Skip to main content

Multicenter prospective study validating the efficacy of a quantitative assessment tool for frailty in patients with urological cancers

Medical Oncology volume 36, Article number: 88 (2019) Cite this article

Abstract

We prospectively validate the efficacy of the frailty discriminant score (FDS) in individuals with urological cancers, as there has been growing importance in evaluating frailty in clinical practice. A prospective, multicenter study was conducted from February 2017 to April 2019. We enrolled 258 patients with urological cancers and 301 community-dwelling participants who were assessed for frailty. Frailty was assessed using FDS that includes ten items, such as physical, mental, and blood biochemical tests. The primary outcome was the non-inferiority (margin 5%) of FDS in discriminating patients with urological cancers from controls (Ctrl). The sensitivity, specificity, and area under the receiver operating characteristic (AUROC) curve for each predictive test were calculated. The secondary endpoints included the prediction of overall survival between patients with urological cancer who have high and low FDS. FDS was significantly higher in patients with urological cancers than that in the Ctrl. The AUROC curves for individuals with non-prostate cancers (such as bladder cancer, upper tract urothelial carcinoma, and renal cell carcinoma; 0.942) and those with prostate cancer (0.943) were within the non-inferior margin. The overall survival values were significantly lower in patients with higher FDS score than in those with lower FDS score. The study met its primary and secondary endpoints. The FDS is a reliable and valid tool for assessing frailty and prognosis in patients with urological cancers.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Lin HS, Watts JN, Peel NM, Hubbard RE. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr. 2016;16(1):157. https://doi.org/10.1186/s12877-016-0329-8.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Droz J-P, Audisio RA, International Society of Geriatric Oncology. Management of urological cancers in older people. Management of cancer in older people; 1. London: Springer; 2013.

    Book  Google Scholar 

  3. Walston J, Hadley EC, Ferrucci L, Guralnik JM, Newman AB, Studenski SA, et al. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. BMC Geriatr. 2006;54(6):991–1001. https://doi.org/10.1111/j.1532-5415.2006.00745.x.

    Article  Google Scholar 

  4. Byard RW. Frailty syndrome—medicolegal considerations. J Forensic Leg Med. 2015;30:34–8. https://doi.org/10.1016/j.jflm.2014.12.016.

    Article  PubMed  Google Scholar 

  5. Verghese J, Holtzer R, Lipton RB, Wang C. Quantitative gait markers and incident fall risk in older adults. J Gerontol Ser A. 2009;64(8):896–901. https://doi.org/10.1093/gerona/glp033.

    Article  Google Scholar 

  6. Sato T, Hatakeyama S, Okamoto T, Yamamoto H, Hosogoe S, Tobisawa Y, et al. Slow gait speed and rapid renal function decline are risk factors for postoperative delirium after urological surgery. PLoS ONE. 2016;11(5):e0153961. https://doi.org/10.1371/journal.pone.0153961.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  7. Townsend NT, Robinson TN. Surgical risk and comorbidity in older urologic patients. Clin Geriatr Med. 2015;31(4):591–601. https://doi.org/10.1016/j.cger.2015.06.009.

    Article  PubMed  Google Scholar 

  8. Isharwal S, Johanning JM, Dwyer JG, Schimid KK, LaGrange CA. Preoperative frailty predicts postoperative complications and mortality in urology patients. World J Urol. 2017;35(1):21–6. https://doi.org/10.1007/s00345-016-1845-z.

    Article  PubMed  Google Scholar 

  9. Fukushima H, Takemura K, Suzuki H, Koga F. Impact of sarcopenia as a prognostic biomarker of bladder cancer. Int J Mol Sci. 2018;19(10):2999. https://doi.org/10.3390/ijms19102999.

    CAS  Article  PubMed Central  Google Scholar 

  10. Lorenzo-Lopez L, Maseda A, de Labra C, Regueiro-Folgueira L, Rodriguez-Villamil JL, Millan-Calenti JC. Nutritional determinants of frailty in older adults: a systematic review. BMC Geriatr. 2017;17(1):108. https://doi.org/10.1186/s12877-017-0496-2.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Okamoto T, Hatakeyama S, Narita S, Takahashi M, Sakurai T, Kawamura S, et al. Impact of nutritional status on the prognosis of patients with metastatic hormone-naive prostate cancer: a multicenter retrospective cohort study in Japan. World J Urol. 2018. https://doi.org/10.1007/s00345-018-2590-2.

