{"paper_id":"21f6f5bf-7b8f-48a3-acf7-60e06a73d980","body_text":"The number of dissected lymph nodes contributes to good prognosis after robot-assisted radical cystectomy for muscle-invasive bladder cancer without lymph node metastasis at clinical staging | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The number of dissected lymph nodes contributes to good prognosis after robot-assisted radical cystectomy for muscle-invasive bladder cancer without lymph node metastasis at clinical staging Takuji Hayashi, Atsunari Kawashima, Masao Tsujihata, Tetsuya Takao, and 15 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8551382/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: Robot-assisted radical cystectomy (RARC) with lymph node (LN) dissection is a curative treatment for muscle-invasive bladder cancer (MIBC). We aimed to investigate the association between the number of dissected LNs in RARC and the prognosis of MIBC. Methods: We retrospectively assessed 304 patients with cT2–T4N0M0 MIBC who underwent RARC between 2018 and 2024. Associations between the number of dissected LNs and regression-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were analyzed using a Cox proportional hazards regression model. We explored a better cutoff number by comparing the hazard ratio (HR) and p value for each cutoff. Results: The median number of dissected LNs was 14 (range: 0–76). Among 304 cases, 54 had LN metastases (17.7%). The number of dissected LNs was significantly associated with RFS, CSS, and OS (p = 0.010, 0.007, and 0.003, respectively) after adjusting for performance status and preoperative laboratory data. When the cutoff value was 20, the HR (95% confidence interval) and p value were 0.624 (0.396–0.982) and 0.041 in RFS, respectively; 0.495 (0.275–0.892) and 0.019 in CSS, respectively; and 0.535 (0.317–0.904) and 0.019 in OS, respectively. The postoperative complication rate did not increase with an increasing number of dissected LNs. Patients with ≥20 dissected LNs demonstrated a significantly lower complication rate (P = 0.009). Conclusion: The number of dissected LNs contributed to good prognosis after RARC for MIBCwithout LN metastasis at clinical staging. A cutoff value of 20 enabled the clear stratification of the prognosis. robot-assisted radical cystectomy lymph node dissection bladder cancer number of dissected lymph nodes prognosis FAN score postoperative complications Figures Figure 1 Figure 2 Figure 3 Introduction Radical cystectomy (RC) with pelvic lymph node (LN) dissection is a curative treatment option for patients with muscle-invasive bladder cancer (MIBC) or high-risk non-MIBC (NMIBC) without metastasis [ 1 , 2 ]. The number of LNs dissected during RC is associated with cancer-specific survival (CSS) in patients without LN metastasis [ 3 ]. On the basis of this report, 16 dissected LNs were defined as one of the oncological trifecta and pentafecta of RC for organ-confined urothelial carcinoma [ 4 ]. Robot-assisted RC (RARC) has become the standard procedure because it offers a less invasive surgical approach than open or laparoscopic RC. A meta-analysis of randomized controlled trials demonstrated that RARC is less invasive than open RC in terms of reduced blood loss and perioperative blood transfusion [ 5 ]. However, no differences in prognosis have been observed between RARC and open RC [ 6 , 7 ]. Several reports suggested that the oncological pentafecta with ≥ 16 dissected LNs is one of the useful tools for assessing the quality of RC in the “RARC” era [ 8 , 9 ]. Recently, two prospective randomized trials revealed that extended LN dissection, which is defined as the dissection of LNs toward the cranial side of the bilateral common iliac region, in RC did not result in improved prognosis in patients with bladder cancer [ 10 , 11 ]. Lerner et al. reported that extended LN dissection is associated with higher perioperative morbidity and mortality [ 11 ]. These results suggest that the number of dissected LNs, rather than their anatomical extent, may contribute to a better prognosis in patients with bladder cancer undergoing RC. We previously reported that the FAN score, which consists of the fibrosis-4 (Fib-4) index, albumin–bilirubin (ALBI) score, and