Prognostic Potential of Modified Five-Item Frailty Index in Radical Cystectomy for Bladder Cancer

By GU Oncology Now Editors - Last Updated: January 19, 2022

Researchers evaluated the association between preoperative scores on a recently developed modified 5-item frailty index and patient prognoses after undergoing radical cystectomy for bladder cancer. Their study, published in Clinical Genitourinary Cancer, presented evidence that high preoperative scores on the modified 5-item frailty index could be a significant independent predictor of a poor prognosis after surgery in patients with bladder cancer.

The study’s lead author, Shimpei Yamashita, did note that high index scores were independently associated with poor overall survival (p = 0.01), but not with poor cancer-specific survival outcomes (p = 0.15).

The multicenter study retrospectively calculated modified 5-item frailty index scores of 238 patients who underwent radical cystectomy for bladder cancer. The patients were then categorized into high (≥ 2) or low (≤ 1) frailty index scores groups for comparison. Cox proportional regression was used to estimate the prognostic strength of the index, as well as to differentiate overall survival and cancer-specific survival outcomes.

The study included a total of 238 patients, of which 53 were categorized into the high index score group and 185 were placed in the low score group. Seventy patients died of bladder cancer (29%) and 21 patients died of other causes (9%). According to the authors, patients with high frailty index scores had a significantly lower rate of overall survival than those with low frailty index scores (p <0.01). Conversely, there was no significant difference in cancer-specific survival rates between the two groups (p = 0.07).

Ultimately, Yamashita and colleagues concluded that the modified 5-item frailty index score could be a practical and effective prognostic marker for evaluating patient prognosis after radical cystectomy, though further validation of the tool is needed.