Clinical implication of a quantitative frailty assessment tool for prognosis in patients with urological cancers

OBJECTIVES: Optimal tools for evaluating frailty among urological cancer patients remain unclear. We aimed to develop a quantitative frailty assessment tool comparing healthy individuals and urological cancer patients, and investigate the clinical implication of quantitative frailty on prognosis in urological cancer patients. RESULTS: Gait speed, hemoglobin, serum albumin, exhaustion, and depression were significantly worse in patients with all types of cancers than in pair-matched controls. Frailty discriminant score (FDS) showed clear separation between controls and urological cancer patients, and significant association with the Fried criteria. Overall survivals were significantly shorter in patients with a higher score (>2.30) than in those with a lower score among nonprostate cancer (bladder, upper tract urothelial carcinoma, and renal cell carcinoma) patients. In prostate cancer patients, overall survivals were significantly shorter in patients with a higher score (>3.30) than in those with a lower score. CONCLUSIONS: FDS was significantly associated with frailty and prognosis in urological cancer patients. This tool for frailty assessment can help patients and physicians make more informed decisions. Further validation study is needed. MATERIALS AND METHODS: Total 605 urological cancer patients presenting to our hospital underwent a prospective frailty assessment. Controls were selected from 2280 community-dwelling subjects. Frailty was assessed via physical status, blood biochemical tests, and mental status. We compared frailty variables between pair-matched controls and urological cancer patients. We developed FDS using frailty variables, and compared with the Fried criteria. The influence of FDS on overall survivals was investigated by Kaplan-Meier analysis and Cox regression analysis.