neutrophil–lymphocyte ratio (NLR), is a prognostic marker for patients with urothelial carcinoma [ 12 , 13 ]. In this study, we aimed to investigate the association between the number of dissected LNs without extended LN dissection in RARC and the prognosis of MIBC while accounting for other preoperative factors, including the FAN score. Methods Study design We included 535 patients with bladder cancer who underwent RARC at The University of Osaka Hospital and 12 affiliated institutions between April 2010 and March 2024. No patient underwent extended LN dissection during RARC. Among the enrolled patients, 304 had MIBC without metastasis (cT2–T4N0M0), 38 had regional LN metastasis (cN1–N3M0), and 8 had distant metastasis (cM1) (Fig. 1 ). This study was approved by the Institutional Review Board of Osaka University Hospital (approval no. 23530). We collected the clinical characteristics, preoperative laboratory data, and surgery-related and perioperative data of patients with MIBC without metastasis (n = 304). The Fib-4 index was calculated as follows: age (years) × AST (U/L) / (platelet count [103/µL] × (ALT [U/L] 0.5), where AST and ALT denote aspartate aminotransferase and alanine aminotransferase, respectively. The ALBI score was calculated using the following formula: log10 (T-bil [mg/dL] × 17.1) × 0.66 + albumin [mg/dL] × 10(− 0.085), where T-bil is the total bilirubin. The cutoff values were Fib-4 index > 3.5, ALBI score > − 2.6, and NLR > 5.0. Postoperative complications were graded according to the Clavien–Dindo classification. Regarding the prognosis after RARC, the regression-free survival (RFS), CSS, and overall survival (OS) were calculated using the Kaplan–Meier method. The association between several factors, including the number of dissected LNs and the prognosis, was explored using univariate and multivariate analyses. We explored a better cutoff value for the number of dissected LNs for prognostic stratification by comparing the hazard ratio (HR) and p value among each cutoff value. Prognosis and postoperative complications were compared between the two groups divided according to the cutoff value. Statistical analysis The univariate and multivariate analyses of the factors associated with RFS, CSS, and OS were performed using the Cox proportional hazards regression model. Between-group comparisons regarding RFS, CSS, and OS were performed using the log-rank test. Statistical analyses were performed using JMP Pro 15.0.0 (SAS Institute Inc., Cary, NC, USA), and p < 0.05 was considered statistically significant. Results Clinical characteristics, perioperative laboratory data, surgery-related data, and perioperative data of 304 patients who underwent RARC Table 1 presents the clinical characteristics and preoperative laboratory data of the 304 patients. The median age was 74 years (range, 45–89), and the median body mass index (BMI) was 21.7 kg/m 2 (range: 12.4–30.4). A total of 225 (74.0%) patients were male. Among the patients, 263 (86.5%) had an Eastern Cooperative Oncology Group performance status (PS) of ≤ 1, whereas 37 (12.2%) had a PS of ≥ 2. Eight patients (2.6%) had a history of radical nephroureterectomy. Regarding clinical T stage, 191 (62.8%) patients had cT2 disease, and 113 (37.2%) had ≥ cT3 disease. Neoadjuvant chemotherapy (NAC) was administered to 195 patients (64.1%). Table 1 Patient characteristics and preoperative laboratory data (n = 304) BMI: body mass index; ECOG: Eastern Cooperative Oncology Group; PS: performance status; RNU: radical nephroureterectomy; NAC: neoadjuvant chemotherapy; eGFR: estimated glomerular filtration rate; NLR: neutrophil–lymphocyte ratio; MLR: monocyte–lymphocyte ratio; T-bil: total bilirubin; FAN, fibrosis-4 index, albumin–bilirubin score, and neutrophil–lymphocyte ratio Age (years) median (range) 74 (45–89) Sex n (%) Male 225 (74.0) Female 79 (26.0) ECOG PS n (%) ≤ 1 263 (86.5) ≥ 2 37 (12.2) Unknown 4 ( 1.3) BMI (kg/m 2 ) median (range) 21.7 (14.5–30.4) Past history of RNU n (%) Yes 8 ( 2.6) No 296 (97.4) Clinical T stage n (%) cT2 191 (62.8) ≥ cT3 113 (37.2) NAC n (%) Yes 195 (64.1) No 109 (35.9) eGFR (mL/min/1.73m 2 ) median (range) 55.6 (3.4-176.7) Platelet (10 4 /L) median (range) 23.2 (4.3–76.8) NLR median (range) 