虚弱与肾细胞癌：将全面老年评估融入共享决策

虚弱是一种老年综合征，表现为抵抗力和生理储备的下降，显著影响老年患者的预后和管理，尤其在手术和肿瘤治疗中具有重要意义。本文综述了在肾块/肾细胞癌（RCC）管理中虚弱评估的方法，重点关注其对诊断、治疗决策和临床结局的影响。通过文献调研，总结了虚弱的定义、评估工具及其在老年肿瘤学中的应用，特别是在RCC中的应用。相关研究显示，虚弱是预后不良的重要因素，影响局部和转移性RCC的治疗选择。筛查工具如Geriatric Screening Tool 8（G8）和Mini-COG测试有助于临床医生筛选≥65岁老年患者，进一步由专门的老年医学专家进行全面老年评估（CGA）。CGA能提供风险分层的见解，指导后续治疗路径。因此，肿瘤多学科讨论中老年医学专家的参与成为优化虚弱患者临床结局的关键步骤。我们提出了一条专门的护理路径，作为在临床实践和研究中实施虚弱评估的第一步。虚弱已成为影响老年RCC患者管理和预后的关键因素，老年医学专家在诊断和治疗路径中的介入，是基于整体患者风险进行筛查和评估的务实策略，促进个体化治疗决策。本文关注于对怀疑为肾细胞癌的肾块患者（≥65岁）进行虚弱筛查的实用策略，以及整合老年医学专家意见的个性化管理算法，超越单纯的患者和肿瘤相关因素。

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.