Pecoraro Alessio, Testa Giuseppe Dario, Marandino Laura, Albiges Laurence, Bex Axel, Capitanio Umberto, Cappiello Ilaria, Masieri Lorenzo, Mir Carme, Roupret Morgan, Serni Sergio, Ungar Andrea, Rivasi Giulia, Campi Riccardo
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.
Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy.
Eur Urol Oncol. 2025 Feb;8(1):190-200. doi: 10.1016/j.euo.2024.09.001. Epub 2024 Sep 20.
Frailty, a geriatric syndrome characterized by decreased resilience and physiological reserve, impacts the prognosis and management of older adults significantly, particularly in the context of surgical and oncological care.
To provide an overview of frailty assessment in the management of older patients with a renal mass/renal cell carcinoma (RCC), focusing on its implications for diagnostic workup, treatment decisions, and clinical outcomes.
A narrative review of the literature was conducted, focusing on frailty definitions, assessment tools, and their application in geriatric oncology, applied to the field of RCC. Relevant studies addressing the prognostic value of frailty, its impact on treatment outcomes, and potential interventions were summarized.
Frailty is a poor prognostic factor and can influence decision-making in the management of both localized and metastatic RCC. Screening tools such as the Geriatric Screening Tool 8 (G8) and the Mini-COG test can aid clinicians to select older patients (ie, aged ≥65 yr) for a further comprehensive geriatric assessment (CGA) performed by dedicated geriatricians. The CGA provides insights to risk stratify patients and guide subsequent treatment pathways. As such, the involvement of geriatricians in multidisciplinary tumor boards emerges as an essential priority to address the complex needs of frail patients and optimize clinical outcomes. Herein, we propose a dedicated care pathway as a first key step to implement frailty assessment in clinical practice and research for RCC.
Frailty has emerged as a crucial factor influencing the management and outcomes of older patients with RCC. Involvement of geriatricians in diagnostic and therapeutic pathways represents a pragmatic approach to screen and assess frailty, fostering individualized treatment decisions according to holistic patient risk stratification.
Frailty, a decline in resilience and physiological reserve, influences treatment decisions and outcomes in elderly patients with renal cell carcinoma, guiding personalized care. In this review, we focused on pragmatic strategies to screen patients with a renal mass suspected for renal cell carcinoma, who are older than 65 yr, for frailty and on personalized management algorithms integrating geriatric input beyond patient- and tumor-related factors.
衰弱是一种以恢复力和生理储备下降为特征的老年综合征，对老年人的预后和管理有重大影响，尤其是在外科和肿瘤护理方面。
概述老年肾肿物/肾细胞癌（RCC）患者管理中的衰弱评估，重点关注其对诊断检查、治疗决策和临床结局的影响。
对文献进行叙述性综述，重点关注衰弱的定义、评估工具及其在老年肿瘤学中的应用，并应用于RCC领域。总结了有关衰弱的预后价值、其对治疗结局的影响以及潜在干预措施的相关研究。
衰弱是一个不良预后因素，可影响局限性和转移性RCC管理中的决策。诸如老年筛查工具8（G8）和简易认知功能测试等筛查工具可帮助临床医生选择老年患者（即年龄≥65岁）进行由专业老年科医生进行的进一步综合老年评估（CGA）。CGA有助于对患者进行风险分层并指导后续治疗途径。因此，老年科医生参与多学科肿瘤委员会成为满足衰弱患者复杂需求并优化临床结局的一项重要优先事项。在此，我们提出一条专门的护理途径，作为在RCC临床实践和研究中实施衰弱评估的首要关键步骤。
衰弱已成为影响老年RCC患者管理和结局的关键因素。老年科医生参与诊断和治疗途径是筛查和评估衰弱的务实方法，有助于根据患者整体风险分层制定个性化治疗决策。
衰弱，即恢复力和生理储备下降，影响老年肾细胞癌患者的治疗决策和结局，指导个性化护理。在本综述中，我们重点关注对疑似肾细胞癌的65岁以上肾肿物患者进行衰弱筛查的务实策略，以及整合除患者和肿瘤相关因素之外的老年科意见的个性化管理算法。