2.630 (0.724–18.300) MLR median (range) 0.321 (0.000–8.000) Albumin (g/dL) median (range) 3.8 (1.9–4.6) AST (U/L) median (range) 19 (6-124) ALT (U/L) median (range) 14 (3-115) T-bil (mg/dL) median (range) 0.5 (0.1–2.1) FAN score n (%) 0 144 (47.4) 1 119 (39.1) 2 30 ( 9.9) 3 3 ( 1.0) Unknown 8 ( 2.6) The median estimated glomerular filtration rate was 55.6 (range: 3.4–176.7) mL/min/1.73 m 2 . For peripheral blood count, the median platelet count was 23.2 (range: 4.3–76.8) × 10 4 /L, the median NLR was 2.630 (range: 0.724–18.300), and the median monocyte–lymphocyte ratio (MLR) was 0.321 (range: 0.000–8.000). The median serum levels of albumin, AST, ALT, and T-bil were 3.8 (range: 1.9–4.6) g/dL, 19 (range: 6–124) U/L, 14 (range: 3–115) U/L, and 0.5 (range: 0.1–2.1) g/dL, respectively. The FAN scores were 0, 1, 2, and 3 in 144 (47.4%), 119 (35.9%), 30 (9.9%), and 3 (1.0%) patients, respectively. Table 2 presents the surgery-related and perioperative data of the 304 patients. Urinary diversion involved ileal conduit in 229 (75.3%) patients, neobladder in 17 (5.6%) patients, and ureterocutaneous fistula in 50 (16.5%) patients. Simultaneous nephroureterectomy was performed in 18 (5.9%) patients. The median surgical time was 466 min (range: 163–1,088 min), and the median blood loss was 365 mL (range: 0–4,650) ml. LN dissection was performed in 287 (94,4%) patients, with a median of 14 dissected LNs (range: 0–76). Pathologically, LN metastasis was identified in 54 (17.8%) patients, with a median of 0 metastatic LNs (range: 0–25). Postoperative complications of any grade, grade ≥ 3, and grade ≤ 2 occurred in 146 (48.0%), 54 (17.8%), and 92 (30.2%) patients, respectively. A total of 175 (57.5%) patients required blood transfusions during their hospital stay. The median postoperative hospital stay was 22 days (range: 8–164) days. A total of 249 patients (81.9%) were discharged within 30 postoperative days. Adjuvant therapy, chemotherapy, nivolumab, and no treatment were administered to 28 (9.2%), 24 (7.9%), and 245 (80.6%) patients, respectively. Table 2 Surgery-related and perioperative data (n = 304) Urinary diversion n (%) Ileal conduit 229 (75.3) Neobladder 17 ( 5.6) Ureterocutaneous fistula 50 (16.5) No 8 ( 2.6) Simultaneous nephroureterectomy n (%) Yes 18 ( 5.9) No 286 (89.0) Surgical time (min) median (range) 466 (163-1,088) Blood loss (mL) median (range) 365 ( 0–4,650) LN dissection n (%) Yes 287 (94.4) No 17 ( 5.6) Number of dissected LNs median (range) 14 (0–76) LN metastasis n (%) Yes 54 (17.8) No 250 (82.2) Number of metastatic lymph node median (range) 0 (0–25) Complication n (%) Yes ≥G3 / ≤G2 only 146 (48.0) 54 (17.8) / 92 (30.2) No 158 (52.0) Blood transfusion in hospital stay n (%) Yes 116 (38.2) No 175 (57.5) Unknown 13 ( 4.3) Postoperative hospital stay (day) median (range) 22 (8-164) Discharge within 30 days n (%) Yes 249 (81.9) No 55 (18.1) Adjuvant therapy n (%) Chemotherapy 28 ( 9.2) Nivolumab 24 ( 7.9) No 245 (80.6) Unknown 7 ( 2.3) LN: lymph node Various preoperative and intraoperative factors related to prognosis after RARC We investigated the various preoperative and intraoperative factors associated with RFS (Table 3 ), CSS (Table 4 ), and OS (Table 5 ) by using univariate and multivariate analyses. Table 3 Related factors with RFS (n = 304) Univariate Multivariate Hazard ratio (95% CI) P value Hazard ratio (95% CI) P value Sex Male vs Female 0.926 (0.595–1.442) 0.734 - - PS ≤ 1 vs ≥ 2 0.295 (0.184–0.473) < 0.001* 0.400 (0.235–0.680) < 0.001* BMI (Continuous) 1.000 (1.000-1.022) 0.193 - - Clinical T stage cT2 vs ≥ cT3 0.515 (0.347–0.764) 0.001* 0.513 (0.336–0.786) 0.002* NAC No vs Yes 1.777 (1.196–2.639) 0.004* 1.528 (0.993–2.351) 0.054 FAN score ≤ 1 vs ≥ 2 0.356 (0.229–0.552) < 0.001* 0.467 (0.260–0.837) 0.011* Number of dissected LNs (Continuous) 0.971 (0.951–0.991) 0.005* 0.973 (0.952–0.993) 0.010* RFS: recurrence-free survival; CI: confidence interval; PS: performance status; BMI: body mass index; NAC: neoadjuvant chemotherapy; LN: lymph node; FAN: fibrosis-4 index, albumin–bilirubin score, and neutrophil–lymphocyte ratio Table 4 Related factors with CSS (n = 304) Univariate Multivariate Hazard ratio (95% CI) P value Hazard ratio (95% CI) P value Sex Male vs