Urologic Oncology-seminars and Original Investigations最新文献

{"title":"Avelumab and taxol chemotherapy in platinum-refractory or ineligible metastatic urothelial carcinoma (AVETAX trial).","authors":"Rohan Garje, Aditya Ravindra, Bilal Rahim, Mathew Kroll, Jeffrey S Johnson, Julie Torres, Jaime Bonner, Vignesh T Packiam, Sarah Mott, Michael O'Donnell, Yousef Zakharia","doi":"10.1016/j.urolonc.2025.04.005","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.04.005","url":null,"abstract":"<p><strong>Background and objective: </strong>This study investigates the role of taxanes and immunotherapy for inoperable advanced or metastatic urothelial carcinoma in patients unable to tolerate or refractory to platinum-based regimens. We aimed to determine the safety and estimate the efficacy of a combination of avelumab and docetaxel in treating advanced or metastatic urothelial carcinoma.</p><p><strong>Methods: </strong>This phase 1b, single-arm, open-label clinical trial involved adults with advanced or metastatic urothelial carcinoma, progressing during or after platinum-containing chemotherapy, within 12 months of neoadjuvant or adjuvant platinum-containing chemotherapy, or ineligible for platinum regimens. Primary objectives were determining the maximum tolerated dose (MTD) of docetaxel with avelumab and estimating efficacy via the objective response rate (ORR). In Phase I, docetaxel (45, 60, 75 mg/m²) was combined with 10 mg/kg avelumab every 3 weeks for 6 cycles, followed by avelumab biweekly as maintenance. The expansion cohort received treatment at the MTD of 75 mg/m² docetaxel with 10 mg/kg of avelumab.</p><p><strong>Results: </strong>Twenty-one patients with advanced or metastatic urothelial carcinoma were studied: 8 cisplatin-refractory and 13 cisplatin-ineligible. The 75 mg/m² dose of docetaxel with 10 mg/kg avelumab was safe, with 1 dose-limiting toxicity (neutropenic fever). The ORR was 52.4% (95% CI: 29.8%-74.3%). Median progression-free survival and overall survival were 14.6 months (95% CI: 2.8-15.8) and 16.6 months (95% CI: 13.2-not reached), respectively.</p><p><strong>Conclusion: </strong>The combination of avelumab and docetaxel shows favorable safety and efficacy in treating advanced or metastatic bladder cancer.</p><p><strong>Trial registration: </strong>Funded by Pfizer Pharmaceuticals; AVETAX; https://classic.</p><p><strong>Clinicaltrials: </strong>gov/ct2/show/NCT03575013, NCT03575013.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study of AI algorithms on mpMRI and PHI for the diagnosis of clinically significant prostate cancer.","authors":"Zeyu Luo, Jialei Li, Kexin Wang, Song Li, Yi Qian, Wenhua Xie, Pengsheng Wu, Xiangpeng Wang, Jun Han, Wei Zhu, Hu Wang, Yi He","doi":"10.1016/j.urolonc.2025.05.007","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.05.007","url":null,"abstract":"<p><strong>Objective: </strong>To study the feasibility of multiple factors in improving the diagnostic accuracy of clinically significant prostate cancer (csPCa).</p><p><strong>Methods: </strong>A retrospective study with 131 patients analyzes age, PSA, PHI and pathology. Patients with ISUP > 2 were classified as csPCa, and others are non-csPCa. The mpMRI images were processed by a homemade AI algorithm, obtaining positive or negative AI results. Four logistic regression models were fitted, with pathological findings as the dependent variable. The predicted probability of the patients was used to test the prediction efficacy of the models. The DeLong test was performed to compare differences in the area under the receiver operating characteristic (ROC) curves (AUCs) between the models.</p><p><strong>Results: </strong>The study includes 131 patients: 62 were diagnosed with csPCa and 69 were non-csPCa. Statically significant differences were found in age, PSA, PIRADS score, AI results, and PHI values between the 2 groups (all P ≤ 0.001). The conventional model (R² = 0.389), the AI model (R² = 0.566), and the PHI model (R² = 0.515) were compared to the full model (R² = 0.626) with ANOVA and showed statistically significant differences (all P < 0.05). The AUC of the full model (0.921 [95% CI: 0.871-0.972]) was significantly higher than that of the conventional model (P = 0.001), AI model (P < 0.001), and PHI model (P = 0.014).</p><p><strong>Conclusion: </strong>Combining multiple factors such as age, PSA, PIRADS score and PHI, adding AI algorithm based on mpMRI, the diagnostic accuracy of csPCa can be improved.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insights of stone-induced carcinogenesis of the urinary tract through biopsies of renal pelvic lesions during lithotomy.","authors":"Long Wang, Yu Xin, Juefei Dong, Jing Tan, Guangming Yin, Weibin Hou","doi":"10.1016/j.urolonc.2025.05.008","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.05.008","url":null,"abstract":"<p><strong>Introduction: </strong>Nephrolithiasis is an established risk factor for upper tract urothelial carcinoma (UTUC), but the carcinogenic mechanisms remain unclear.