Preoperative intrinsic capacity phenotypes forecast adverse physical resilience trajectories following surgery in older bladder cancer patients

Abstract

Purpose

This study assessed the predictive value of preoperative intrinsic capacity (IC) phenotypes for physical resilience (PR) trajectories in older adults undergoing elective bladder cancer surgery.

Methods

A prospective study was conducted from October 2024 to March 2025 on 327 elderly patients (mean age 69.71 ± 6.96 years) who underwent elective bladder cancer surgery. Latent class analysis (LCA) was used to identify different intrinsic capacity types based on the five domains: vitality, locomotion, cognition, psychology, and sensory. Latent class growth model (LCGM) was applied to identify different trajectories of physical resilience over time. Multiple correspondence analysis (MCA) and multivariate logistic regression were used to study the association between intrinsic capacity types and physical resilience trajectories.

Results

LCA identified three intrinsic capacity phenotypes: High intrinsic capacity (35.2 %), Moderate intrinsic capacity-Low Vitality (28.4 %), and Low intrinsic capacity-Low Mobility and Cognition (36.4 %). LCGM identified four physical resilience trajectories: Moderate-Stable (30.6 %), Moderate-Increasing (31.2 %), High-Increasing (28.1 %), and Low-Stable (10.0 %). A significant association was found between intrinsic capacity phenotypes and physical resilience trajectories. After adjustment, the Low Mobility-Cognition and Low Vitality phenotypes were associated with significantly higher risks of adverse recovery trajectories. Poorer self-rated health, lower BMI, and lower education level also predicted worse resilience.

Conclusions

Preoperative intrinsic capacity phenotypes, particularly those characterized by deficits in mobility, cognition, and vitality, independently predict physical resilience trajectories in older adults after bladder cancer surgery. Assessing these phenotypes enables early identification of high-risk patients and supports targeted prehabilitation strategies.