• Pulmonology

Background:

• Cardiopulmonary exercise testing (CPET) using VO2 max is crucial for assessing operative risk in patients undergoing major surgery, particularly for non-small cell lung cancer (NSCLC).
• Existing guidelines, such as those from the American College of Chest Physicians (ACCP), provide VO2 max thresholds for risk stratification.
• The National Emphysema Treatment Trial (NETT) developed a homogenous NULPD (no lung, no pulmonary disease) surrogate for VO2 max estimation, offering a potentially more refined risk assessment tool.

Purpose of the Study:

• To compare the predictive accuracy of VO2 max values derived from ACCP Guidelines versus the NETT surrogate for operative mortality.
• To estimate mid and long-term non-cancer-related survival in patients stratified by NETT VO2 max risk categories.
• To evaluate the potential for expanding surgical indications for curative resection in selected NSCLC patients based on refined risk assessment.

Main Methods:

• Comparative analysis of VO2 max values and predicted operative mortalities using ACCP Guidelines and the NETT surrogate.
• Stratification of patients into low, mid, and high-risk categories based on VO2 max values.
• Estimation of non-cancer-related survival at two and eight years post-operatively for different risk groups.

Main Results:

• NETT and ACCP Guideline VO2 max values showed similar predictions for low and mid-risk operative mortality.
• The NETT high-risk subset demonstrated a significantly lower operative mortality (14%) compared to the ACCP high-risk group (26%).
• Estimated two-year non-cancer-related survival rates were 100% (low), 74% (mid), and 59% (high) risk; eight-year rates were 48% (low), 26% (mid), and 14% (high).

Conclusions:

• The NETT VO2 max surrogate may offer a more accurate risk stratification for operative mortality, particularly in high-risk patients.
• The findings suggest that the NETT surrogate could support extending indications for curative resection in carefully selected NSCLC patients.
• The study indicates that curative resection for NSCLC does not necessarily shorten long-term (eight-year) longevity and provides estimates for non-cancer-related survival.