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.
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.
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.
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.
BJUI compass. 2026 Apr 30*** epublish ***
Yu Ishizuya, Atsunari Kawashima, Shimpei Yamashita, Takeshi Ujike, Tetsuya Takao, Osamu Miyake, Hiroki Osaki, Hiromu Horitani, Toshichika Iwanishi, Tsuyoshi Takada, Yuta Oki, Takahiro Yoshida, Makoto Matsushita, Ken-Ichi Kakimoto, Akira Nagahara, Takuji Hayashi, Yoshiyuki Yamamoto, Taigo Kato, Koji Hatano, Yasuo Kohjimoto, Isao Hara, Norio Nonomura
Department of Urology The University of Osaka Graduate School of Medicine Suita Japan., Department of Urology Wakayama Medical University Wakayama Japan., Department of Urology Osaka Rosai Hospital Sakai Japan., Department of Urology Osaka General Medical Center Osaka Japan., Department of Urology Toyonaka Municipal Hospital Toyonaka Japan., Department of Urology Osaka Keisatsu Hospital Osaka Japan., Department of Urology Higashiosaka City Medical Center Higashiosaka Japan., Department of Urology Sakai City Medical Center Sakai Japan., Department of Urology Minoh City Hospital Minoh Japan., Department of Urology National Hospital Organization Osaka National Hospital Osaka Japan., Department of Urology Hyogo Prefectural Nishinomiya Hospital Nishinomiya Japan., Department of Urology Ikeda Municipal Hospital Ikeda Japan., Department of Urology Nippon Life Hospital Osaka Japan., Department of Urology Osaka International Cancer Institute Osaka Japan.