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Effect of frailty and comorbidity on surgical contraindication in patients with localized prostate cancer (FRART-PC
Hirotake Kodama1, Shingo Hatakeyama2, Masaki Momota1
1Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Objectives:
To determine how frailty and comorbidities affect surgical contraindication in patients with localized prostate cancer (CaP).
Materials And Methods:
We evaluated the effects of frailty in 479 patients with localized CaP who were treated with robot-assisted radical prostatectomy (RARP), or radiotherapy (RT) eligible for surgery (RT-nonfrail), or those with RT ineligible for surgery due to frailty or comorbidity (RT-frail) from February 2017 to April 2020. We retrospectively compared the geriatric 8 screening (G8) scores between patients with surgical indications (RARP and RT-nonfrail groups) and those with surgical contraindications (RT-frail group). The effect of G8 score in the RT-frail groups was investigated using multivariate logistic regression analysis. We developed and validated a nomogram for surgical contraindication in patients with localized CaP.
Results:
The median age of patients was 70 years. There were 256, 60, and 163 patients in the RARP, RT-nonfrail, and RT-frail, respectively. The G8 score in the RARP and RT-nonfrail groups was significantly higher than in the RT-frail group (15 vs. 14, respectively, P < 0.001). Age, comorbidities (cerebrocardiovascular disease or chronic respiratory disease), and G8 score were significantly associated with the RT-frail group. The nomogram showed that the area under the curve was 0.872 and 0.923 in the training and validation sets, respectively. The cutoff for surgical contraindication was >39.5%.
Conclusions:
The G8 score and comorbidities have a significant effect on surgical contraindication in patients with localized CaP.