Female 0.822 (0.487–1.388) 0.464 - - PS ≤ 1 vs ≥ 2 0.347 (0.191–0.630) <0.001* 0.540 (0.270–1.079) 0.081 BMI (Continuous) 1.000 (1.000-1.023) 0.610 - - Clinical T stage cT2 vs ≥ cT3 0.450 (0.278–0.727) 0.001* 0.405 (0.241–0.679) <0.001* NAC No vs Yes 1.586 (1.035–2.428) 0.034* 1.684 (1.003–2.827) 0.049* FAN score ≤ 1 vs ≥ 2 0.200 (0.107–0.376) <0.001* 0.381 (0.184–0.789) 0.009* Number of dissected LNs (Continuous) 0.963 (0.937–0.987) 0.004* 0.964 (0.938–0.989) 0.007* CSS: cancer-specific survival; CI: confidence interval; PS: performance status; BMI: body mass index; NAC: neoadjuvant chemotherapy; LN: lymph node; FAN: fibrosis-4 index, albumin–bilirubin score, and neutrophil–lymphocyte ratio Table 5 Related factors with OS (n = 304) Univariate Multivariate Hazard ratio (95% CI) P value Hazard ratio (95% CI) P value Sex Male vs Female 0.788 (0.491–1.262) 0.321 - - PS ≤ 1 vs ≥ 2 0.414 (0.256–0.670) <0.001* 0.562 (0.307–1.029) 0.062 BMI (Continuous) 1.000 (1.000–1.000) 0.068 0.897 (0.833–0.967) 0.005 Clinical T stage cT2 vs ≥ cT3 0.508 (0.328–0.785) 0.002* 0.588(0.364–0.953) 0.031* NAC No vs Yes 2.044 (1.320–3.162) 0.002* 1.796 (1.126–2.867) 0.014* FAN score ≤ 1 vs ≥ 2 0.187 (0.107–0.326) <0.001* 0.283 (0.150–0.532) < 0.001* Number of dissected LNs (Continuous) 0.963 (0.940–0.986) 0.002* 0.964 (0.941–0.988) 0.003* OS: overall survival; CI: confidence interval; PS: performance status; BMI: body mass index; NAC: neoadjuvant chemotherapy; LN: lymph node; FAN: fibrosis-4 index, albumin–bilirubin score, and neutrophil–lymphocyte ratio In the univariate analysis, RFS was significantly associated with PS (≤ 1 vs. ≥2, p < 0.001), clinical T stage (cT2 vs. ≥cT3, p = 0.001), NAC (no vs. yes, p = 0.004), FAN score (≤ 1 vs. ≥2, p < 0.001), and number of dissected LNs (continuous, p = 0.005). In the multivariate analysis, RFS was significantly associated with PS (p < 0.001), clinical T stage (p = 0.002), FAN score (p = 0.011), and number of dissected LNs (p = 0.010). In the univariate analysis, CSS was significantly associated with PS (≤ 1 vs. ≥2, p < 0.001), clinical T stage (cT2 vs. ≥cT3, p = 0.001), NAC (no vs. yes, p = 0.034), FAN score (≤ 1 vs. ≥2, p < 0.001), and number of dissected LNs (continuous, p = 0.004). In the multivariate analysis, CSS was significantly associated with clinical T stage (p < 0.001), NAC (p = 0.049), FAN score (p = 0.009), and number of dissected LNs (p = 0.007). In the univariate analysis, OS was significantly associated with PS (≤ 1 vs. ≥2, p < 0.001), clinical T stage (cT2 vs. ≥cT3, p = 0.002), NAC (no vs. yes, p = 0.002), FAN score (≤ 1 vs. ≥2, p < 0.001), and number of dissected LNs (continuous, p = 0.002). In the multivariate analysis, OS was significantly associated with BMI (continuous, p = 0.005), clinical T stage (p = 0.031), NAC (p = 0.014), FAN score (p < 0.001), and number of dissected LNs (p = 0.003). Better cutoff value for dissected LNs for the prognostic stratification We explored the optimal cutoff value for the number of dissected LNs for prognostic stratification by comparing the HR and p value among each cutoff value (Fig. 2 ). When the cutoff value was 20, the HR (95% confidence interval) and p value were 0.624 (0.396–0.982) and 0.041 in RFS, respectively; 0.495 (0.275–0.892) and 0.019 in CSS, respectively; and 0.535 (0.317–0.904) and 0.019 in OS, respectively. Table 6 shows the comparison of surgery-related data between patients with < 20 dissected LNs (n = 201) and those with ≥ 20 (n = 103). The patients with ≥ 20 dissected LNs demonstrated significantly longer surgical time (p < 0.001), lower blood loss (p = 0.041), lower rate of complications of any grade or grade ≤ 2 (p = 0.005, 0.009, respectively), and greater number of metastatic LNs (p = 0.030) than those with < 20 dissected LNs. There were no significant differences in the rates of grade 3 postoperative complications or pathologically identified LN metastases between the two groups. Supplemental Table S1 shows the detailed information on postoperative complications. The patients with ≥ 20 dissected LNs demonstrated a significantly lower rate of grade ≤ 3 lymphocele (p = 0.021) and higher rates of ureteral stenosis of any grade and grade ≥ 3 (p = 0.048, both). Supplemental Table S2 shows