    Article  PubMed  Google Scholar 

  12. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol Ser A. 2001;56(3):M146–56.

    CAS  Article  Google Scholar 

  13. Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K. A standard procedure for creating a frailty index. BMC Geriatr. 2008;8:24. https://doi.org/10.1186/1471-2318-8-24.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Hamaker ME, Jonker JM, de Rooij SE, Vos AG, Smorenburg CH, van Munster BC. Frailty screening methods for predicting outcome of a comprehensive geriatric assessment in elderly patients with cancer: a systematic review. Lancet Oncol. 2012;13(10):e437–44. https://doi.org/10.1016/s1470-2045(12)70259-0.

    Article  PubMed  Google Scholar 

  15. Suskind AM, Jin C, Cooperberg MR, Finlayson E, Boscardin WJ, Sen S, et al. Preoperative frailty is associated with discharge to skilled or assisted living facilities after urologic procedures of varying complexity. Urology. 2016. https://doi.org/10.1016/j.urology.2016.03.073.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Suskind AM, Walter LC, Jin C, Boscardin J, Sen S, Cooperberg MR, et al. Impact of frailty on complications in patients undergoing common urological procedures: a study from the American College of Surgeons National Surgical Quality Improvement database. BJU Int. 2016;117(5):836–42. https://doi.org/10.1111/bju.13399.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Droz JP, Boyle H, Albrand G, Mottet N, Puts M. Role of geriatric oncologists in optimizing care of urological oncology patients. Eur Urol Focus. 2017;3(4–5):385–94. https://doi.org/10.1016/j.euf.2017.10.012.

    Article  PubMed  Google Scholar 

  18. Sathianathen NJ, Jarosek S, Lawrentschuk N, Bolton D, Konety BR. A simplified frailty index to predict outcomes after radical cystectomy. Eur Urol Focus. 2018. https://doi.org/10.1016/j.euf.2017.12.011.

    Article  PubMed  Google Scholar 

  19. Mitsuzuka K, Arai Y. Metabolic changes in patients with prostate cancer during androgen deprivation therapy. Int J Urol. 2018;25(1):45–53. https://doi.org/10.1111/iju.13473.

    Article  PubMed  Google Scholar 

  20. Pearl JA, Patil D, Filson CP, Arya S, Alemozaffar M, Master VA, et al. Patient frailty and discharge disposition following radical cystectomy. Clin Genitourin Cancer. 2017;15(4):e615–21. https://doi.org/10.1016/j.clgc.2016.12.013.

    Article  PubMed  Google Scholar 

  21. Meng X, Press B, Renson A, Wysock JS, Taneja SS, Huang WC, et al. Discriminative ability of commonly used indexes to predict adverse outcomes after radical cystectomy: comparison of demographic data, American Society of Anesthesiologists, modified charlson comorbidity index, and modified frailty index. Clin Genitourin Cancer. 2018;16(4):e843–50. https://doi.org/10.1016/j.clgc.2018.02.009.

    Article  PubMed  Google Scholar 

  22. De Nunzio C, Cicione A, Izquierdo L, Lombardo R, Tema G, Lotrecchiano G, et al. Multicenter analysis of postoperative complications in octogenarians after radical cystectomy and ureterocutaneostomy: the role of the frailty index. Clin Genitourin Cancer. 2019. https://doi.org/10.1016/j.clgc.2019.07.002.

    Article  PubMed  Google Scholar 

  23. Okita K, Hatakeyama S, Fujita N, Konishi S, Yamamoto H, Imai A, et al. Postoperative weight loss followed by radical cystectomy predicts poor prognosis in patients with muscle-invasive bladder cancer. Med Oncol. 2018;36(1):7. https://doi.org/10.1007/s12032-018-1232-2.

