Evaluation of the 3-minute chair rise test as part of preoperative evaluation for patients with non-small cell lung cancer

Lung Cancer

Azzi M, et al. Thorac Cancer 2020.


BACKGROUND: Peak oxygen uptake ( V ˙ O 2 peak ) measured by a cardiopulmonary exercise test (CPX) is the gold-standard for predicting surgical risk in patients with non-small cell lung cancer (NSCLC). The 3-minute chair rise test (3CRT) is a simple test requiring minimal resources. This study aimed to determine the ability of 3CRT to predict V ˙ O 2 peak in patients with NSCLC.

METHODS: Retrospective data from CPX and 3CRT carried out in 36 patients with NSCLC between March 2018 and February 2019 were included. A multivariate analysis was undertaken to derive a predictive V ˙ O 2 peak equation based on performance on the 3CRT. In addition, sensitivity-specificity analysis was carried out to estimate a threshold 3CRT value for the prediction of V ˙ O 2 peak ≥ 15 mL/kg/minute.

RESULTS: The following equation was obtained: V ˙ O 2 peak predicted = (0.04765 × FEV1) - (0.207 59 × BMI) - (0.115 89 × age) + (0.386 09 × vertical distance) + 16.628 69; r2 = 0.75, P < 0.01. The bias between the V ˙ O 2 peak values predicted and measured during CPX was 0.0 ± 1.7 mL/kg/minute (95% limits of agreement [-3.5 to 3.5]). A performance ≥49 chair rises predicted V ˙ O 2 peak ≥ 15 mL/kg/minute with a sensitivity of 0.75 and a specificity of 0.81.

CONCLUSIONS: The level of error in the prediction of V ˙ O 2 peak from 3CRT performance was too great to recommend that 3CRT should replace CPX as the sole measurement of V ˙ O 2 peak . Nevertheless, the 3CRT could help to identify those patients that require CPX prior to lung resection surgery for NSCLC, larger prospective study is needed to confirm this hypothesis.

KEY POINTS: SIGNIFICANT FINDINGS OF THE STUDY: Cardiopulmonary exercise tests can stratify the surgical risk. Prediction of the peak oxygen uptake ( V ˙ O 2 peak ) value from the 3CRT yields an unacceptable level of error. However, a performance of 49 chair rises or more during the 3CRT could indicate a V ˙ O 2 peak ≥ 15 mL / kg / minute.

WHAT THIS STUDY ADDS: The 3CRT is a useful screening tool to determine the necessity for a comprehensive cardiopulmonary exercise test, whose access is limited in clinical practice. It could also allow early screening of patients requiring specific prehabilitation programs.