</p><p><strong>Patients and methods: </strong>This study analyzed renal pelvic mucosal biopsies obtained during percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for stones, aiming to characterize the spectrum of stone-associated urothelial lesions and gain insights into lithogenic carcinogenesis.</p><p><strong>Results: </strong>A total of 72 biopsies were performed on suspicious areas in 68 patients undergoing PCNL or RIRS. Histopathological results revealed 5 urothelial carcinoma, 1 squamous cell carcinomas, and 3 adenocarcinoma and 1 unspecified cancer, giving an overall detection rate of 13.89% for cancerous lesions. Various precursor lesions were also identified, including urothelial atypia, squamous metaplasia, and intestinal metaplasia. This study provides representative CT images of these stone-associated malignant tumors of the renal pelvis, and gives preliminary evidence that these tumors are frequently demonstrating squamous or glandular differentiation.</p><p><strong>Conclusion: </strong>The identification of diverse precursor lesions supports the hypothesis that calculi induce stepwise oncogenic transformation, potentially via chronic inflammation and urothelial injury. Further research on lithogenic carcinogenesis may elucidate therapeutic targets for this aggressive subset of UTUC.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global trends and regional variations in PCa burden: A focus on China's rapid growth.","authors":"Yu Gan, Hengfeng Zhou, Panpan Feng, Han Gao, Rui Li, Shuo Wang","doi":"10.1016/j.urolonc.2025.05.001","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.05.001","url":null,"abstract":"<p><strong>Background: </strong>Prostate cancer (PCa) is a leading malignancy among men globally, with varying incidence across regions. While high-income countries have effectively controlled PCa through early detection and treatment, middle- and low-income regions, including China, are experiencing rising incidence rates. Understanding these trends is crucial for effective prevention and management.</p><p><strong>Methods: </strong>Utilizing data from the Global Burden of Disease (GBD) database, we analyzed global and regional trends in age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs) for PCa from 1990 to 2021. Bayesian Age-Period-Cohort (BAPC) models and Join-point regression were employed to assess temporal trends and project future incidence rates until 2035. Regional disparities were examined across Socio-Demographic Index (SDI) levels.</p><p><strong>Results: </strong>Globally, the ASIR of PCa modestly increased from 32.6 to 34.1 per 100,000 (1990-2021), while ASMR and DALYs significantly declined in high-SDI regions, reflecting advancements in screening and treatment. In contrast, middle- and low-SDI regions showed rising incidence rates, limited mortality reductions, and persistent disease burdens. In China, ASIR rose from 5.0 to 9.3 per 100,000 (EAPC: 1.834) and is projected to reach 14.7 by 2035, driven by an aging population, improved screening, and lifestyle changes. However, ASMR in China remained stable, and DALYs slightly increased, indicating a sustained disease burden.</p><p><strong>Conclusion: </strong>The increasing incidence and persistent burden of PCa in middle- and low-SDI regions, including China, necessitate targeted strategies. Enhancing prostate-specific antigen screening, reducing overdiagnosis, improving healthcare accessibility, and promoting lifestyle changes.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reality check: The management of small renal masses in 2025 and beyond: Learning from the evolution of prostate cancer care.","authors":"Simon John Christoph Soerensen, Eugene Shkolyar, Benjamin I Chung, John T Leppert","doi":"10.1016/j.urolonc.2025.04.008","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.04.008","url":null,"abstract":"<p><p>The early detection of small renal masses challenges us to distinguish between small renal masses appropriate for early treatment and those that can be safely managed conservatively. Clinicians caring for patients with small renal masses can draw numerous parallels to the evolution of the evaluation and treatment of patients diagnosed with low-risk prostate cancer. Reflexive treatment can have both serious side effects and long-term health implications that may outweigh the potential benefits-especially among those with limited life expectancy or significant comorbidities. In this article, we present current practices in the management of small renal masses that warrant a new perspective, and we propose a new Tumor-Organ Patient (TOP) conceptual framework to reduce overtreatment of small renal masses. The TOP model incorporates tumor biology, but also considers the patient's risk for loss of kidney function (the organ), as well as the patient's overall health (e.g. age, comorbidity, life expectancy). As we continue to refine our understanding of small renal masses, it is critical to learn the lessons of low-risk prostate cancer and to first \"do no harm.