Frailty and comorbidity surpass probable sarcopenia in predicting survival of mCRPC patients treated with first-line ARPIs: a comprehensive geriatric analysis.

Yuan-Ling Cheng, Chien-Chang Kao, En Meng, Tai-Lung Cha, Yi-Ta Tsai, Chih-Wei Tsao, Ming-Hsin Yang

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Article in World journal of urology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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7 authors.

Yuan-Ling ChengDivision of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan.

Chien-Chang KaoDivision of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan.

En MengDivision of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan.

Tai-Lung ChaDivision of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan.

Yi-Ta TsaiGraduate School of Medical Sciences, National Defense Medical University, Taipei, Taiwan.

Chih-Wei TsaoDivision of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan.

Ming-Hsin YangDivision of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan. msy681028@gmail.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo evaluate the impact of probable sarcopenia on overall survival (OS), toxicity, and quality of life (QoL) in metastatic castration-resistant prostate cancer (mCRPC) patients receiving androgen receptor pathway inhibitors (ARPIs), adjusting for geriatric and inflammatory markers.

methodsWe retrospectively analyzed 213 mCRPC patients treated with first-line abiraterone or enzalutamide. Probable sarcopenia (low muscle mass) was defined as SMI < 40.8 cm²/m². Geriatric (G8), comorbidity (CIRS-G), and inflammatory markers were assessed. Primary endpoints were OS and grade ≥ 3 toxicity.

resultsPatients with probable sarcopenia (n = 93) had shorter median OS (12.7 vs. 24.7 months; p < 0.001) and increased univariable mortality risk (HR = 2.17, p < 0.001). Despite similar 3-month PSA50 responses (86.0% vs. 85.8%, p = 1.000), the prognostic impact of low muscle mass attenuated in multivariable analysis (HR = 1.05, p = 0.783). Instead, frailty (G8: HR = 0.85, p < 0.001) and comorbidities (CIRS-G: HR = 1.21, p < 0.001) independently predicted mortality. A CART model identified a high-risk phenotype (CIRS-G > 8.5, NLR > 3.35, albumin ≤ 3.35 g/dL) experiencing 98% grade ≥ 3 toxicity. Furthermore, probable sarcopenia was associated with significantly faster QoL deterioration.

conclusionMortality associated with low muscle mass in mCRPC is primarily driven by physiological frailty and comorbidities. Integrating geriatric and inflammatory assessments refines clinical risk stratification and anticipates severe toxicity. External validation is warranted.

Indexed as

Androgen Receptor AntagonistsFrailtyPhenylthiohydantoinProstatic Neoplasms, Castration-ResistantSarcopeniaAgedAged, 80 and overBenzamidesComorbidityGeriatric AssessmentHumansMaleNitrilesPrognosisQuality of LifeRetrospective StudiesAndrogen Receptor AntagonistsBenzamidesenzalutamideNitrilesPhenylthiohydantoinAndrogen receptor antagonistsDrug-related side effects and adverse reactionsFrailtyProstatic neoplasms, Castration-resistantSarcopeniaSurvival rate

Identifiers

PMID42578984

DOI10.1007/s00345-026-06669-7

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.