Effect of comorbidity for patients with non-small cell lung cancer on exercise tolerance and cardiopulmonary function: A propensity score matching study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Xinyu ¹ , LI Jin ² , GAO Min ^1,2 , RAN Xin ¹ , TONG Yiman ¹ ,  CHEN Wei ^1,2

1. The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou, 221010, Jiangsu, P. R. China;
2. Department of Rehabilitation Medicine, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, 221009, Jiangsu, P. R. China;

Corresponding?author：

CHEN Wei, Email: chenwei2339@163.com

Keywords：

Non-small cell lung cancer; cardiopulmonary exercise testing; Charlson comorbidity index; preoperative assessment

DOI：

10.7507/1007-4848.202306002

Video：

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Objective To observe the effect of comorbidity for patients with non-small cell lung cancer (NSCLC) on exercise tolerance and cardiopulmonary function. Methods NSCLC patients who underwent cardiopulmonary exercise testing (CPET) before surgery were retrospectively included. According to the Charlson comorbidity index (CCI) score, patients were divided into two groups: a CCI≥3 group and a CCI＜3 group. The patients were matched with a ratio of 1 : 1 by propensity score matching according to the age, body mass index, sex, smoking history, exercise habits, pathological stage and type of surgery. After matching, CPET indexes were compared between the two groups to explore the differences in exercise tolerance and cardiopulmonary function. Results A total of 276 patients were included before matching. After matching, 56 patients were enrolled with 28 patients in each group, including 38 (67.9%) males and 18 (32.1%) females with an average age of (70.7±6.8) years. Compared with the CCI＜3 group, work rate at peak (WR peak), WR peak/predicted value (WR peak%), kilogram oxygen uptake at anaerobic threshold (VO₂/kg AT), VO₂/kg peak, VO₂/kg peak%, peak carbon dioxide output, the minute ventilation to carbon dioxide production slope, O₂ pulse peak and O₂ pulse peak% of CCI≥3 group were statistically different (P＜0.05). Among them, the rate of postoperative pulmonary complication in the CCI≥3 group was higher than that in the CCI＜3 group (60.7% vs. 32.1%, P=0.032). Conclusion In the NSCLC patients, exercise tolerance and cardiopulmonary function decreased in patients with CCI≥3 compared with those with CCI<3. CPET can provide an objective basis for risk assessment in patients with comorbidity scored by CCI for pulmonary resection.