\"</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PSA kinetics and predictors of PSA response in metastatic hormone-sensitive prostate cancer treated with androgen receptor signaling inhibitors.","authors":"Rocío Martínez-Corral, Pedro De Pablos-Rodríguez, Celia Bardella-Altarriba, Francisco Javier Vera-Ballesteros, Arnau Abella-Serra, Victor Rodríguez-Part, María Elena Martínez-Corral, Natalia Picola-Brau, Alicia López-Abad, Álvaro Gómez-Ferrer, Manuel Beamud-Cortés, José Francisco Suárez-Novo, Pedro Ángel López-González, Mireia García-Puche, Ana María Álvarez-Gracia, Daniel Pérez-Fentes","doi":"10.1016/j.urolonc.2025.05.006","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.05.006","url":null,"abstract":"<p><strong>Background: </strong>PSA response is a key prognostic tool in metastatic hormone-sensitive prostate cancer (mHSPC). Data from SWOG 9346 and TITAN post-hoc analyses demonstrated the prognostic value of PSA thresholds at 6-7 months after androgen deprivation therapy (ADT) or ADT plus apalutamide. However, variability in thresholds and timing highlights the need to explore PSA kinetics in real-world cohorts. This study investigates PSA dynamics and their predictors following Androgen Receptor Signaling Inhibitors (ARSI) initiation.</p><p><strong>Methods: </strong>This multicenter study included mHSPC patients treated with ADT+ARSI between June 2017 and October 2024. Exclusions included ADT monotherapy, triplet therapy, or ARSI initiation >6 months post-ADT. PSA kinetics were analyzed over 12 months, focusing on SWOG (0.2-4 ng/ml) and TITAN (0.02-0.2 ng/ml) thresholds. Logistic regression and SHAP (SHapley Additive exPlanations) analysis identified predictors of achieving low (<0.2 ng/ml) or ultralow (<0.02 ng/ml) PSA at 6 months.</p><p><strong>Results: </strong>Among 586 mHSPC patients (median follow-up: 23 months), most had synchronous (58%), low-volume (58%), and ISUP grade 4-5 (64%) disease. At 6 months, 74%, 19%, and 7% achieved PSA <0.2 ng/ml, 0.2-4 ng/ml, and >4 ng/ml (SWOG cutoffs), while 36%, 35%, and 29% achieved PSA <0.02 ng/ml, 0.02-0.2 ng/ml, and >0.2 ng/ml (TITAN cutoffs). Baseline PSA <50 ng/ml and metachronous disease were strong predictors of ultralow PSA.</p><p><strong>Conclusion: </strong>SWOG and TITAN thresholds offer distinct PSA stratifications, with SWOG grouping more patients into the lowest PSA category and TITAN providing a more balanced distribution. Baseline PSA and metachronous disease are key predictors of favorable PSA responses, emphasizing their importance in guiding management.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What motivates bladder cancer patients to be active? A qualitative study assessing attitudes towards physical activity and digital health technologies.","authors":"Alex Zhu, Jessica Sher, Richard Li, Otari Ioseliani, Leah Cantor, Elena G Brewer, Karla Landis, David Bridges, Sean A Munson, Hanna Hunter, Cindy Lin, Sarah P Psutka","doi":"10.1016/j.urolonc.2025.05.002","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.05.002","url":null,"abstract":"<p><strong>Introduction and objective: </strong>Patients undergoing neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) are often older, frail and deconditioned, leaving them with limited reserve to endure the demands of treatment. As a result, improving physical fitness in this population remains a critical need. Two emerging means to do so include the implementation of exercise programs pre- and postsurgery (i.e. (p)rehabilitation), and the use of digital health technologies (i.e. Fitbit®, Apple Watch™, exercise apps) to incentivize physical activity. However, little is known about the motivations of NAC/RC patients to be active or their perceptions towards digital health technologies.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with bladder cancer survivors who previously underwent NAC/RC. We asked participants to reflect upon their experience throughout the course of treatment as it pertained to (1) barriers of physical activity, (2) facilitators of physical activity, and (3) how digital health technologies can promote physical activity. These findings will inform the design of a Phase II exercise prehabilitation trial (GetMoving, NCT06040762).</p><p><strong>Results: </strong>9 patients were interviewed and common themes emerged. Patients undergoing NAC/RC desired a structured exercise plan outlining the duration, intensity and frequency of exercise to perform. Encouragement to exercise and \"check ins\" from their provider were critical in maintaining their motivation to exercise. Objective measurements of their fitness would help with setting fitness goals and adhering to training plans. All patients would use digital health technologies to improve their health.</p><p><strong>Conclusions: </strong>We provide a novel study assessing the perceptions of bladder cancer survivors towards exercise motivations and digital health technologies.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cover 2 - Masthead","authors":"","doi":"10.1016/S1078-1439(25)00188-7","DOIUrl":"10.1016/S1078-1439(25)00188-7","url":null,"abstract":"","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 7","pages":"Page IFC"},"PeriodicalIF":2.