Presentation Authors: Shingo Hatakeyama*, Atsushi Imai, Hayato Yamamoto, Teppei Matsumoto, Osamu Soma, Takahiro Yoneyama, Yasuhiro Hashimoto, Takuya Koie, Chikara Ohyama, Hirosaki, Japan
Introduction: Although measuring frailty is important to estimate risks and to aid shared decision making, the impact of frailty on surgical indication in muscle-invasive bladder cancer (MIBC) remain unclear. We aimed to investigate the impact of frailty on treatment modality selection in patients with MIBC.
Methods: Between October. 2013 and June 2017, we prospectively underwent frailty evaluation in 102 patients with localized or locally advanced MIBC (T2-4NxM0). Frailty evaluation included modified frailty index (mFI), Fried phenotype criteria, and frailty discriminant score (FDS). We compared frailty between the patients who underwent radical cystectomy (RC) and bladder preservation therapy (non-RC). Agreement was tested using Cohenâ€™s k coefficient. The Kaplan-Meier method was used to compare overall survival (OS). Optimal cutoff values of frailty between the RC and non-RC groups was defined by receiver operating characteristic curve.
Results: Of 102, 60 and 42 patients were classified to RC and non-RC group, respectively. The median age in the non-RC group was significantly higher than that in the RC group (81 vs. 68 years). Frailty was significant in the non-RC group than that of RC group in mFI (0.09 vs. 0.18), Fried criteria (0.50 vs. 2.00), and FDS (1.96 vs. 3.52). Cohenâ€™s k coefficients were 0.403 (0.4-0.6; moderate) between Fried criteria and mFI, 0.443 (0.4-0.6; moderate) between Fried criteria and FDS, and 0.347 (0.2-0.4; fair) between mFI and FDS. Higher frailty values (Fried criteria â‰¥2, or FDS â‰¥2.50) were significantly associated with poor OS than those of lower values. However, no association was observed between the mFI < 0.18 and â‰¥0.18.
Conclusions: Frailty was significantly associated with surgical indication in patients with MIBC. Fried criteria and FDS may predict poor OS in patents with MIBC. Measuring frailty is important to estimate risks and to aid shared decision making.