Is Cardiopulmonary Exercise Testing Predictive of Survival Outcomes in Patients Undergoing Surgery for Ovarian...

Preoperative cardiopulmonary exercise testing (CPET) provides an objective measure of a patient's functional capacity under stress. However, the association between CPET and long-term outcomes for women with ovarian cancer have not been assessed. The aim was to determine whether cardiorespiratory fitness, as measured by CPET parameters-peak oxygen uptake (VO₂ peak), ventilatory efficiency at anaerobic threshold (VE/VCO₂ at AT), and anaerobic threshold (AT)-could predict overall survival (OS) and recurrence -free survival (RFS) in patients with all stages of ovarian cancer.

This was a retrospective cohort study of patients who underwent CPET prior to surgery for suspected or confirmed ovarian cancer during 2019-2023 at the Northern Gynaecological Oncology Centre, United Kingdom. CPET outcomes were risk-stratified, with thresholds of AT ≥ 10 mL/min, VO₂ peak ≥ 15 mL/kg/min, and VE/VCO₂ at AT ≤ 34 indicating lower risk. Primary outcomes included OS and RFS.

A total of 303 patients were included, of whom 56 (18.5%) had a staging laparotomy, 130 (42.9%) underwent primary cytoreductive surgery, and 117 (38.6%) underwent interval cytoreductive surgery. Survival analysis showed that VO₂ peak ≥ 15 was significantly associated with improved OS of the whole population (p = 0.032). VE/VCO₂ at AT ≤ 34 was associated with improved survival in patients with advanced stage disease (p = 0.025) after ovarian cancer surgery. There was no association between CPET parameters and RFS.

We found that peak VO₂ ≥ 15 was associated with improvement of overall survival in patients with all stages of ovarian cancer. In addition, VE/VCO₂ at AT ≤ 34 was associated with overall survival in patients with advanced-stage disease.