Frailty predicts outcome of partial nephrectomy and guides treatment decision towards active surveillance and tumor ablation

Abstract Purpose To examine frailty and comorbidity as predictors of outcome of nephron sparing surgery (NSS) and as decision tools for identifying candidates for active surveillance (AS) or tumor ablation (TA). Methods Frailty and comorbidity were assessed using the modified frailty index of the Canadian Study of Health and Aging (11-CSHA) and the age-adjusted Charlson-Comorbidity Index (aaCCI) as well as albumin and the radiological skeletal-muscle-index (SMI) in a cohort of n = 447 patients with localized renal masses. Renal tumor anatomy was classified according to the RENAL nephrometry system. Regression analyses were performed to assess predictors of surgical outcome of patients undergoing NSS as well as to identify possible influencing factors of patients undergoing alternative therapies (AS/TA). Results Overall 409 patient underwent NSS while 38 received AS or TA. Patients undergoing TA/AS were more likely to be frail or comorbid compared to patients undergoing NSS (aaCCI: p < 0.001, 11-CSHA: p < 0.001). Gender and tumor complexity did not vary between patients of different treatment approach. 11-CSHA and aaCCI were identified as independent predictors of major postoperative complications (11-CSHA ≥ 0.27: OR = 3.6, p = 0.001) and hospital re-admission (aaCCI ≥ 6: OR = 4.93, p = 0.003) in the NSS cohort. No impact was found for albumin levels and SMI. An aaCCI > 6 and/or 11-CSHA ≥ 0.27 (OR = 9.19, p < 0.001), a solitary kidney (OR = 5.43, p = 0.005) and hypoalbuminemia (OR = 4.6, p = 0.009), but not tumor complexity, were decisive factors to undergo AS or TA rather than NSS. Conclusion In patients with localized renal masses, frailty and comorbidity indices can be useful to predict surgical outcome and support decision-making towards AS or TA.

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Triggers for delayed intervention in patients with small renal masses undergoing active surveillance: a systematic review

Minerva Urologica e Nefrologica ◽

10.23736/s0393-2249.20.03870-9 ◽

2020 ◽

Vol 72 (4) ◽

Cited By ~ 1

Author(s):

Riccardo Campi ◽

Francesco Sessa ◽

Francesco Corti ◽

Diego M. Carrion ◽

Andrea Mari ◽

...

Keyword(s):

Systematic Review ◽

Active Surveillance ◽

Small Renal Masses ◽

Renal Masses ◽

Delayed Intervention

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Faculty Opinions recommendation of Active surveillance of small renal masses offers short-term oncological efficacy equivalent to radical and partial nephrectomy.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717948514.793453573 ◽

2012 ◽

Author(s):

Robert Huddart

Keyword(s):

Partial Nephrectomy ◽

Active Surveillance ◽

Short Term ◽

Small Renal Masses ◽

Renal Masses

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Clinical and radiological findings for small renal masses under active surveillance

Urologic Oncology Seminars and Original Investigations ◽

10.1016/j.urolonc.2021.04.010 ◽

2021 ◽

Author(s):

Tarek Ajami ◽

Carmen Sebastia ◽

Daniel Corominas ◽

Maria Jose Ribal ◽

Carlos Nicolau ◽

...

Keyword(s):

Active Surveillance ◽

Radiological Findings ◽

Small Renal Masses ◽

Renal Masses

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Active Surveillance of Small Renal Masses: A Systematic Review

Kidney Cancer ◽

10.3233/kca-210114 ◽

2021 ◽

pp. 1-14

Author(s):

Elizabeth E. Ellis ◽

Edward Messing

Keyword(s):

Active Surveillance ◽

Meta Analysis ◽

Cost Effective ◽

Management Approach ◽

Small Renal Masses ◽

Cancer Specific Survival ◽

Renal Masses ◽

Review Current ◽

Delayed Intervention

Background: Our goal is to review current literature regarding active surveillance (AS) of small renal masses (SRMs) and identify trends in survival outcomes, factors that predict the need for further intervention, and quality of life (QOL). Methods: We performed a comprehensive literature search in PubMed and EMBASE and identified 194 articles. A narrative summary was performed in lieu of a meta-analysis due to the heterogeneity of selected studies. Results: Seventeen articles were chosen to be featured in this review. Growth rate (GR) was not an accurate predictor of malignancy, although it was the characteristic most commonly used to trigger delayed intervention (DI). The mean 5-year overall survival (OS) of all studies was 73.6% ±1.7% for AS groups. The combined cancer specific survival (CSS) for AS is 97.1% ±0.6% , compared to 98.6% ±0.4% for the primary intervention (PI) groups, (p = 0.038). Conclusions: Short and intermediate-term data demonstrate that AS with the option for DI is a management approach whose efficacy (in terms of CSS) approaches that of PI at 5 years, is cost effective, and prevents overtreatment, especially in patients with significant comorbidities.