a summary of the comparisons of other data between the two groups. The patients with ≥ 20 dissected LNs were significantly younger (p = 0.021), had a greater rate of PS ≤ 1 (p = 0.045) and had ≥ cT3 (p = 0.014) compared with those with < 20 dissected LNs. There were no significant differences in the other factors between the two groups. Table 6 Comparison of surgery-related data between groups divided by number of dissected LNs (n = 304) LNs < 20 LNs ≥ 20 P value Surgical time (min) median (range) 447 (163-1,088) 505 (261–852) < 0.001* Blood loss (mL) median (range) 410 ( 0–3,073) 340 ( 0–4,650) 0.041* Complications n (%) All grade 108 (53.7) 38 (36.9) 0.005* Grade ≥ 3 39 (19.4) 15 (14.6) 0.296 Grade ≤ 2 only 69 (34.3) 23 (22.3) 0.009* Lymph node metastasis n (%) 31 (15.4) 23 (22.3) 0.254 Number of metastatic LNs median (range) 0 (0–13) 0 (0–25) 0.030* LN: lymph node Figure 3 shows the comparisons of the prognosis between the two groups. The patients with ≥ 20 dissected LNs had significantly better RFS (p = 0.041), CSS (p = 0.019), and OS (p = 0.019) than those with < 20 dissected LNs. Discussion This study revealed that the number of dissected LNs contributed to a good prognosis after RARC for MIBC without LN metastasis at clinical staging. A meta-analysis of 25 previous reports showed that a greater number of dissected LNs was associated with more favorable outcomes in patients treated with RC [ 14 ]. In a previous report, ≥ 16 dissected LNs during RC was associated with CSS [ 3 ]; therefore, ≥ 16 dissected LNs was considered as an important factor of RC [ 4 ]. In the current study, a cutoff value of 20 enabled better prognostic stratification than a cutoff value of 16. This difference may be caused by chronological improvements in surgical procedures or the difference between RARC and open/laparoscopic RC. We also investigated the association of various preoperative and intraoperative factors, including the number of dissected LNs, with the prognosis of patients with bladder cancer and regional LN metastasis (n = 38, Supplemental Table S3 ). The number of dissected LNs was not significantly associated with the prognosis in this group. In the univariate analysis, NAC was significantly associated with CSS (p = 0.002) and OS (p = 0.003), and FAN score (≤ 1 vs. ≥2) was significantly associated with RFS (p < 0.001), CSS (p = 0.036), and OS (p = 0.049). Moreover, the cutoff value of 20 dissected LNs did not enable prognostic stratification in the group (Supplemental Fig. S1 ). Although the number of cases was small, the results suggest that the number of dissected LNs did not contribute to an improvement in the prognosis of patients with regional LN metastases who underwent RARC. Neoadjuvant systemic treatment might result in improved survival, similar to that reported in recent studies [ 15 , 16 ]. The clinical significance of LN dissection in patients with NMIBC remains controversial. A report using the National Cancer Database of the United States demonstrated that LN dissection in patients with cT1 NMIBC resulted in the pathological identification of LN metastasis in 13.3% of cases and better OS than patients who did not undergo LN dissection [ 17 ]. In another study, LN dissection was not a significant prognostic factor in patients preoperatively diagnosed with NMIBC [ 18 ]. Owing to the difficulty in accurately diagnosing NMIBC, we did not analyze LN dissection during RARC in patients with NMIBC in this cohort. Although the scale of this study was comparatively large, it had certain limitations. First, this study had a retrospective design and limited patient information. Incomplete records or selection bias may have affected the data collection. The indicators for performing RC or LN dissection in patients with bladder cancer depend on the treatment strategy of each institution, which may lead to selection bias. Moreover, the number of dissected LNs may depend on the pathologist at each institution. There were significant differences in the number of dissected LNs among the institutions (Supplemental Fig. S2 ). It is important to standardize the surgical techniques and perioperative management strategies in each institution for a more accurate analysis of the prognosis and