{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T17:16:20Z","timestamp":1792343780424,"version":"4.4.0"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Bladder cancer predominantly affects older adults, with approximately 70% of cases occurring in individuals aged \u226565 years, placing a substantial proportion of patients at increased risk of frailty and age-related comorbidities. However, the impact of frailty on the surgical outcomes of such patients remains unclear. The present systematic review examined the role of frailty in predicting major complications, mortality, readmission, and non-home discharge in patients undergoing radical cystectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, Web of Science, Embase, and Scopus were searched up to May 10, 2025, for relevant studies. Random-effects meta-analysis of crude and adjusted data was conducted to compare outcomes between frail and non-frail patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sixteen studies with 55,811 patients were included. Analysis of crude data showed that risk of major complications (OR: 1.09 95% CI: 0.60, 1.98 I\n                      <jats:sup>2<\/jats:sup>\n                      = 84%), all complications (OR: 1.77 95% CI: 0.63, 4.95 I\n                      <jats:sup>2<\/jats:sup>\n                      = 0%), short-term mortality (&amp;lt;1 year) (OR: 2.23 95% CI: 0.63, 7.84 I\n                      <jats:sup>2<\/jats:sup>\n                      = 57%), long-term mortality (&amp;gt;1 year) (OR: 1.81 95% CI: 0.87, 3.80 I\n                      <jats:sup>2<\/jats:sup>\n                      = 71%), and readmission rates (OR: 1.55 95% CI: 0.51, 4.65 I\n                      <jats:sup>2<\/jats:sup>\n                      = 0%) did not differ significantly between frail and non-frail patients. However, meta-analysis of adjusted data showed increased risk of major complications (OR: 2.50 95% CI: 1.59, 3.95 I\n                      <jats:sup>2<\/jats:sup>\n                      = 20%), mortality (OR: 2.12 95% CI: 1.41, 3.18 I\n                      <jats:sup>2<\/jats:sup>\n                      = 88%), and non-home discharge (OR: 4.10 95% CI: 2.07, 8.13 I\n                      <jats:sup>2<\/jats:sup>\n                      = 40%) in frail patients as compared to non-frail patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Frailty could be a risk factor for adverse outcomes in patients undergoing radical cystectomy. Further robust studies reporting adjusted data are needed to supplement current conclusions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/prospero\/<\/jats:ext-link>\n                      , identifier CRD420251041804.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1740552","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T05:26:39Z","timestamp":1773379599000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of frailty on adverse outcomes after radical cystectomy: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"16","author":[{"given":"Jiayi","family":"Fang","sequence":"first","affiliation":[{"name":"Anesthesia Surgery Center-Operating Room, West China Hospital of Sichuan University","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongqiong","family":"Tan","sequence":"additional","affiliation":[{"name":"Anesthesia Surgery Center-Operating Room, West China Hospital of Sichuan University","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2023.03.029","article-title":"Epidemiology of bladder cancer in 2023: A systematic review of risk factors","volume":"84","author":"Jubber","year":"2023","journal-title":"Eur Urol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"394","DOI":"10.3322\/caac.21492","article-title":"Global cancer statistics 2018: globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"68","author":"Bray","year":"2018","journal-title":"CA Cancer J Clin"},{"key":"B3","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1016\/j.eururo.2016.06.010","article-title":"Bladder cancer incidence and mortality: A global overview and recent trends","volume":"71","author":"Antoni","year":"2017","journal-title":"Eur Urol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.37029\/jcas.v9i1.485","article-title":"Risk factors for bladder cancer: results of a survey of hospital patients","volume":"9","author":"Shadab","year":"2023","journal-title":"J Cancer Allied Spec"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.euo.2022.10.003","article-title":"Epidemiology, screening, and prevention of bladder cancer","volume":"5","author":"Lobo","year":"2022","journal-title":"Eur Urol Oncol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.arr.2023.102082","article-title":"Recent developments in frailty identification, management, risk factors and prevention: A narrative review of leading journals in geriatrics and gerontology","volume":"91","author":"Dent","year":"2023","journal-title":"Ageing Res Rev"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1038\/s43587-021-00099-3","article-title":"The degree of frailty as a translational measure of health in aging","volume":"1","author":"Howlett","year":"2021","journal-title":"Nat Aging"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1111\/wvn.12508","article-title":"Adverse