Background and Aims

The incidence of frailty is increasing as the population ages, which has important clinical implications given the associations between frailty and poor outcomes in the bladder cancer population. Due to a multi-organ system decline and decreased physiologic reserve, frail patients are vulnerable to stressors of disease and have poorer mortality and morbidity rates than their nonfrail peers. The association between frailty and poor outcomes has been documented across multiple populations, including radical cystectomy, creating a need for frailty assessments to be used preoperatively for risk stratification. We aim to provide a review of the common frailty assessments and their relevance to radical cystectomy patients.

Findings

A variety of assessments for frailty exist, from short screening items to comprehensive geriatric assessments. The syndrome spans multiple organ systems, as do the potential diagnostic instruments. Some instruments are less practical for use in clinical practice by urologists, such as the Canadian Study of Health and Aging Frailty Index and Comprehensive Geriatric Assessment. The tool most studied in radical cystectomy is the modified Frailty Index, associated with high grade complications and 30-days mortality. Frailty often coexists with malnutrition and sarcopenia, stressing the importance of screening for and addressing these syndromes to improve patient's perioperative outcomes.

Conclusions

There is no universally agreed upon frailty assessment, but the most studied in radical cystectomy is the modified Frailty Index, providing valuable data with which to counsel patients preoperatively. Alterations in immune phenotypes provide potential future diagnostic biomarkers for frailty.

中文翻译：

---

膀胱癌虚弱的评估。

背景和目标

脆弱的发生率随着人群的年龄增长而增加，考虑到脆弱与膀胱癌人群预后不良之间的关联，这具有重要的临床意义。由于多器官系统的下降和生理储备的减少，体弱的患者比不体弱的患者更容易受到疾病的压力，死亡率和发病率也较差。在包括根治性膀胱切除术在内的多个人群中，已经证明了脆弱与不良结局之间的关联，这需要对脆弱性评估进行术前评估以进行风险分层。我们旨在对常见的脆弱评估及其与根治性膀胱切除术患者的相关性进行回顾。

发现

从脆弱性筛查项目到全面的老年医学评估，都存在各种脆弱性评估。该综合征跨越多个器官系统，潜在的诊断工具也是如此。有些仪器在泌尿科医师的临床实践中不太实用，例如《加拿大健康与衰老脆弱指数研究》和《老年医学综合评估》。根治性膀胱切除术研究最多的工具是改良的脆弱指数，与高度并发症和30天死亡率相关。体弱常常与营养不良和肌肉减少症并存，强调筛查和解决这些综合征以改善患者围手术期结局的重要性。

结论

尚无关于脆弱性评估的普遍共识，但在根治性膀胱切除术中研究最多的是改良的脆弱性指数，该指数提供了有价值的数据，可在术前为患者提供咨询。免疫表型的改变为脆弱提供了潜在的未来诊断生物标志物。