complications. Finally, the geographical area investigated in this study was limited to Osaka, Japan. Further studies with larger cohorts are required to validate these results. In conclusion, the number of dissected LNs contributed to good prognosis after RARC for MIBC without LN metastasis at clinical staging and without a higher rate of postoperative complications. A cutoff value of 20 enabled clear prognostic stratification in this study. Statements and Declarations Acknowledgments The authors would like to thank the patients and their families for participating in this study as well as the staff for supporting this study. We would like to thank Editage (www.editage.jp) for the English language editing. Funding The authors did not receive support from any organization for the submitted work. Competing interests All authors declare that they have no conflicts of interest. Ethics approval and consent to participate This study was approved by the Institutional Review Board of Osaka University Hospital (No. 23530), and the need for consent to participate was waived. This study was conducted in accordance with the Declaration of Helsinki. Data availability All data generated or analyzed during this study are included in this published article and its supplementary information files. Clinical trial number Not applicable. Consent to publish declaration Not applicable. 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(2021) FAN score comprising fibrosis-4 index, albumin-bilirubin score and neutrophil-lymphocyte ratio is a prognostic marker of urothelial carcinoma patients treated with pembrolizumab. Sci Rep 11:21199. https://doi.org/10.1038/s41598-021-00509-x Ishizuya Y, Kawashima A, Horibe Y et al. (2025) FAN score predicts prognosis after platinum-based first-line chemotherapy in patients with metastatic urothelial carcinoma. Sci Rep 15:4640. https://doi.org/10.1038/s41598-025-86212-7 Li F, Hong X, Hou L et al. (2016) A greater number of dissected lymph nodes is associated with more favorable outcomes in bladder cancer treated by radical cystectomy: a meta-analysis. Oncotarget 7:61284–61294. https://doi.org/10.18632/oncotarget Crocerossa F, Autorino R, Carbonara U et al. (2022) Extent of lymph node dissection and impact on survival in radical cystectomy for advanced bladder cancer. Curr Opin Urol 32:607–613. https://doi.org/10.1097/MOU.0000000000001035 von Deimling M, Furrer M, Mertens LS et al (2024) Impact of the extent of lymph node dissection on survival outcomes in clinically lymph node-positive bladder cancer. BJU Int 133:341–350. https://doi.org/10.1111/bju.16210 Moldovan M, Nam P, Satpathy Y et al. (2024) Oncological and Survival Outcomes of Pelvic Lymph Node Dissection in Patients with Nonmuscle Invasive Bladder Cancer Undergoing Radical Cystectomy Using the National Cancer Database. Clin Genitourin Cancer 22:102197. https://doi.org/10.1016/j.clgc.2024.102197 Sazuka T, Taoka R, Miki J et al. (2025) Impact of lymph-node dissection during radical cystectomy for non-muscle-invasive bladder cancer: Japanese multicenter retrospective study. Int J Clin Oncol 30:1417–1425. https://doi.org/10.1007/s10147-025-02778-2 Additional Declarations No competing interests reported. Supplementary Files FigureS1clean.jpg Supplemental Fig. S1 Stratification of RFS, CSS, and OS with a cutoff value of 20 dissected LNs in patients with regional LN metastases (cN1-3M0, n = 38) using the Kaplan–Meier method RFS, recurrence-free survival; CSS, cancer-specific survival; OS, overall survival; HR, hazard ratio; CI, confidence interval; LN, lymph node FigureS2clean.jpg Supplemental Fig. S2 (A–L) Comparison of the number of dissected LNs between institutions. “L” represents the academic institution defined as control. *: p < 0.05 LN; lymph node TableS1clean.docx TableS2clean.docx TableS3clean.