# Is Cardiopulmonary Exercise Testing Predictive of Survival Outcomes in Patients Undergoing Surgery for Ovarian Cancer?

## TL;DR

This study shows that better cardiovascular fitness, measured by CPET, is linked to longer survival in ovarian cancer patients after surgery.

## Contribution

The study is the first to evaluate CPET's predictive value for survival outcomes in ovarian cancer patients.

## Key findings

- Higher VO2 Peak (≥15) is associated with longer overall survival in ovarian cancer patients.
- Lower VE/VCO2 at AT (≤34) is linked to improved survival in patients with advanced-stage ovarian cancer.
- No association was found between CPET and disease recurrence.

## Abstract

Treatment of ovarian cancer involves a combination of extensive surgery and chemotherapy. Due to the impact of ovarian cancer on a patient’s physical wellbeing and nutritional status, this population is usually characterised by poor physical fitness. Preoperative cardiopulmonary exercise testing (CPET) is used to assess patients’ ability to withstand the stress of an extensive surgery. In addition, CPET has also been recognised as a tool to predict survival outcomes after various cancer surgeries, but this has not yet been evaluated for patients with ovarian cancer. The aim of our study was to evaluate the value of CPET in predicting overall and recurrence-free survival in patients undergoing ovarian cancer surgery. We found that patients with a higher VO2 Peak ≥ 15 and a lower VE/VCO2 at AT ≤ 34 have longer overall survival. We did not find any relation between CPET and disease recurrence. We believe that improving cardiovascular fitness may play a role in improving survival in ovarian cancer patients.

Preoperative cardiopulmonary exercise testing (CPET) provides an objective measure of a patient’s functional capacity under stress. However, the association between CPET and long-term outcomes for women with ovarian cancer have not been assessed. The aim was to determine whether cardiorespiratory fitness, as measured by CPET parameters—peak oxygen uptake (VO2 peak), ventilatory efficiency at anaerobic threshold (VE/VCO2 at AT), and anaerobic threshold (AT)—could predict overall survival (OS) and recurrence -free survival (RFS) in patients with all stages of ovarian cancer. Methods: This was a retrospective cohort study of patients who underwent CPET prior to surgery for suspected or confirmed ovarian cancer during 2019–2023 at the Northern Gynaecological Oncology Centre, United Kingdom. CPET outcomes were risk-stratified, with thresholds of AT ≥ 10 mL/min, VO2 peak ≥ 15 mL/kg/min, and VE/VCO2 at AT ≤ 34 indicating lower risk. Primary outcomes included OS and RFS. Results: A total of 303 patients were included, of whom 56 (18.5%) had a staging laparotomy, 130 (42.9%) underwent primary cytoreductive surgery, and 117 (38.6%) underwent interval cytoreductive surgery. Survival analysis showed that VO2 peak ≥ 15 was significantly associated with improved OS of the whole population (p = 0.032). VE/VCO2 at AT ≤ 34 was associated with improved survival in patients with advanced stage disease (p = 0.025) after ovarian cancer surgery. There was no association between CPET parameters and RFS. Conclusions: We found that peak VO2 ≥ 15 was associated with improvement of overall survival in patients with all stages of ovarian cancer. In addition, VE/VCO2 at AT ≤ 34 was associated with overall survival in patients with advanced-stage disease.