Invited Commentary

Abstract

A simple test such as stair-climbing to predict prognosis after surgery for early stage lung cancer has great appeal. Most thoracic surgeons are familiar with the use of stair-climbing to determine the fitness of patients for surgery. A simple test (stair-climbing) accompanied by the surgeon's intuition, experience, and a few objective tests has been a valuable tool for surgeons. The simple stair-climb is usually not standardized, lacks objective assessment, and is not scientific. Despite these limitations, few deny its usefulness in patient assessment. Some authors, including the present authors, have tried to address these limitations and improve our understanding of this test relative to tolerating surgery. The authors [1Brunelli A. Pompili C. Berardi R. et al.Performance at preoperative stair-climbing test is associated with prognosis after pulmonary resection in stage I non-small cell lung cancer.Ann Thorac Surg. 2012; 93: 1796-1801Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar] have now taken another step and have used this simple test to predict prognosis after surgery for early stage lung cancer. It would be too easy to dismiss this finding as oversimplified. The observation of a correlation between stair-climbing and prognosis begs further questions. Is it reproducible? What is stair-climbing measuring, or is it just a surrogate for something else? Larger numbers of patients are required to confirm these findings. Can this test predict outcome in advanced disease? Is there a role for monitoring stair-climbing after surgery? Does a more objective test such as the 6-min walk test have a similar prognostic value? Should we focus more on conditioning as part of our therapy of lung cancer? What exactly does stair-climbing measure? Is it, as the authors suggest, changes “in body weight composition or beneficial changes in metabolism and sex hormones, growth factors, adipokines, immune function, or inflammation” or just a coincidence? Hopefully the observations of Brunelli and colleagues [1Brunelli A. Pompili C. Berardi R. et al.Performance at preoperative stair-climbing test is associated with prognosis after pulmonary resection in stage I non-small cell lung cancer.Ann Thorac Surg. 2012; 93: 1796-1801Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar] will encourage investigators to dig deeper to determine whether this simple “test” used for so long by thoracic surgeons has even greater meaning. Performance at Preoperative Stair-Climbing Test Is Associated With Prognosis After Pulmonary Resection in Stage I Non-Small Cell Lung CancerThe Annals of Thoracic SurgeryVol. 93Issue 6PreviewThis investigation evaluated whether the performance at a preoperative symptom-limited stair-climbing test was a prognostic factor in resected pathologic stage I non-small cell lung cancer (NSCLC). Full-Text PDF