Preoperative physical activity patterns and postoperative outcomes in early-stage non-small cell lung cancer: a retrospective observational cohort study.

BACKGROUND: Physical activity is a potentially influential lifestyle factor affecting recovery and survival in early-stage non-small cell lung cancer (NSCLC) patients. This study examined associations between preoperative exercise and postoperative complications, disease-free survival (DFS), and lung cancer-specific survival (LCSS) in Initiatives for Early Lung Cancer Research on Treatment (IELCART) patients. METHODS: We analyzed 252 patients with clinical stage IA NSCLC (≤30 mm) enrolled in the IELCART study at the Mount Sinai Health System (2016-2024) who underwent surgical resection and completed preoperative Godin Leisure-Time Exercise Questionnaires. Patients were categorized as active (score ≥14) or sedentary (<14) based on preoperative exercise level. Outcomes included postoperative complications, DFS, and LCSS. Multivariable logistic and Cox regression models were adjusted for demographic, clinical, and tumor characteristics. RESULTS: Of 252 patients (median age 72 years, 62% female), 126 were active and 126 sedentary. Groups were similar in baseline characteristics except active patients were less likely to have >2 comorbidities (35% vs. 47%, P=0.03) and more likely to have part-solid nodules (27% vs. 12%, P<0.001). Postoperative complications occurred in 29% overall; active patients had a numerically higher complication rate than sedentary patients (32% vs. 25%, P=0.30), though this difference was not statistically significant. Median follow-up was 32 months. No statistically significant differences were observed in DFS [adjusted hazard ratio (HR) =0.64, 95% confidence interval (CI): 0.26-1.59, P=0.34] or LCSS (adjusted HR =0.68, 95% CI: 0.19-2.46, P=0.57) between groups. Older age, male sex, and Black or Hispanic ethnicity were associated with higher complication risk. CONCLUSIONS: In this cohort of clinical stage IA NSCLC patients, we did not observe evidence that preoperative physical activity was significantly associated with postoperative complications or survival outcomes after adjustment. Active patients had numerically higher complication rates, while survival trends were non-significantly favorable. Studies with objective exercise measurements and larger sample sizes are needed to clarify these associations and guide prehabilitation strategies in early-stage NSCLC.