health effects of frailty: systematic review and meta-analysis of middle-aged and older adults with implications for evidence-based practice","volume":"18","author":"Chu","year":"2021","journal-title":"Worldviews Evid Based Nurs"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e076743","DOI":"10.1136\/bmj-2023-076743","article-title":"Advances in diagnosis and treatment of bladder cancer","volume":"384","author":"Lopez-Beltran","year":"2024","journal-title":"BMJ"},{"key":"B10","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1186\/s12893-025-02887-9","article-title":"Radical cystectomy for bladder cancer in sub-saharan africa: techniques, challenges, and survival outcomes: A comprehensive review","volume":"25","author":"Nhungo","year":"2025","journal-title":"BMC Surg"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-020-01578-9","article-title":"Association between mortality and frailty in emergency general surgery: A systematic review and meta-analysis","volume":"48","author":"Fehlmann","year":"2022","journal-title":"Eur J Trauma Emerg Surg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1038\/s41571-023-00744-3","article-title":"Global trends in the epidemiology of bladder cancer: challenges for public health and clinical practice","volume":"20","author":"van Hoogstraten","year":"2023","journal-title":"Nat Rev Clin Oncol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.urolonc.2018.10.002","article-title":"Frailty as a predictor of complications after radical cystectomy: A prospective study of various preoperative assessments","volume":"37","author":"Burg","year":"2019","journal-title":"Urol Oncol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.clgc.2019.07.002","article-title":"Multicenter analysis of postoperative complications in octogenarians after radical cystectomy and ureterocutaneostomy: the role of the frailty index","volume":"17","author":"De Nunzio","year":"2019","journal-title":"Clin Genitourin Cancer"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1111\/bju.15132","article-title":"Preoperative frailty and outcome in patients undergoing radical cystectomy","volume":"126","author":"van der Vlies","year":"2020","journal-title":"BJU Int"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.22540\/JFSF-07-147","article-title":"Outcomes of radical cystectomy in pt4 bladder cancer frail patients: alpha high-volume single center study","volume":"7","author":"Stamatakos","year":"2022","journal-title":"J Frailty Sarcopenia Falls"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71","article-title":"The Prisma 2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-14-45","article-title":"Newcastle-ottawa scale: comparing reviewers\u2019 to authors\u2019 Assessments","volume":"14","author":"Lo","year":"2014","journal-title":"BMC Med Res Methodol"},{"key":"B19","volume-title":"Cochrane handbook for systematic reviews of interventions version 6.0","author":"Higgins","year":"2024"},{"key":"B20","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.urology.2019.04.057","article-title":"Predicting short-term outcomes after radical cystectomy based on frailty","volume":"133","author":"Michel","year":"2019","journal-title":"Urology"},{"key":"B21","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.suronc.2019.10.014","article-title":"Patient frailty predicts worse perioperative outcomes and higher cost after radical cystectomy","volume":"32","author":"Palumbo","year":"2020","journal-title":"Surg Oncol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.euf.2017.12.011","article-title":"A Simplified Frailty Index to Predict Outcomes after Radical Cystectomy","volume":"5","author":"Sathianathen","year":"2019","journal-title":"Eur Urol Focus"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1159\/000499263","article-title":"The usefulness of the modified frailty index for muscle-invasive bladder cancer patients treated with radical cystectomy","volume":"14","author":"Voskamp","year":"2020","journal-title":"Curr Urol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.31799","article-title":"Validating the predictors of outcomes after radical cystectomy for bladder cancer","volume":"125","author":"Woldu","year":"2019","journal-title":"Cancer"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/j.clgc.2021.12.016","article-title":"Modified 5-item frailty index score as prognostic marker after radical cystectomy in bladder cancer","volume":"20","author":"Yamashita","year":"2022","journal-title":"Clin Genitourin Cancer"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/j.clgc.2023.03.004","article-title":"The short- and long-term effect of radical cystectomy in frail patients with bladder cancer","volume":"21","author":"Pyrgidis","year":"2023","journal-title":"Clin Genitourin Cancer"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgo.2023.101627","article-title":"11-item modified frailty index and outcomes after radical cystectomy","volume":"14","author":"Savin","year":"2023","journal-title":"J Geriatr Oncol"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-023-13565-6","article-title":"Impact of chart-derived frailty index on 1-year mortality after radical cystectomy in 1004 patients with bladder