Relationship of frailty with treatment modality selection in patients with muscle-invasive bladder cancer (FRART-BC study)
Hiromichi Iwamura, Shingo Hatakeyama, Masaki Momota, Yuta Kojima, Takuma Narita, Teppei Okamoto, Naoki Fujita, Itsuto Hamano, Kyou Togashi, Tomoko Hamaya, Tohru Yoneyama, Hayato Yamamoto, Takahiro Yoneyama, Yasuhiro Hashimoto, Chikara Οhyama
Abstract
BACKGROUND: We aimed to investigate the association of frailty with treatment selection in patients with muscle-invasive bladder cancer (MIBC) as frailty is one of the key factors for modality selection. METHODS: We retrospectively evaluated frailty in 169 patients with MIBC from January 2014 to September 2020 using the Fried phenotype, modified frailty index, and frailty discriminant score. The primary purpose was comparing the frailty between the patients who underwent radical cystectomy (RC) with those who had trimodal therapy (TMT) for bladder preservation. Secondary purposes were comparing the frailty between the groups and the effect of TMT on overall survival adjusting the frailty by multivariate Cox proportional hazards analysis using inverse probability of treatment weighting (IPTW)-adjusted model. RESULTS: . 69 years). Frailty levels and prevalence in the Fried phenotype, modified frailty index, and frailty discriminant score were significantly higher in the TMT group than those in the RC group. Logistic regression analysis showed that frailty was significantly associated with the TMT selection. Overall survival was significantly shorter in the TMT group by the IPTW-adjusted Cox regression analysis (hazard ratio 2.48, P=0.043). CONCLUSIONS: Frailty was significantly different between the RC and TMT in patients with MIBC and might be one of the key factors for treatment selection.