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210. Development of a modified frailty index for adult spinal deformities independent of functional changes following surgical correction: a true baseline risk assessment tool

The Spine Journal ◽

10.1016/j.spinee.2020.05.621 ◽

2020 ◽

Vol 20 (9) ◽

pp. S103-S104

Author(s):

Peter G. Passias ◽

Katherine E. Pierce ◽

Virginie Lafage ◽

Renaud Lafage ◽

Breton Line ◽

...

Keyword(s):

Risk Assessment ◽

Assessment Tool ◽

Frailty Index ◽

Surgical Correction ◽

Risk Assessment Tool ◽

Baseline Risk ◽

Spinal Deformities ◽

Functional Changes ◽

Modified Frailty Index

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MP63-01 MODIFIED FRAILTY INDEX PREDICTS MORTALITY AND ADVERSE OUTCOMES IN PATIENTS UNDERGOING RENAL SURGERY: ANALYSIS OF THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) DATABASE

The Journal of Urology ◽

10.1016/j.juro.2015.02.2333 ◽

2015 ◽

Vol 193 (4S) ◽

Author(s):

Jamie S. Pak ◽

Danny Lascano ◽

Julia B. Finkelstein ◽

Mark V. Silva ◽

G. Joel DeCastro ◽

...

Keyword(s):

Quality Improvement ◽

Frailty Index ◽

Adverse Outcomes ◽

Quality Improvement Program ◽

Renal Surgery ◽

Improvement Program ◽

Surgical Quality ◽

Modified Frailty Index

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The modified frailty index-11 predicts medium-term outcomes after endovascular revascularisation for chronic limb threatening ischaemia in Asian patients

Vascular ◽

10.1177/1708538120988228 ◽

2021 ◽

pp. 170853812098822

Author(s):

Shereen XY Soon ◽

Reuban D’Çruz ◽

Charyl JQ Yap ◽

Wei Ling Tay ◽

Siew Ping Chng ◽

...

Keyword(s):

Complication Rate ◽

Early Recognition ◽

Frailty Index ◽

Arterial Disease ◽

Unplanned Readmission ◽

Medium Term ◽

Post Intervention ◽

Asian Patients ◽

Modified Frailty Index ◽

The Mean

Objective The aim was to evaluate the utility of frailty, as defined by the modified Frailty Index-1 1 (mFI-11) on predicting outcomes following endovascular revascularisation in Asian patients with chronic limb-threatening ischaemia (CLTI). Methods CLTI patients who underwent endovascular revascularisation between January 2015 and March 2017 were included. Patients were retrospectively scored using the mFI-11 to categorise frailty as low, medium or high risk. Observed outcomes included 30-day complication rate and unplanned readmissions, 1-, 6- and 12-month mortality, and ambulation status at 6- and 12 months post-intervention. Results A total of 233 patients (250 procedures) were included; 137 (58.8%) were males and the mean age was 69.0 (±10.7) years. 202/233 (86.7%) were diabetic and 196/233 (84.1%) had a prior diagnosis of peripheral arterial disease (PAD). The mean mFI-11 score was 4.2 (±1.5). 28/233 (12.0%), 155/233 (66.5%), and 50/233 (21.5%) patients were deemed low (mF-11 score 0–2), moderate (mFI-11 score 3–5) and high (mFI-11 score 5–7) frailty risk, respectively. High frailty was associated with an increased 12-month mortality (OR 8.54, 95% CI 1.05–69.5; p = 0.05), 30-day complication rate (OR 9.41, 95% CI 2.01–44.1; p < 0.01) and 30-day unplanned readmission (OR 5.06, 95% CI 1.06–24.2; p = 0.04). Furthermore, a high score was associated with a significantly worse 6- (OR 0.320, 95% CI 0.120–0.840; p = 0.02) and 12-month (OR 0.270, 95% CI 0.100–0.710; p < 0.01) ambulatory status. Conclusion The mFI-11 is a useful, non-invasive tool that can be readily calculated using readily available patient data, for prediction of medium-term outcomes for Asian CLTI patients following endovascular revascularisation. Early recognition of short- and mid-term loss of ambulation status amongst high-frailty patients in this challenging cohort of patients could aid decision-making for whether a revascularisation or amputation-first policy is appropriate, and manage patient and caregiver expectations on potential improvement in functional outcome.

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