Frailty has been recognized as a major risk factor for adverse perioperative and oncological outcomes in patients with genitourinary malignancies. Yet, the evidence supporting such an association in patients with renal cell carcinoma (RCC) is still sparse. Herein we provide an updated comprehensive overview of the impact of frailty on perioperative and oncologic outcomes in patients undergoing surgery or ablation for RCC.
A systematic review of the English-language literature was conducted using the MEDLINE (Via PubMed), Web of Science and the Cochrane Library databases according to the principles highlighted by the EAU Guidelines Office and the PRISMA statement recommendations. The review protocol was registered on PROSPERO (CRD42021242516). The overall quality of evidence was assessed according to GRADE recommendations.
Overall, 18 studies were included in the qualitative analysis. Most of these were retrospective single-centre series including patients undergoing surgery for non-metastatic RCC. The overall quality of evidence was low. A variety of measures were used for frailty assessment, including the Canadian Study of Health and Aging Frailty Index, the five-item frailty index, the Modified Rockwood's Clinical Frailty Scale Score, the Hopkins Frailty score, the Groningen Frailty Index, and the Geriatric nutritional risk index. Sarcopenia was defined based on the Lumbar skeletal muscle mass at cross-sectional imaging, the skeletal muscle index, the total psoas area, or the psoas muscle index. Overall, available studies point to frailty and sarcopenia as potential independent risk factors for worse perioperative and oncological outcomes after surgery or ablation for different RCC stages. Increased patient's frailty was indeed associated with higher risk of perioperative complications, healthcare resources utilization, readmission rates and longer hospitalization periods, as well as potentially lower cancer specific or overall survival.
Frailty has been consistently associated with worse outcomes after surgery for RCC, reinforcing the value of preoperative frailty assessment in carefully selected patients. Given the low quality of the available evidence (especially in the setting of tumour ablation), prospective studies are needed to standardize frailty assessments and to identify patients who are expected to benefit most from preoperative geriatric evaluation, aiming to optimize decision-making and postoperative outcomes in patients with RCC.
Minerva urology and nephrology. 2021 Oct 29 [Epub ahead of print]
Riccardo Campi, Alessandro Berni, Daniele Amparore, Riccardo Bertolo, Umberto Capitanio, Umberto Carbonara, Selcuk Erdem, Alexandre Ingels, Onder Kara, Tobias Klatte, Maximilian Kriegmair, Michele Marchioni, Andrea Minervini, Maria C Mir, Rocco Papalia, Nicola Pavan, Angela Pecoraro, Juan Gomez Rivas, Giulia Rivasi, Eduard Roussel, Andrea Ungar, Sergio Serni, Francesco Esperto, European Society of Residents in Urology (ESRU) and the EAU Young Academic Urologists (YAU) Renal Cancer group
Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy - ., Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy., European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group., Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy., Department of Surgery, University of Cambridge, Cambridge, UK., Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy., Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain., Department of Urology, Campus Bio-Medico University, Rome, Italy., Department of Urology, La Paz University Hospital, Madrid, Spain., Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy.