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

Abstract

Background: Peak oxygen uptake ((Formula presented.)) 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 (Formula presented.) 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 (Formula presented.) 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 (Formula presented.) ≥ 15 mL/kg/minute. Results: The following equation was obtained: (Formula presented.) 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 (Formula presented.) 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 (Formula presented.) ≥ 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 (Formula presented.) from 3CRT performance was too great to recommend that 3CRT should replace CPX as the sole measurement of (Formula presented.). 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 ((Formula presented.)) 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 (Formula presented.) ≥ 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.