Introduction Lung cancer is the leading cause of cancer-related death worldwide, with 1.2 million deaths each year. 1 Non–small-cell lung cancer (NSCLC) represents approximately 80% of all lung cancers. The poor prognosis is frequently caused by late diagno- sis with an overall 5-year survival of 15%. 2 In fact, only 20%- 30% of patients are eligible for thoracic surgery. The associated mortality and morbidity means that this treatment is restricted to selected patients. 3,4 In 2001, the British Thoracic Society (BTS) established guide- lines for the selection of patients with NSCLC before thoracic surgery. 5 These guidelines advise preoperative selection of patients based on age, performance status (PS), nutritional status, comor- bidities, and pulmonary function testing. 5 A decline in pulmo- nary function tests has been related to an increase in postoperative complications and long-term pulmonary disability. 6,7 The BTS guidelines recommend that pulmonary function tests might be minimal if the preoperative forced expiratory volume in 1 second Laurent Greillier, 1 Pascal Thomas, 2 Anderson Loundou, 3 Christophe Doddoli, 2 Monique Badier, 4 Pascal Auquier, 3 Fabrice Barlési 1,3 Abstract BACKGROUND: Pulmonary function tests are used to select patients with non–small-cell lung cancer (NSCLC) suitable for thoracic surgery. We studied the impact of pulmonary function tests on both quantitative (morbidity, mortality, and overall survival [OS]) and qualitative (quality of life [QOL]) outcomes of patients undergoing thoracic surgery for NSCLC. PATIENTS AND METHODS: Patients with proven or highly probable NSCLC referred for thoracic surgery were eligible. The postoperative outcomes morbidity, 90-day mortality, OS, and QOL based on PGWBI and European Organi- zation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 were studied according to the results of the preoperative pulmonary function tests (forced expiratory volume in 1 second [FEV 1 ]; vital capacity, residual volume, total lung capacity, airways resistance, diffusing capacity corrected for alveolar volume). RESULTS: A total of 110 patients were studied, with 94 patients eligible for analysis. Postoperative mortality and morbidity affected 9.5% and 40% of patients, respectively. These patients presented with significantly lower preoperative values of vital capac- ity, total lung capacity, and diffusing capacity corrected for alveolar volume and higher preoperative values of airways resistance compared with patients with an uncomplicated postoperative course. Better survival was correlated with higher preoperative values of FEV 1 , vital capacity, total lung capacity, and a lower pulmonary distension, especially when expressed as a percentage of predicted value. None of the postoperative QOL scores was influenced by preop- erative pulmonary function tests results. CONCLUSION: Pulmonary function tests allow a relatively good prediction of postoperative quantitative outcomes such as postoperative morbidity and mortality as well as OS after thoracic surgery for NSCLC. However, pulmonary function tests remain poorly correlated to postoperative qualitative outcomes, making QOL a separate and essential assessment of the health status of patients with resected NSCLC. Clinical Lung Cancer, Vol. 8, No. 9, 554-561, 2007 Key words: Forced expiratory volume, Postoperative complications, Quality of life Pulmonary Function Tests as a Predictor of Quantitative and Qualitative Outcomes After Thoracic Surgery for Lung Cancer Submitted: May 1, 2007; Revised: Aug 7, 2007; Accepted: Aug 23, 2007 1 Department of Thoracic Oncology 2 Department of Thoracic Surgery Université de la Méditerranée – Assistance Publique, Hôpitaux de Marseille 3 Université de la Méditerranée – Laboratoire de Santé Publique. Evaluation hospitalière – Mesure de la Santé perçue (EA 3279) 4 Pulmonary Function Laboratory, Université de la Méditerranée – Assistance Publique, Hôpitaux de Marseille France Electronic forwarding or copying is a violation of US and International Copyright Laws. Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by CIG Media Group, LP, ISSN #1525-7304, provided the appropriate fee is paid directly to Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923 USA 978-750-8400. o riginal contribution Address for correspondence: Fabrice Barlési, MD, PhD, Service d’Oncologie Thoracique, Fédération des Maladies Respiratoires, Hôpital Sainte-Marguerite, 270, Bd de Sainte-Marguerite, 13274 Marseille, France Fax: 33-491-74-55-24; e-mail: fabrice.barlesi@mail.ap-hm.fr 554 Clinical Lung Cancer November 2007