Lee J; Department of Thoracic & Cardiovascular Surgery, Pusan
National University Hospital, Korea
Cho HS; Cho JS; Kim YD; Ahn HY; Kim SH

Interdisciplinary Cardiovascular and Thoracic Surgery. 41(7), 2026 Jul 01.

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 centre 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 2-sided alpha
= 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 body mass index (BMI) (23.1 vs 24.4 kg/m2) and
lower forced expiratory volume in 1 second/forced vital capacity
(FEV1/FVC) (69.5% vs 72.7%). In the univariable analysis, age (odds ratio
[OR] 1.07), female sex (OR 0.28 vs male), BMI (OR 0.88 per kg/m2),
FEV1/FVC (OR 0.96 per %), ventilatory equivalent for carbon dioxide
(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% confidence interval [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. Receiver
operating characteristic curves showed poor discrimination: peak oxygen
consumption (VO2peak) area under the curve (AUC), 0.52; anaerobic
threshold (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). Cardiopulmonary exercise testing should complement
clinical and spirometric predictors rather than serve as a stand-alone
gatekeeper.