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Using a cross-sectional design, 392 NSCLC patients underwent an incremental cardiopulmonary cycling exercise test to symptom limitation with expired gas analysis to determine VO2peak. Performance status (PS) was assessed using the Eastern Cooperative Oncology Group (ECOG) tool. There was a significant decrease in VO2peak across increasing ECOG categories (P?Casein kinase 2 Cooperative Oncology Group (ECOG) performance score provide a subjective evaluation of a patient's global physical functioning and are found to be strong, independent predictors of mortality in patients with thoracic malignancies.[1] Consequently, these tools are also routinely used to determine the optimal therapeutic approach as well as eligibility for clinical trials. Unfortunately, despite extensive clinical use, PS scoring systems have a number of limitations due to their subjectivity, poor reliability between users and inability to predict prognosis Vismodegib order in patients with ��good�� PS scores (i.e. ECOG 0�C1; Karnofsky PS ��70).[2] Peak oxygen consumption (VO2peak) is the gold standard measurement Trichostatin A supplier of cardiorespiratory fitness and an objective measure of physical performance. It is a robust predictor of mortality.[3, 4] It is most commonly determined in clinical populations using a cardiopulmonary exercise test (CPET) to symptom limitation. A symptom-limited CPET is a safe method for objectively evaluating functional capacity in a broad range of cancer patients including operable[5] and inoperable non-small-cell lung cancer (NSCLC).[6] Presurgical VO2peak is a strong, independent predictor of survival in NSCLC with higher VO2peak associated with a statistically significant 21�C24% reduction in the risk of mortality compared with patients in the lowest VO2peak category.[7] It is not known to what extent VO2peak varies across different ECOG PS groups in lung cancer patients. Furthermore, it is unclear if an objective measure of physical performance may be useful in the clinical management. It could be speculated that patients with a poor, physician-determined PS score could have preserved VO2peak, and if so, these individuals may benefit from treatment reserved for patients with a better PS.