Abstract
Frailty is a multidimensional syndrome reflecting decreased physiological reserve and increased vulnerability to stressors, which may adversely affect cancer prognosis. However, its impact on survival outcomes in patients with renal cell carcinoma (RCC) remains unclear. This meta-analysis aimed to evaluate the association between frailty and survival in RCC patients. A systematic search of PubMed, Embase, and Web of Science was conducted for longitudinal studies assessing frailty in adults with RCC. Studies using validated frailty assessment tools and reporting overall survival (OS) and/or progression-free survival (PFS) were included. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using random-effects models. Subgroup and sensitivity analyses were performed to explore heterogeneity. Eight cohort studies involving 15,989 RCC patients were included. Frailty was associated with significantly poorer OS (HR = 1.79, 95% CI: 1.45-2.20; I² = 30%) and PFS (HR = 2.17, 95% CI: 1.54-3.04; I² = 0%). The association between frailty and OS remained robust across sensitivity analyses by excluding one study at a time and was consistent across subgroups stratified by cancer stage, treatment modality, patient age, frailty assessment method, follow-up duration, and analytic model (all p values for subgroup differences > 0.05). Subtype-specific data according to the histologic type of RCC were unavailable, which limits detailed prognostic interpretation. No significant publication bias was detected. Frailty may be significantly associated with poorer survival outcomes in patients with RCC. Incorporating frailty assessment into routine clinical evaluation may aid in prognostication and individualized treatment planning for this patient population.