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-8551382\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":581525734,\"identity\":\"b7493b0e-3795-4f4e-bdae-c88abe3cf321\",\"order_by\":0,\"name\":\"Takuji Hayashi\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"The University of Osaka Graduate School of Medicine\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Takuji\",\"middleName\":\"\",\"lastName\":\"Hayashi\",\"suffix\":\"\"},{\"id\":581525735,\"identity\":\"d03ff646-1536-4d15-b9de-323f31241854\",\"order_by\":1,\"name\":\"Atsunari Kawashima\",\"email\":\"data:image/png;base64,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\",\"orcid\":\"\",\"institution\":\"The University of Osaka Graduate School of Medicine\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Atsunari\",\"middleName\":\"\",\"lastName\":\"Kawashima\",\"suffix\":\"\"},{\"id\":581525736,\"identity\":\"229260b3-7497-4e4f-b259-3e5385e4f806\",\"order_by\":2,\"name\":\"Masao Tsujihata\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Osaka Rosai Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Masao\",\"middleName\":\"\",\"lastName\":\"Tsujihata\",\"suffix\":\"\"},{\"id\":581525737,\"identity\":\"9ffefda1-d6f9-4de1-a5a8-282e6e9b5ea6\",\"order_by\":3,\"name\":\"Tetsuya Takao\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Osaka General Medical Center\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Tetsuya\",\"middleName\":\"\",\"lastName\":\"Takao\",\"suffix\":\"\"},{\"id\":581525743,\"identity\":\"b298ff5d-546f-4581-9eb3-eca3ca4a9e3c\",\"order_by\":4,\"name\":\"Osamu Miyake\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Toyonaka Municipal Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Osamu\",\"middleName\":\"\",\"lastName\":\"Miyake\",\"suffix\":\"\"},{\"id\":581525746,\"identity\":\"46446595-61a4-4694-abfb-6084c0d79b0d\",\"order_by\":5,\"name\":\"Koji Yazawa\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Osaka Keisatsu Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Koji\",\"middleName\":\"\",\"lastName\":\"Yazawa\",\"suffix\":\"\"},{\"id\":581525753,\"identity\":\"261fe9ba-acaf-4f05-a309-e665e0e7e939\",\"order_by\":6,\"name\":\"Yutaka Ono\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Higashiosaka City Medical Center\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Yutaka\",\"middleName\":\"\",\"lastName\":\"Ono\",\"suffix\":\"\"},{\"id\":581525754,\"identity\":\"8dc5a2e5-cde7-4857-b33d-db43007afdcc\",\"order_by\":7,\"name\":\"Hitoshi Takayama\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Sakai City Medical Center\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Hitoshi\",\"middleName\":\"\",\"lastName\":\"Takayama\",\"suffix\":\"\"},{\"id\":581525756,\"identity\":\"abad4300-5da7-4306-b6c8-b9553f80a40c\",\"order_by\":8,\"name\":\"Tsuyoshi Takada\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Minoh City Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Tsuyoshi\",\"middleName\":\"\",\"lastName\":\"Takada\",\"suffix\":\"\"},{\"id\":581525758,\"identity\":\"d039cf22-5bb1-46c8-b01e-ec6e3e634638\",\"order_by\":9,\"name\":\"Kensaku Nishimura\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Osaka National Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Kensaku\",\"middleName\":\"\",\"lastName\":\"Nishimura\",\"suffix\":\"\"},{\"id\":581525762,\"identity\":\"ba25e1db-f473-4f37-aac2-6243c263510a\",\"order_by\":10,\"name\":\"Hidefumi Kishikawa\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hyogo Prefectural Nishinomiya Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Hidefumi\",\"middleName\":\"\",\"lastName\":\"Kishikawa\",\"suffix\":\"\"},{\"id\":581525763,\"identity\":\"aba897d6-4b6f-4851-8665-6275af92c952\",\"order_by\":11,\"name\":\"Hitoshi Inoue\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Ikeda City Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Hitoshi\",\"middleName\":\"\",\"lastName\":\"Inoue\",\"suffix\":\"\"},{\"id\":581525766,\"identity\":\"7847c407-1435-44a4-8f1b-667683f1da9f\",\"order_by\":12,\"name\":\"Ken-ichi Kakimoto\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Nippon Life Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Ken-ichi\",\"middleName\":\"\",\"lastName\":\"Kakimoto\",\"suffix\":\"\"},{\"id\":581525769,\"identity\":\"f11d677a-f215-44e8-a542-f82293b357e3\",\"order_by\":13,\"name\":\"Akira Nagahara\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Osaka International Cancer Institute\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Akira\",\"middleName\":\"\",\"lastName\":\"Nagahara\",\"suffix\":\"\"},{\"id\":581525773,\"identity\":\"7e8c86c1-7c42-41e3-a064-cfec20291faa\",\"order_by\":14,\"name\":\"Yu