The prognostic value of physical functioning on survival in patients with nonsmall cell lung cancer: a systematic review and meta-analysis.

BACKGROUND

Physical functioning has emerged as a potentially valuable prognostic indicator in patients with nonsmall cell lung cancer (NSCLC). This systematic review and meta-analysis aimed to evaluate the prognostic value of objectively measured components of physical functioning on survival outcomes across treatment modalities.

METHODS

Medline, Web of Science and Scopus were searched up to May 2025. Eligible studies included adult patients with NSCLC and assessed at least one objectively measured physical functioning indicator in relation to survival outcomes. Indicators were categorised using the International Classification of Functioning, Disability and Health (ICF) framework into "body functions and structures", "activities" and "participation" and studies were stratified into "surgery" and "nonsurgery" groups. Meta-analyses were conducted when data permitted it.

RESULTS

58 studies (19 436 patients) were included. Most assessments were performed before treatment. In the surgical group, only "activities"-based measures were evaluated. A meta-analysis restricted to this group showed that survivors had substantially higher (functional) exercise capacity, measured through cardiopulmonary exercise testing and field tests (standardised mean difference 0.79). In nonsurgical cohorts, prognostic value extended across all ICF domains, with low handgrip strength (hazard ratio (HR) 1.27), low (functional) exercise capacity (HR 2.11) and physical inactivity (HR 2.86) associated with significantly higher mortality. Notably, no studies in surgical cohorts evaluated "body functions" or "participation". Heterogeneity and varying thresholds were noted across studies.

CONCLUSIONS

Objectively measured physical functioning is a significant prognostic indicator of survival in NSCLC. Routine assessment could enhance risk stratification and guide personalised care. Future research should address longitudinal changes, standardisation of measures and targeted interventions.