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144154703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and perioperative outcomes of re-operative retroperitoneal robotic partial nephrectomy.","authors":"Milan H Patel, Ruben Blachman-Braun, Lauren Loebach, Braden Millan, Jaskirat Saini, Sandeep Gurram, W Marston Linehan, Mark W Ball","doi":"10.1016/j.urolonc.2025.05.003","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.05.003","url":null,"abstract":"<p><strong>Purpose: </strong>To present our experience with re-operative retroperitoneal partial nephrectomy (Re-RetroPN), evaluate its feasibility and safety, and compare perioperative outcomes, including renal function metrics, pathology, and complication rates, between patients that underwent Re-RetroPN and those that underwent re-operative transperitoneal robotic partial nephrectomy (Re-TransPN).</p><p><strong>Methods: </strong>A retrospective cohort study was conducted identifying patients who underwent re-operative robotic partial nephrectomy (PN) at our institution from January 2008 to December 2024. Demographic, clinical, perioperative, and pathological data were recorded and analyzed.</p><p><strong>Results: </strong>A total of 186 patients who underwent robotic re-operative PN were analyzed (173 Re-TransPN vs. 13 Re-RetroPN), and 1 patient was converted from Re-RetroPN to Re-TransPN. Overall, 17 (9.1%) had a solitary kidney, 138 (74.2%) underwent their second ipsilateral partial nephrectomy, and 48 (25.8%) had their third. A total of 894 tumors were removed (825 with Re-TransPN, 69 with Re-RetroPN), with a median of 3 (2-6) tumors per procedure. Perioperative metrics, including estimated blood loss, operative time, and percentage of cases performed without hilar clamping were similar between groups. Positive surgical margins were observed in 7 (4.0%) patients in the Re-TransPN group, with no positive margins reported in the Re-RetroPN group. Renal function parameters at 3 months and complication rates were comparable between groups, with 1 (7.7%) patient in the Re-RetroPN group experiencing a Clavien-Dindo grade ≥3 complications.</p><p><strong>Conclusion: </strong>Re-RetroPN is a feasible and safe option for carefully selected patients, with comparable outcomes to Re-TransPN. It provides advantages in certain scenarios, such as improved access to posteriorly located tumors and avoidance of the peritoneal cavity.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of a claims-based frailty index with perioperative outcomes and survival among older adults undergoing radical cystectomy for bladder cancer.","authors":"Boris Gershman, John Ernandez, Sumedh Kaul, Agustin Perez-Londoño, Aaron Fleishman, Ruslan Korets, Peter Chang, Andrew A Wagner, Simon Kim, Joaquim Bellmunt, Nima Aghdam, Ellen P McCarthy, Dae Hyun Kim, Aria F Olumi","doi":"10.1016/j.urolonc.2025.04.009","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.04.009","url":null,"abstract":"<p><strong>Objective: </strong>Frailty is increasingly recognized as an important component of geriatric assessment in older adults and an important predictor of clinical outcomes. Bladder cancer (BC) is a potentially lethal disease, and treatments like radical cystectomy (RC) are associated with high rates of morbidity. We examined the associations of baseline frailty with perioperative outcomes and survival in a population-based cohort of older adults undergoing RC.</p><p><strong>Materials and methods: </strong>We identified older adults aged 66 to 89 years with Tany Nany cM0 urothelial carcinoma of the bladder who underwent RC from 2000 to 2017 in SEER-Medicare. Baseline frailty was assessed using the claims-based frailty index (CFI), a validated deficit accumulation frailty measure, within the 12-months preceding surgery. The associations of CFI with perioperative outcomes and survival were evaluated using multivariable regression models.</p><p><strong>Results: </strong>A total of 6,041 patients were included in the study cohort, including 2,640 (44%) who were robust (CFI <0.15), 2,980 (49%) who were prefrail (CFI 0.15-<0.25), and 421 (7%) who were mildly to severely frail (CFI ≥0.25). Increasing CFI was associated with statistically significantly higher rates of prolonged hospitalization, 90-day emergency department utilization, 90-day complications, and 90-day hospital readmission, and fewer healthy days at home (HDAH). CFI remained independently associated with an increased risk of perioperative outcomes and worse mortality in multivariable regression models.</p><p><strong>Conclusions: </strong>In a national, contemporary cohort of older adults with BC undergoing RC, increasing frailty was independently associated with a higher risk of perioperative morbidity, fewer HDAH, and worse mortality. The CFI provides an objective assessment to improve decision-making in older adults with bladder cancer.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}