cancer","volume":"30","author":"Yu","year":"2023","journal-title":"Ann Surg Oncol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2024.08.055","article-title":"Comparing frailty indices for risk stratification in urologic oncology: which index to choose","volume":"194","author":"Deol","year":"2024","journal-title":"Urology"},{"key":"B30","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1007\/s00345-024-05248-y","article-title":"Radical cystectomy in patients aged < 80 years versus >\/= 80 years: analysis of preoperative geriatric assessment scores in predicting postoperative morbidity and mortality","volume":"42","author":"Duwe","year":"2024","journal-title":"World J Urol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.urolonc.2024.01.012","article-title":"The association between frailty, hypogonadism, and postoperative outcomes among men undergoing radical cystectomy","volume":"42","author":"Greenberg","year":"2024","journal-title":"Urol Oncol"},{"key":"B32","article-title":"Quantitative synthesis-an update","volume-title":"Methods guide for effectiveness and comparative effectiveness reviews. Ahrq methods for effective health care","author":"Morton","year":"2008"},{"key":"B33","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1016\/j.amjsurg.2018.11.020","article-title":"Impact of frailty on outcomes in surgical patients: A systematic review and meta-analysis","volume":"218","author":"Panayi","year":"2019","journal-title":"Am J Surg"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1111\/bju.15314","article-title":"Implementation of frailty preoperative assessment to predict outcome in patients undergoing urological surgery: A systematic review and meta-analysis","volume":"127","author":"Aceto","year":"2021","journal-title":"BJU Int"},{"key":"B35","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1186\/s12882-023-03358-0","article-title":"Frailty and prognosis of patients with kidney transplantation: A meta-analysis","volume":"24","author":"Zheng","year":"2023","journal-title":"BMC Nephrol"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1177\/10547738221100350","article-title":"Frailty assessment for outcome prediction of patients with prostate cancer receiving radical prostatectomy: A meta-analysis of cohort studies","volume":"31","author":"Liu","year":"2022","journal-title":"Clin Nurs Res"},{"key":"B37","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1080\/2090598X.2020.1841538","article-title":"Frailty impact on postoperative complications and early mortality rates in patients undergoing radical cystectomy for bladder cancer: A systematic review","volume":"19","author":"Ornaghi","year":"2020","journal-title":"Arab J Urol"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2018.10.006","article-title":"Robotic assisted radical cystectomy vs open radical cystectomy: systematic review and meta-analysis","volume":"201","author":"Sathianathen","year":"2019","journal-title":"J Urol"},{"key":"B39","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1007\/s11701-024-02026-1","article-title":"Robotic assisted vs open radical cystectomy: an updated systematic review and meta-analysis","volume":"18","author":"Cella","year":"2024","journal-title":"J Robot Surg"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1097\/JU.0000000000000570","article-title":"Large single institution comparison of perioperative outcomes and complications of open radical cystectomy, intracorporeal robot-assisted radical cystectomy and robotic extracorporeal approach","volume":"203","author":"Zhang","year":"2020","journal-title":"J Urol"},{"key":"B41","doi-asserted-by":"publisher","first-page":"e20240556","DOI":"10.1590\/S1677-5538.IBJU.2024.0556","article-title":"Radical cystectomy with elective indication to cutaneous ureterostomy: single-center comparative analysis between open and robotic surgery in frail patients","volume":"51","author":"Sighinolfi","year":"2025","journal-title":"Int Braz J Urol"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1","DOI":"10.5582\/irdr.2023.01113","article-title":"Global frailty screening tools: review and application of frailty screening tools from 2001 to 2023","volume":"13","author":"Deng","year":"2024","journal-title":"Intractable Rare Dis Res"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2020.e04797","article-title":"Comparison of geriatric assessment tools for frailty among community elderly","volume":"6","author":"Sukkriang","year":"2020","journal-title":"Heliyon"},{"key":"B44","doi-asserted-by":"publisher","first-page":"57","DOI":"10.22540\/JFSF-05-057","article-title":"Frailty assessment and postoperative complications in urologic oncology operations","volume":"5","author":"Kostakopoulos","year":"2020","journal-title":"J Frailty Sarcopenia Falls"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1740552\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T05:26:41Z","timestamp":1773379601000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1740552\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,13]]},"references-count":44,"alternative-id":["10.3389\/fonc.2026.1740552"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1740552","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,13]]},"article-number":"1740552"}}