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 ( $\dot{V}{O}_{2\text{peak}}$ ) 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 $\dot{V}{O}_{2\text{peak}}$ 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 $\dot{V}{O}_{2\text{peak}}$ 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 $\dot{V}{O}_{2\text{peak}}$ ≥ 15 mL/kg/minute.

Results: The following equation was obtained: $\dot{V}{O}_{2\text{peak}}$ 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 $\dot{V}{O}_{2\text{peak}}$ 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 $\dot{V}{O}_{2\text{peak}}$ ≥ 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 $\dot{V}{O}_{2\text{peak}}$ from 3CRT performance was too great to recommend that 3CRT should replace CPX as the sole measurement of $\dot{V}{O}_{2\text{peak}}$ . 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 ( $\dot{V}{O}_{2\text{peak}}$ ) 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 $\dot{V}{O}_{2\text{peak}}$ ≥ 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.

Keywords: Cardiopulmonary exercise testing; field test; lung surgery; non-small cell lung cancer; preoperative assessment.