Preoperative cardiopulmonary exercise testing and 30-day postoperative complications after lung resection for non–small cell lung cancer: a retrospective cohort study
Jonggeun Lee, Ho Seong Cho, Jeong Su Cho, Yeong Dae Kim, Hyo Yeong Ahn, Sang Hun KimAbstract
Objectives
We examined whether cardiopulmonary exercise testing (CPET) variables predict 30‑day postoperative complications in patients undergoing anatomical resection for non‑small cell lung cancer (NSCLC).
Methods
Consecutive patients who underwent segmentectomy or greater between January 2023 and March 2025 at a single tertiary center were reviewed. All patients underwent CPET within 30 days preoperatively. Data on demographics, comorbidities, pulmonary function, operative factors, and outcomes were collected. Associations were assessed using univariable and multivariable logistic regression; discrimination was evaluated with receiver operating characteristic curve (ROC). Results with two‑sided α = 0.05 were considered significant. Statistical analyses were conducted with R 4.4.2 (stats).
Results
Among 353 patients (mean age 68.4 ± 8.4 years; 58.1% male individuals), 33 (9.4%) experienced complications. Patients were older (71.8 vs 68.0 years) and more often male individuals (81.8% vs 55.6%) than controls; they had lower BMI (23.1 vs 24.4 kg/m2) and lower FEV1/FVC (69.5% vs 72.7%). In the univariable analysis, age (OR 1.07), female sex (OR 0.28 vs male), BMI (OR 0.88 per kg/m2), FEV1/FVC (OR 0.96 per %), VE/VCO2 slope (OR 1.06 per unit), attained stage (OR 0.66 per stage), and operation time (OR 1.58 per hour) were associated with complications. In the multivariable analysis, BMI (OR 0.86, 95% CI 0.75–1.00), FEV1/FVC (OR 0.94, 95% CI 0.90–0.99), and VE/VCO2 slope (OR 1.06, 95% CI 1.00–1.11) remained independent predictors. ROC curves showed poor discrimination: VO2peak AUC, 0.52; AT, 0.59; VE/VCO2 slope, 0.40; and AT time 0.43. Dichotomized cut‑offs were generally non‑informative.
Conclusions
Individual CPET variables had limited discriminative accuracy (AUC < 0.6). CPET should complement clinical and spirometric predictors rather than serve as a stand‑alone gatekeeper.