Medical Oncology

, 36:88 | Cite as

Multicenter prospective study validating the efficacy of a quantitative assessment tool for frailty in patients with urological cancers

  • Osamu Soma
  • Shingo HatakeyamaEmail author
  • Teppei Okamoto
  • Naoki Fujita
  • Itsuto Hamano
  • Toshikazu Tanaka
  • Masaki Momota
  • Tohru Yoneyama
  • Hayato Yamamoto
  • Atsushi Imai
  • Takahiro Yoneyama
  • Yasuhiro Hashimoto
  • Kazuaki Yoshikawa
  • Toshiaki Kawaguchi
  • Hisao Saitoh
  • Shigeyuki Nakaji
  • Tadashi Suzuki
  • Chikara Ohyama
Original Paper


We prospectively validate the efficacy of the frailty discriminant score (FDS) in individuals with urological cancers, as there has been growing importance in evaluating frailty in clinical practice. A prospective, multicenter study was conducted from February 2017 to April 2019. We enrolled 258 patients with urological cancers and 301 community-dwelling participants who were assessed for frailty. Frailty was assessed using FDS that includes ten items, such as physical, mental, and blood biochemical tests. The primary outcome was the non-inferiority (margin 5%) of FDS in discriminating patients with urological cancers from controls (Ctrl). The sensitivity, specificity, and area under the receiver operating characteristic (AUROC) curve for each predictive test were calculated. The secondary endpoints included the prediction of overall survival between patients with urological cancer who have high and low FDS. FDS was significantly higher in patients with urological cancers than that in the Ctrl. The AUROC curves for individuals with non-prostate cancers (such as bladder cancer, upper tract urothelial carcinoma, and renal cell carcinoma; 0.942) and those with prostate cancer (0.943) were within the non-inferior margin. The overall survival values were significantly lower in patients with higher FDS score than in those with lower FDS score. The study met its primary and secondary endpoints. The FDS is a reliable and valid tool for assessing frailty and prognosis in patients with urological cancers.


Frailty Frailty discriminant score Urological cancer Prostate cancer Renal cell carcinoma Urothelial carcinoma 



We thank Yusuke Ishibashi, Yuki Fujita, and Yukie Nishizawa for their invaluable help with the data collection.

Author contributions

Conception and design: SH, CO. Acquisition of data: OS, TO, NF, IH, TT, MM, HY, AI, TY, YH, KY, and TK. Drafting of the manuscript: SH. Critical revision of the manuscript: CO. Statistical analysis: SH, TY, and AI. Funding: SH, CO, and SN. Administrative, technical, and material support: TY and SN.


This study was supported by Japan Society for the Promotion of Science (JSPS) KAENHI Grant Nos. of 15H02563, 17K11119, and 18K09157 and a research Grant from the 31st Japanese Society of Geriatric Urology.

Compliance with ethical standards

Conflicts of interest

All authors have declared no conflicts of interests.

Ethical approval

This multicenter prospective study was performed according to the ethical standards of the Declaration of Helsinki and was approved by the ethics review board of the Hirosaki University School of Medicine (authorization number: 2014-297), Mutsu General Hospital, Aomori Prefectural Central Hospital, and Oyokyo Kidney Research Institute Hirosaki Hospital. All participants provided a written informed consent.

Supplementary material

12032_2019_1313_MOESM1_ESM.pptx (617 kb)
Supplementary material 1 (PPTX 616 kb)
12032_2019_1313_MOESM2_ESM.docx (11 kb)
Supplementary material 2 (DOCX 10 kb)