Citation： WANG Xinyu, LI Jin, GAO Min, RAN Xin, TONG Yiman, CHEN Wei. Effect of comorbidity for patients with non-small cell lung cancer on exercise tolerance and cardiopulmonary function: A propensity score matching study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(8): 1115-1120. doi: 10.7507/1007-4848.202306002 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	中華醫學會腫瘤學分會, 中華醫學會雜志社. 中華醫學會肺癌臨床診療指南(2022版). 中華腫瘤雜志, 2022, 44(6): 457-490.Oncology Society of Chinese Medical Association, Chinese Medical Association Publishing House. Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2022 edition). Chin J Oncol, 2022, 44(6): 457-490.
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4.	Zhu D, Ding R, Ma Y, et al. Comorbidity in lung cancer patients and its association with hospital readmission and fatality in China. BMC Cancer, 2021, 21(1): 557.
5.	Albano D, Bilfinger T, Feraca M, et al. A multidisciplinary lung cancer program: does it reduce delay between diagnosis and treatment? Lung, 2020, 198(6): 967-972.
6.	Patella M, Tessitore A, Cianfarani A, et al. Early outcome of anatomical lung resection for non-small cell lung cancer in the elderly. Eur Rev Med Pharmacol Sci, 2021, 25(16): 5129-5136.
7.	Cihanbeylerden M, Yumrukuz M, Kurt B, et al. Effect of pulmonary functions on survival in patients with operable non-small cell lung cancer. J Coll Physicians Surg Pak, 2022, 32(5): 606-612.
8.	中華醫學會心血管病學分會, 中國康復醫學會心肺預防與康復專業委員會, 中華心血管病雜志編輯委員會. 心肺運動試驗臨床規范應用中國專家共識. 中華心血管病雜志, 2022, 50(10): 973-986.Chinese Society of Cardiology, Chinese Medical Association, Professional Committee of Cardiopulmonary Prevention and Rehabilitation of Chinese Rehabilitation Medical Association, Editorial Board of Chinese Journal of Cardiology. Chinese expert consensus on standardized clinical application of cardiopulmonary exercise testing. Chin J Cardiol, 2022, 50(10): 973-986.
9.	Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis, 1987, 40(5): 373-383.
10.	Birim O, Kappetein AP, Bogers AJ. Charlson comorbidity index as a predictor of long-term outcome after surgery for nonsmall cell lung cancer. Eur J Cardiothorac Surg, 2005, 28(5): 759-762.
11.	Ha D, Ries AL, Lippman SM, et al. Effects of curative-intent lung cancer therapy on functional exercise capacity and patient-reported outcomes. Support Care Cancer, 2020, 28(10): 4707-4720.
12.	Levett DZH, Jack S, Swart M, et al. Perioperative cardiopulmonary exercise testing (CPET): consensus clinical guidelines on indications, organization, conduct, and physiological interpretation. Br J Anaesth, 2018, 120(3): 484-500.
13.	Brunelli A, Kim AW, Berger KI, et al. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): e166S-e190S.
14.	Charlson ME, Carrozzino D, Guidi J, et al. Charlson comorbidity index: a critical review of clinimetric properties. Psychother Psychosom, 2022, 91(1): 8-35.
15.	Su XE, Hong WP, He HF, et al. Recent advances in postoperative pulmonary rehabilitation of patients with non-small cell lung cancer (Review). Int J Oncol, 2022, 61(6): 156.
16.	Okada S, Shimomura M, Ishihara S, et al. Clinical significance of postoperative pulmonary complications in elderly patients with lung cancer. Interact Cardiovasc Thorac Surg, 2022, 35(2): ivac153.
17.	Su H, Yan G, Li Z, et al. Analysis of perioperative complications and related risk factors of thoracotomy and complete video-assisted thoracoscopic surgery lobectomy. Am J Transl Res, 2022, 14(4): 2393-2401.
18.	Licker M, Schnyder JM, Frey JG, et al. Impact of aerobic exercise capacity and procedure-related factors in lung cancer surgery. Eur Respir J, 2011, 37(5): 1189-1198.
19.	Lindenmann J, Fink-Neuboeck N, Fediuk M, et al. Preoperative peak oxygen consumption: a predictor of survival in resected lung cancer. Cancers (Basel), 2020, 12(4): 836.
20.	Fang Y, Ma G, Lou N, et al. Preoperative maximal oxygen uptake and exercise-induced changes in pulse oximetry predict early postoperative respiratory complications in lung cancer patients. Scand J Surg, 2014, 103(3): 201-208.
21.	車琳. 心肺運動試驗: 原理及常用指標. 臨床心電學雜志, 2017, 26(4): 243-247.Che L. Cardiopulmonary exercise testing: principles and common parameters. J Clin Electrocardiol, 2017, 26(4): 243-247.
22.	Dun Y, Wu S, Cui N, et al. Prognostic role of minute ventilation/carbon dioxide production slope for perioperative morbidity and long-term survival in resectable patients with nonsmall-cell lung cancer: a prospective study using propensity score overlap weighting. Int J Surg, 2023, 109(9): 2650-2659.
23.	Mazur A, Brat K, Homolka P, et al. Ventilatory efficiency is superior to peak oxygen uptake for prediction of lung resection cardiovascular complications. PLoS One, 2022, 17(8): e0272984.
