BJUI compass · 2026
Preoperative FAN score predicts survival outcomes after radical cystectomy for bladder cancer.
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Ishizuya Yu, Kawashima Atsunari, Yamashita Shimpei, Ujike Takeshi, Takao Tetsuya, Miyake Osamu, Osaki Hiroki, Horitani Hiromu, Iwanishi Toshichika, Takada Tsuyoshi, Oki Yuta, Yoshida Takahiro, Matsushita Makoto, Kakimoto Ken-Ichi, Nagahara Akira, Hayashi Takuji, Yamamoto Yoshiyuki, Kato Taigo, Hatano Koji, Kohjimoto Yasuo, Hara Isao, Nonomura Norio
Аннотация
OBJECTIVE: This study aimed to evaluate whether the preoperative FAN score-composed of the fibrosis-4 (Fib-4) index, albumin-bilirubin (ALBI) score and neutrophil-lymphocyte ratio (NLR)-predicts recurrence-free, cancer-specific and overall survival after radical cystectomy for bladder cancer.
PATIENTS AND METHODS: We retrospectively analysed 1121 patients who underwent radical cystectomy at 13 institutions between April 2010 and March 2024. Associations between the FAN score and recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS) were evaluated. Prognostic performance was assessed in an independent cohort of 296 patients from three institutions.
RESULTS: FAN score distribution was 0 (n = 600, 53.5%), 1 (n = 409, 36.5%) and ≥2 (n = 112, 10.0%). Patients with a FAN score ≥2 had significantly worse RFS (median: not reached vs 12.3 months; p < 0.0001), CSS (not reached vs 22.8 months; p < 0.0001) and OS (112.5 vs 16.1 months; p < 0.0001) than those with a FAN score ≤1. On multivariable analysis, a FAN score ≥2 was an independent predictor of poorer RFS (HR 2.12, 95% CI 1.55-2.91; p < 0.0001), CSS (HR 2.80, 95% CI 2.00-3.92; p < 0.0001) and OS (HR 2.70, 95% CI 2.03-3.59; p < 0.0001). These associations were consistently observed in an independent cohort of 296 patients.
CONCLUSIONS: The FAN score is an independent prognostic marker of adverse outcomes after radical cystectomy for bladder cancer and may help stratify patients for perioperative management and follow-up.
PATIENTS AND METHODS: We retrospectively analysed 1121 patients who underwent radical cystectomy at 13 institutions between April 2010 and March 2024. Associations between the FAN score and recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS) were evaluated. Prognostic performance was assessed in an independent cohort of 296 patients from three institutions.
RESULTS: FAN score distribution was 0 (n = 600, 53.5%), 1 (n = 409, 36.5%) and ≥2 (n = 112, 10.0%). Patients with a FAN score ≥2 had significantly worse RFS (median: not reached vs 12.3 months; p < 0.0001), CSS (not reached vs 22.8 months; p < 0.0001) and OS (112.5 vs 16.1 months; p < 0.0001) than those with a FAN score ≤1. On multivariable analysis, a FAN score ≥2 was an independent predictor of poorer RFS (HR 2.12, 95% CI 1.55-2.91; p < 0.0001), CSS (HR 2.80, 95% CI 2.00-3.92; p < 0.0001) and OS (HR 2.70, 95% CI 2.03-3.59; p < 0.0001). These associations were consistently observed in an independent cohort of 296 patients.
CONCLUSIONS: The FAN score is an independent prognostic marker of adverse outcomes after radical cystectomy for bladder cancer and may help stratify patients for perioperative management and follow-up.