    CAS  Article  PubMed  Google Scholar 

  24. Hernandez Torres C, Hsu T. Comprehensive geriatric assessment in the older adult with cancer: a review. Eur Urol Focus. 2017;3(4–5):330–9. https://doi.org/10.1016/j.euf.2017.10.010.

    Article  PubMed  Google Scholar 

  25. Soma O, Hatakeyama S, Okamoto T, Fujita N, Matsumoto T, Tobisawa Y, et al. Clinical implication of a quantitative frailty assessment tool for prognosis in patients with urological cancers. Oncotarget. 2018;9(25):17396–405. https://doi.org/10.18632/oncotarget.24712.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Tanaka Y, Hatakeyama S, Tanaka T, Yamamoto H, Narita T, Hamano I, et al. The influence of serum uric acid on renal function in patients with calcium or uric acid stone: a population-based analysis. PLoS ONE. 2017;12(7):e0182136. https://doi.org/10.1371/journal.pone.0182136.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  27. Kido K, Hatakeyama S, Imai A, Yamamoto H, Tobisawa Y, Yoneyama T, et al. Sleep disturbance has a higher impact on general and mental quality of life reduction than Nocturia: results from the community health survey in Japan. Eur Urol Focus. 2018. https://doi.org/10.1016/j.euf.2018.04.017.

    Article  PubMed  Google Scholar 

  28. Matsumoto T, Hatakeyama S, Imai A, Tanaka T, Hagiwara K, Konishi S, et al. Relationship between oxidative stress and lower urinary tract symptoms: results from a community health survey in Japan. BJU Int. 2019;123(5):877–84. https://doi.org/10.1111/bju.14535.

    CAS  Article  PubMed  Google Scholar 

  29. Narita T, Hatakeyama S, Yoneyama T, Narita S, Yamashita S, Mitsuzuka K, et al. Clinical implications of serum N-glycan profiling as a diagnostic and prognostic biomarker in germ-cell tumors. Cancer Med. 2017;6(4):739–48. https://doi.org/10.1002/cam4.1035.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  30. Oikawa M, Hatakeyama S, Yoneyma T, Tobisawa Y, Narita T, Yamamoto H, et al. Significance of serum N-glycan profiling as a diagnostic biomarker in urothelial carcinoma. Eur Urol Focus. 2018;4(3):405–11. https://doi.org/10.1016/j.euf.2016.11.004.

    Article  PubMed  Google Scholar 

  31. Tanaka T, Hatakeyama S, Yamamoto H, Narita T, Hamano I, Matsumoto T, et al. Clinical relevance of aortic calcification in urolithiasis patients. BMC Urol. 2017;17(1):25. https://doi.org/10.1186/s12894-017-0218-2.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  32. Momota M, Hatakeyama S, Tokui N, Sato T, Yamamoto H, Tobisawa Y, et al. The impact of preoperative severe renal insufficiency on poor postsurgical oncological prognosis in patients with urothelial carcinoma. Eur Urol Focus. 2018. https://doi.org/10.1016/j.euf.2018.03.003.

    Article  PubMed  Google Scholar 

  33. Okita K, Hatakeyama S, Tanaka T, Ikehata Y, Tanaka T, Fujita N, et al. Impact of disagreement between two risk group models on prognosis in patients with metastatic renal-cell carcinoma. Clin Genitourin Cancer. 2019;17(3):e440–6. https://doi.org/10.1016/j.clgc.2019.01.006.

    Article  PubMed  Google Scholar 

  34. Revenig LM, Canter DJ, Taylor MD, Tai C, Sweeney JF, Sarmiento JM, et al. Too frail for surgery? Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes. J Am Coll Surg. 2013;217(4):665–70. https://doi.org/10.1016/j.jamcollsurg.2013.06.012.

    Article  PubMed  Google Scholar 

  35. Amrock LG, Neuman MD, Lin HM, Deiner S. Can routine preoperative data predict adverse outcomes in the elderly? Development and validation of a simple risk model incorporating a chart-derived frailty score. J Am Coll Surg. 2014;219(4):684–94. https://doi.org/10.1016/j.jamcollsurg.2014.04.018.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Clegg A, Rogers L, Young J. Diagnostic test accuracy of simple instruments for identifying frailty in community-dwelling older people: a systematic review. Age Ageing. 2015;44(1):148–52. https://doi.org/10.1093/ageing/afu157.