24.	Campione A, Terzi A, Bobbio M, et al. Oxygen pulse as a predictor of cardiopulmonary events in lung resection. Asian Cardiovasc Thorac Ann, 2010, 18(2): 147-152.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. 中華醫學會腫瘤學分會, 中華醫學會雜志社. 中華醫學會肺癌臨床診療指南(2022版). 中華腫瘤雜志, 2022, 44(6): 457-490.Oncology Society of Chinese Medical Association, Chinese Medical Association Publishing House. Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2022 edition). Chin J Oncol, 2022, 44(6): 457-490.
3. 李思思, 張艷, 李宏潔, 等. 老年癌癥患者共病的研究進展. 中國全科醫學, 2020, 23(7): 880-883, 888.Li SS, Zhang Y, Li HJ, et al. Advances in research on comorbidities in elderly cancer patients. Chin Gen Pract, 2020, 23(7): 880-883, 888.
4. Zhu D, Ding R, Ma Y, et al. Comorbidity in lung cancer patients and its association with hospital readmission and fatality in China. BMC Cancer, 2021, 21(1): 557.
5. Albano D, Bilfinger T, Feraca M, et al. A multidisciplinary lung cancer program: does it reduce delay between diagnosis and treatment? Lung, 2020, 198(6): 967-972.
6. Patella M, Tessitore A, Cianfarani A, et al. Early outcome of anatomical lung resection for non-small cell lung cancer in the elderly. Eur Rev Med Pharmacol Sci, 2021, 25(16): 5129-5136.
7. Cihanbeylerden M, Yumrukuz M, Kurt B, et al. Effect of pulmonary functions on survival in patients with operable non-small cell lung cancer. J Coll Physicians Surg Pak, 2022, 32(5): 606-612.
8. 中華醫學會心血管病學分會, 中國康復醫學會心肺預防與康復專業委員會, 中華心血管病雜志編輯委員會. 心肺運動試驗臨床規范應用中國專家共識. 中華心血管病雜志, 2022, 50(10): 973-986.Chinese Society of Cardiology, Chinese Medical Association, Professional Committee of Cardiopulmonary Prevention and Rehabilitation of Chinese Rehabilitation Medical Association, Editorial Board of Chinese Journal of Cardiology. Chinese expert consensus on standardized clinical application of cardiopulmonary exercise testing. Chin J Cardiol, 2022, 50(10): 973-986.
9. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis, 1987, 40(5): 373-383.
10. Birim O, Kappetein AP, Bogers AJ. Charlson comorbidity index as a predictor of long-term outcome after surgery for nonsmall cell lung cancer. Eur J Cardiothorac Surg, 2005, 28(5): 759-762.
11. Ha D, Ries AL, Lippman SM, et al. Effects of curative-intent lung cancer therapy on functional exercise capacity and patient-reported outcomes. Support Care Cancer, 2020, 28(10): 4707-4720.
12. Levett DZH, Jack S, Swart M, et al. Perioperative cardiopulmonary exercise testing (CPET): consensus clinical guidelines on indications, organization, conduct, and physiological interpretation. Br J Anaesth, 2018, 120(3): 484-500.
13. Brunelli A, Kim AW, Berger KI, et al. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): e166S-e190S.
14. Charlson ME, Carrozzino D, Guidi J, et al. Charlson comorbidity index: a critical review of clinimetric properties. Psychother Psychosom, 2022, 91(1): 8-35.
15. Su XE, Hong WP, He HF, et al. Recent advances in postoperative pulmonary rehabilitation of patients with non-small cell lung cancer (Review). Int J Oncol, 2022, 61(6): 156.
16. Okada S, Shimomura M, Ishihara S, et al. Clinical significance of postoperative pulmonary complications in elderly patients with lung cancer. Interact Cardiovasc Thorac Surg, 2022, 35(2): ivac153.
17. Su H, Yan G, Li Z, et al. Analysis of perioperative complications and related risk factors of thoracotomy and complete video-assisted thoracoscopic surgery lobectomy. Am J Transl Res, 2022, 14(4): 2393-2401.
18. Licker M, Schnyder JM, Frey JG, et al. Impact of aerobic exercise capacity and procedure-related factors in lung cancer surgery. Eur Respir J, 2011, 37(5): 1189-1198.
19. Lindenmann J, Fink-Neuboeck N, Fediuk M, et al. Preoperative peak oxygen consumption: a predictor of survival in resected lung cancer. Cancers (Basel), 2020, 12(4): 836.
20. Fang Y, Ma G, Lou N, et al. Preoperative maximal oxygen uptake and exercise-induced changes in pulse oximetry predict early postoperative respiratory complications in lung cancer patients. Scand J Surg, 2014, 103(3): 201-208.
21. 車琳. 心肺運動試驗: 原理及常用指標. 臨床心電學雜志, 2017, 26(4): 243-247.Che L. Cardiopulmonary exercise testing: principles and common parameters. J Clin Electrocardiol, 2017, 26(4): 243-247.
22. Dun Y, Wu S, Cui N, et al. Prognostic role of minute ventilation/carbon dioxide production slope for perioperative morbidity and long-term survival in resectable patients with nonsmall-cell lung cancer: a prospective study using propensity score overlap weighting. Int J Surg, 2023, 109(9): 2650-2659.
23. Mazur A, Brat K, Homolka P, et al. Ventilatory efficiency is superior to peak oxygen uptake for prediction of lung resection cardiovascular complications. PLoS One, 2022, 17(8): e0272984.
24. Campione A, Terzi A, Bobbio M, et al. Oxygen pulse as a predictor of cardiopulmonary events in lung resection. Asian Cardiovasc Thorac Ann, 2010, 18(2): 147-152.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effect of comorbidity for patients with non-small cell lung cancer on exercise tolerance and cardiopulmonary function: A propensity score matching study

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