Association of performance in a stair-climbing test with complications and survival after lung cancer resection in the video-assisted thoracoscopic surgery era: population-based outcomes

Abstract

IntroductionWith a population-based cohort in the VATS era, we aimed to evaluate the value of stair-climbing test (SCT) on short- and long-term outcomes of lung cancer surgery.MethodsAll patients operated due to primary lung cancer in Central Finland and Ostrobothnia from 2013 to June 2020 were included. For the analysis, clinical variables including the outcome of SCT and cause-specific mortality were available. Short- and long-term outcomes were compared between <11 m (n=66) and >12 m SCT (n=217) groups.ResultsPatients with poor performance (<11 m) had more comorbidities and worse lung function but did not differ in tumor stage or treatment. No differences between groups were observed in major morbidity rate (10.6% versus 11.1%, p=0.918) or median hospital stay (5 (IQR 4–7) versus 4 (IQR 3–7), p=0.179). At 1-year, fewer patients were alive and living at home in <11 m group (81.3%) compared to >12 m group (94.2%), p=0.002. No difference was observed in cancer-specific 5-year survival. Non-cancer-specific survival (62.9% versus 83.1%, p<0.001) and overall survival (49.9% versus 70.0%, p<0.001) were worse in <11 m group. After adjustment for confounding factors, SCT remained as a significant predictor for non-cancer-specific (4.28; 95%CI 2.10 to 8.73) and overall mortality (2.38; 95%CI 1.43 to 3.98).ConclusionsWith SCT-based exercise testing, VATS can be performed safely, with similar major morbidity rate in poor performance group (<11 m) compared to >12 m group. Poor exercise performance increases non-cancer-specific mortality. Being a major predictor of survival, exercise capacity should be included in prognostic models.

Effect of adherence to treatment guidelines on overall survival in elderly non-small-cell lung cancer patients

“…Based on 2017 Finnish guidelines, these patients were over-treated, emphasizing the importance of updating guidelines based on new information. Diagnostic procedures and subsequent lung cancer treatment have improved markedly over the last decade [29][30][31]. Mini-invasive video-assisted thoracoscopy (VATS) surgery has reduced perioperative morbidity and mortality rates, allowing a higher percentage of elderly high-risk patients to undergo surgical treatment [30,31].…”

“…Diagnostic procedures and subsequent lung cancer treatment have improved markedly over the last decade [29][30][31]. Mini-invasive video-assisted thoracoscopy (VATS) surgery has reduced perioperative morbidity and mortality rates, allowing a higher percentage of elderly high-risk patients to undergo surgical treatment [30,31]. In addition, advances in SBRT have improved the possibilities of curative treatment with limited toxicity in the most fragile patients [29,32].…”

“…Better guideline adherence to functional assessment prior to curative treatment, such as surgery and radiotherapy, may allow the selection of elderly patients for treatment. The stair climbing test is a simple way to evaluate risk before surgery among elderly NSCLC patients with low FEV1 [31]. The ability of this test to evaluate risk evaluation before other treatment modalities such as chemoradiotherapy has not been determined.…”

Standard Lymphadenectomy for Esophageal and Lung Cancer: Variability in the Number of Examined Lymph Nodes Among Pathologists and Its Survival Implication

“… 1 Physical evaluation was systematic physical performance testing, described in detail earlier. 11 , 12 For survival data, medical records and the Death Registry from Statistics Finland was used. The follow-up ended December 31, 2021.…”