    Article  PubMed  Google Scholar 

  37. Revenig LM, Canter DJ, Kim S, Liu Y, Sweeney JF, Sarmiento JM, et al. Report of a simplified frailty score predictive of short-term postoperative morbidity and mortality. J Am Coll Surg. 2015;220(5):904–11. https://doi.org/10.1016/j.jamcollsurg.2015.01.053.

    Article  PubMed  Google Scholar 

  38. Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M, et al. Gait speed and survival in older adults. JAMA. 2011;305(1):50–8. https://doi.org/10.1001/jama.2010.1923.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  39. Baitar A, Van Fraeyenhove F, Vandebroek A, De Droogh E, Galdermans D, Mebis J, et al. Evaluation of the Groningen Frailty Indicator and the G8 questionnaire as screening tools for frailty in older patients with cancer. J Geriatr Oncol. 2013;4(1):32–8. https://doi.org/10.1016/j.jgo.2012.08.001.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Yusuke Ishibashi, Yuki Fujita, and Yukie Nishizawa for their invaluable help with the data collection.

Funding

This study was supported by Japan Society for the Promotion of Science (JSPS) KAENHI Grant Nos. of 15H02563, 17K11119, and 18K09157 and a research Grant from the 31st Japanese Society of Geriatric Urology.

Author information

Affiliations

  1. Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan

    Osamu Soma, Shingo Hatakeyama, Teppei Okamoto, Naoki Fujita, Itsuto Hamano, Toshikazu Tanaka, Masaki Momota, Hayato Yamamoto, Atsushi Imai, Takahiro Yoneyama, Yasuhiro Hashimoto & Chikara Ohyama

  2. Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan

    Tohru Yoneyama & Chikara Ohyama

  3. Department of Urology, Mutsu General Hospital, Mutsu, Japan

    Kazuaki Yoshikawa

  4. Department of Urology, Aomori Prefectural Central Hospital, Aomori, Japan

    Toshiaki Kawaguchi

  5. Department of Urology, Oyokyo Kidney Research Institute, Hirosaki, Japan

    Hisao Saitoh & Tadashi Suzuki

  6. Department of Social Medicine, Hirosaki University School of Medicine, Hirosaki, Japan

    Shigeyuki Nakaji

Authors
  1. Osamu Soma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shingo Hatakeyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Teppei Okamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Naoki Fujita
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Itsuto Hamano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Toshikazu Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Masaki Momota
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tohru Yoneyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hayato Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Atsushi Imai
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Takahiro Yoneyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Yasuhiro Hashimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Kazuaki Yoshikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Toshiaki Kawaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Hisao Saitoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Shigeyuki Nakaji
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Tadashi Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Chikara Ohyama
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception and design: SH, CO. Acquisition of data: OS, TO, NF, IH, TT, MM, HY, AI, TY, YH, KY, and TK. Drafting of the manuscript: SH. Critical revision of the manuscript: CO. Statistical analysis: SH, TY, and AI. Funding: SH, CO, and SN. Administrative, technical, and material support: TY and SN.

Corresponding author

Correspondence to Shingo Hatakeyama.

Ethics declarations

Conflicts of interest

All authors have declared no conflicts of interests.

Ethical approval

This multicenter prospective study was performed according to the ethical standards of the Declaration of Helsinki and was approved by the ethics review board of the Hirosaki University School of Medicine (authorization number: 2014-297), Mutsu General Hospital, Aomori Prefectural Central Hospital, and Oyokyo Kidney Research Institute Hirosaki Hospital. All participants provided a written informed consent.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 616 kb)

Supplementary material 2 (DOCX 10 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Soma, O., Hatakeyama, S., Okamoto, T. et al. Multicenter prospective study validating the efficacy of a quantitative assessment tool for frailty in patients with urological cancers. Med Oncol 36, 88 (2019). https://doi.org/10.1007/s12032-019-1313-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12032-019-1313-x

Keywords

  • Frailty
  • Frailty discriminant score
  • Urological cancer
  • Prostate cancer
  • Renal cell carcinoma
  • Urothelial carcinoma