  1. 1.
    Lin HS, Watts JN, Peel NM, Hubbard RE. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr. 2016;16(1):157. Scholar
  2. 2.
    Droz J-P, Audisio RA, International Society of Geriatric Oncology. Management of urological cancers in older people. Management of cancer in older people; 1. London: Springer; 2013.CrossRefGoogle Scholar
  3. 3.
    Walston J, Hadley EC, Ferrucci L, Guralnik JM, Newman AB, Studenski SA, et al. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. BMC Geriatr. 2006;54(6):991–1001. Scholar
  4. 4.
    Byard RW. Frailty syndrome—medicolegal considerations. J Forensic Leg Med. 2015;30:34–8. Scholar
  5. 5.
    Verghese J, Holtzer R, Lipton RB, Wang C. Quantitative gait markers and incident fall risk in older adults. J Gerontol Ser A. 2009;64(8):896–901. Scholar
  6. 6.
    Sato T, Hatakeyama S, Okamoto T, Yamamoto H, Hosogoe S, Tobisawa Y, et al. Slow gait speed and rapid renal function decline are risk factors for postoperative delirium after urological surgery. PLoS ONE. 2016;11(5):e0153961. Scholar
  7. 7.
    Townsend NT, Robinson TN. Surgical risk and comorbidity in older urologic patients. Clin Geriatr Med. 2015;31(4):591–601. Scholar
  8. 8.
    Isharwal S, Johanning JM, Dwyer JG, Schimid KK, LaGrange CA. Preoperative frailty predicts postoperative complications and mortality in urology patients. World J Urol. 2017;35(1):21–6. Scholar
  9. 9.
    Fukushima H, Takemura K, Suzuki H, Koga F. Impact of sarcopenia as a prognostic biomarker of bladder cancer. Int J Mol Sci. 2018;19(10):2999. Scholar
  10. 10.
    Lorenzo-Lopez L, Maseda A, de Labra C, Regueiro-Folgueira L, Rodriguez-Villamil JL, Millan-Calenti JC. Nutritional determinants of frailty in older adults: a systematic review. BMC Geriatr. 2017;17(1):108. Scholar
  11. 11.
    Okamoto T, Hatakeyama S, Narita S, Takahashi M, Sakurai T, Kawamura S, et al. Impact of nutritional status on the prognosis of patients with metastatic hormone-naive prostate cancer: a multicenter retrospective cohort study in Japan. World J Urol. 2018. Scholar
  12. 12.
    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol Ser A. 2001;56(3):M146–56.CrossRefGoogle Scholar
  13. 13.
    Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K. A standard procedure for creating a frailty index. BMC Geriatr. 2008;8:24. Scholar
  14. 14.
    Hamaker ME, Jonker JM, de Rooij SE, Vos AG, Smorenburg CH, van Munster BC. Frailty screening methods for predicting outcome of a comprehensive geriatric assessment in elderly patients with cancer: a systematic review. Lancet Oncol. 2012;13(10):e437–44. Scholar
  15. 15.
    Suskind AM, Jin C, Cooperberg MR, Finlayson E, Boscardin WJ, Sen S, et al. Preoperative frailty is associated with discharge to skilled or assisted living facilities after urologic procedures of varying complexity. Urology. 2016. Scholar
  16. 16.
    Suskind AM, Walter LC, Jin C, Boscardin J, Sen S, Cooperberg MR, et al. Impact of frailty on complications in patients undergoing common urological procedures: a study from the American College of Surgeons National Surgical Quality Improvement database. BJU Int. 2016;117(5):836–42. Scholar
  17. 17.
    Droz JP, Boyle H, Albrand G, Mottet N, Puts M. Role of geriatric oncologists in optimizing care of urological oncology patients. Eur Urol Focus. 2017;3(4–5):385–94. Scholar
  18. 18.
    Sathianathen NJ, Jarosek S, Lawrentschuk N, Bolton D, Konety BR. A simplified frailty index to predict outcomes after radical cystectomy. Eur Urol Focus. 2018. Scholar
  19. 19.
    Mitsuzuka K, Arai Y. Metabolic changes in patients with prostate cancer during androgen deprivation therapy. Int J Urol. 2018;25(1):45–53. Scholar
  20. 20.
    Pearl JA, Patil D, Filson CP, Arya S, Alemozaffar M, Master VA, et al. Patient frailty and discharge disposition following radical cystectomy. Clin Genitourin Cancer. 2017;15(4):e615–21. Scholar
  21. 21.
    Meng X, Press B, Renson A, Wysock JS, Taneja SS, Huang WC, et al. Discriminative ability of commonly used indexes to predict adverse outcomes after radical cystectomy: comparison of demographic data, American Society of Anesthesiologists, modified charlson comorbidity index, and modified frailty index. Clin Genitourin Cancer. 2018;16(4):e843–50. Scholar
  22. 22.
    De Nunzio C, Cicione A, Izquierdo L, Lombardo R, Tema G, Lotrecchiano G, et al. Multicenter analysis of postoperative complications in octogenarians after radical cystectomy and ureterocutaneostomy: the role of the frailty index. Clin Genitourin Cancer. 2019. Scholar
  23. 23.
    Okita K, Hatakeyama S, Fujita N, Konishi S, Yamamoto H, Imai A, et al. Postoperative weight loss followed by radical cystectomy predicts poor prognosis in patients with muscle-invasive bladder cancer. Med Oncol. 2018;36(1):7. Scholar
