The gap of frailty value from a community-dwelling population predict oncological outcomes in patients with urological cancers

Abstract

Background: As a quantitative frailty evaluation in cancer patients remains challenging, we investigated whether the gap of frailty values between community-dwelling population and tumor-bearing cancer patients predict prognosis in patients with urological cancer. Method(s): Frailty assessment was performed in 521 cancer patients presenting to our university hospital between August 2013 to March 2016. Frailty was assessed using a validated tool that included 1) physical capabilities, 2) serum biochemical test, and 3) exhaustion. Age and sex adjusted estimated healthy values were determined by linear regression analysis from 1090 community-dwelling healthy subjects (HLT) who underwent frailty assessment. The gap of frailty values: [(estimated - actual)/estimated] was regarded as a frailty gap (%), and the total frailty gap was established by adding each frailty gap. We retrospectively compared total frailty gap between HLT and cancer patients. Total frailty gap < 20% were classified non-frail, 20-100% were mild-frail, 100-170% were moderate-frail, and > 170% were severe-frail. Independent factors that were significantly associated with overall survival in cancer patients were evaluated by multivariate regression analysis. Result(s): Urological cancer included bladder cancer (n = 143), prostate cancer (n = 232), renal cell carcinoma (n = 90), and upper tract urothelial carcinoma (n = 56). Median total frailty gap in HLT and patient with urological cancer were -3% and 97%, respectively. Severe-frail were significantly associated with poor overall survival. Multivariate Cox regression analysis showed metastatic disease, and total frailty gap were selected as independent predictors for poor prognosis in patients with urological cancers. Limitations of the present study were retrospective nature and a need for further validation study. Conclusion(s): Quantitative evaluation of frailty gap independently predicts overall survival in patients with urological cancers. Assessing frailty can help patients and physicians make more informed decisions.