  24. 24.
    Hernandez Torres C, Hsu T. Comprehensive geriatric assessment in the older adult with cancer: a review. Eur Urol Focus. 2017;3(4–5):330–9. Scholar
  25. 25.
    Soma O, Hatakeyama S, Okamoto T, Fujita N, Matsumoto T, Tobisawa Y, et al. Clinical implication of a quantitative frailty assessment tool for prognosis in patients with urological cancers. Oncotarget. 2018;9(25):17396–405. Scholar
  26. 26.
    Tanaka Y, Hatakeyama S, Tanaka T, Yamamoto H, Narita T, Hamano I, et al. The influence of serum uric acid on renal function in patients with calcium or uric acid stone: a population-based analysis. PLoS ONE. 2017;12(7):e0182136. Scholar
  27. 27.
    Kido K, Hatakeyama S, Imai A, Yamamoto H, Tobisawa Y, Yoneyama T, et al. Sleep disturbance has a higher impact on general and mental quality of life reduction than Nocturia: results from the community health survey in Japan. Eur Urol Focus. 2018. Scholar
  28. 28.
    Matsumoto T, Hatakeyama S, Imai A, Tanaka T, Hagiwara K, Konishi S, et al. Relationship between oxidative stress and lower urinary tract symptoms: results from a community health survey in Japan. BJU Int. 2019;123(5):877–84. Scholar
  29. 29.
    Narita T, Hatakeyama S, Yoneyama T, Narita S, Yamashita S, Mitsuzuka K, et al. Clinical implications of serum N-glycan profiling as a diagnostic and prognostic biomarker in germ-cell tumors. Cancer Med. 2017;6(4):739–48. Scholar
  30. 30.
    Oikawa M, Hatakeyama S, Yoneyma T, Tobisawa Y, Narita T, Yamamoto H, et al. Significance of serum N-glycan profiling as a diagnostic biomarker in urothelial carcinoma. Eur Urol Focus. 2018;4(3):405–11. Scholar
  31. 31.
    Tanaka T, Hatakeyama S, Yamamoto H, Narita T, Hamano I, Matsumoto T, et al. Clinical relevance of aortic calcification in urolithiasis patients. BMC Urol. 2017;17(1):25. Scholar
  32. 32.
    Momota M, Hatakeyama S, Tokui N, Sato T, Yamamoto H, Tobisawa Y, et al. The impact of preoperative severe renal insufficiency on poor postsurgical oncological prognosis in patients with urothelial carcinoma. Eur Urol Focus. 2018. Scholar
  33. 33.
    Okita K, Hatakeyama S, Tanaka T, Ikehata Y, Tanaka T, Fujita N, et al. Impact of disagreement between two risk group models on prognosis in patients with metastatic renal-cell carcinoma. Clin Genitourin Cancer. 2019;17(3):e440–6. Scholar
  34. 34.
    Revenig LM, Canter DJ, Taylor MD, Tai C, Sweeney JF, Sarmiento JM, et al. Too frail for surgery? Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes. J Am Coll Surg. 2013;217(4):665–70. Scholar
  35. 35.
    Amrock LG, Neuman MD, Lin HM, Deiner S. Can routine preoperative data predict adverse outcomes in the elderly? Development and validation of a simple risk model incorporating a chart-derived frailty score. J Am Coll Surg. 2014;219(4):684–94. Scholar
  36. 36.
    Clegg A, Rogers L, Young J. Diagnostic test accuracy of simple instruments for identifying frailty in community-dwelling older people: a systematic review. Age Ageing. 2015;44(1):148–52. Scholar
  37. 37.
    Revenig LM, Canter DJ, Kim S, Liu Y, Sweeney JF, Sarmiento JM, et al. Report of a simplified frailty score predictive of short-term postoperative morbidity and mortality. J Am Coll Surg. 2015;220(5):904–11. Scholar
  38. 38.
    Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M, et al. Gait speed and survival in older adults. JAMA. 2011;305(1):50–8. Scholar
  39. 39.
    Baitar A, Van Fraeyenhove F, Vandebroek A, De Droogh E, Galdermans D, Mebis J, et al. Evaluation of the Groningen Frailty Indicator and the G8 questionnaire as screening tools for frailty in older patients with cancer. J Geriatr Oncol. 2013;4(1):32–8. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Osamu Soma
    • 1
  • Shingo Hatakeyama
    • 1
    Email author
  • Teppei Okamoto
    • 1
  • Naoki Fujita
    • 1
  • Itsuto Hamano
    • 1
  • Toshikazu Tanaka
    • 1
  • Masaki Momota
    • 1
  • Tohru Yoneyama
    • 2
  • Hayato Yamamoto
    • 1
  • Atsushi Imai
    • 1
  • Takahiro Yoneyama
    • 1
  • Yasuhiro Hashimoto
    • 1
  • Kazuaki Yoshikawa
    • 3
  • Toshiaki Kawaguchi
    • 4
  • Hisao Saitoh
    • 5
  • Shigeyuki Nakaji
    • 6
  • Tadashi Suzuki
    • 5
  • Chikara Ohyama
    • 1
    • 2
  1. 1.Department of UrologyHirosaki University Graduate School of MedicineHirosakiJapan
  2. 2.Department of Advanced Transplant and Regenerative MedicineHirosaki University Graduate School of MedicineHirosakiJapan
  3. 3.Department of UrologyMutsu General HospitalMutsuJapan
  4. 4.Department of UrologyAomori Prefectural Central HospitalAomoriJapan
  5. 5.Department of UrologyOyokyo Kidney Research InstituteHirosakiJapan
  6. 6.Department of Social MedicineHirosaki University School of MedicineHirosakiJapan

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