Iashizuya\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"The University of Osaka Graduate School of Medicine\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Yu\",\"middleName\":\"\",\"lastName\":\"Iashizuya\",\"suffix\":\"\"},{\"id\":581525775,\"identity\":\"260b0ccc-b8ca-4d01-982c-1804cd725166\",\"order_by\":15,\"name\":\"Yoshiyuki Yamamoto\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"The University of Osaka Graduate School of Medicine\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Yoshiyuki\",\"middleName\":\"\",\"lastName\":\"Yamamoto\",\"suffix\":\"\"},{\"id\":581525777,\"identity\":\"7c838d47-844a-4e7e-9300-fd55653d716d\",\"order_by\":16,\"name\":\"Taigo Kato\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"The University of Osaka Graduate School of Medicine\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Taigo\",\"middleName\":\"\",\"lastName\":\"Kato\",\"suffix\":\"\"},{\"id\":581525778,\"identity\":\"59e97427-1682-4919-aaf6-7efafeed35d3\",\"order_by\":17,\"name\":\"Koji Hatano\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"The University of Osaka Graduate School of Medicine\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Koji\",\"middleName\":\"\",\"lastName\":\"Hatano\",\"suffix\":\"\"},{\"id\":581525780,\"identity\":\"4a4c555b-9ec8-488f-b4be-99acf35c1dc5\",\"order_by\":18,\"name\":\"Norio Nonomura\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"The University of Osaka Graduate School of Medicine\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Norio\",\"middleName\":\"\",\"lastName\":\"Nonomura\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2026-01-08 13:52:22\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-8551382/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-8551382/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":101404814,\"identity\":\"8b8d049a-8da5-4c92-a594-e26ea445c3d8\",\"added_by\":\"auto\",\"created_at\":\"2026-01-29 10:37:54\",\"extension\":\"jpg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":127371,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eSchematic diagram of the criteria in this study. Patients with MIBC and without metastases (cT2–T4N0M0, n = 304) were extracted from 535 patients who underwent RARC at our affiliated institutions from April 2010 to March 2024\\u003c/p\\u003e\\n\\u003cp\\u003eRARC, robot-assisted radical cystectomy; MIBC, muscle-invasive bladder cancer; NMIBC, non-muscle-invasive bladder cancer; LN, lymph node\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure1clean.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8551382/v1/c41c7c051f193e96bcb477e7.jpg\"},{\"id\":101751526,\"identity\":\"397a15fc-c559-49f6-b2bf-ccd660c96a12\",\"added_by\":\"auto\",\"created_at\":\"2026-02-03 10:21:02\",\"extension\":\"jpg\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":96019,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eHR (95% CI) and p value of each cutoff value for dissected LNs for the stratification of RFS, CSS, and OS after RARC\\u003c/p\\u003e\\n\\u003cp\\u003eHR, hazard ratio; CI, confidence interval; LN, lymph node; RFS, recurrence-free survival; CSS, cancer-specific survival; OS, overall survival; RARC, robot-assisted radical cystectomy\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure2clean.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8551382/v1/68c7c63af2f4d7a191069998.jpg\"},{\"id\":101404822,\"identity\":\"db1f6e50-57b0-451c-ac89-e8e34def28ba\",\"added_by\":\"auto\",\"created_at\":\"2026-01-29 10:37:54\",\"extension\":\"jpg\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":100253,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eStratification of RFS, CSS, and OS with a cutoff value of 20 dissected LNs using the Kaplan–Meier method.\\u003c/p\\u003e\\n\\u003cp\\u003eRFS, recurrence-free survival; CSS, cancer-specific survival; OS, overall survival; HR, hazard ratio; CI, confidence interval; LN, lymph node\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure3clean.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8551382/v1/43ff413824a504205fa9e4c6.jpg\"},{\"id\":104402609,\"identity\":\"005b986a-c6cb-4ee3-af0a-de6ffb29f5a7\",\"added_by\":\"auto\",\"created_at\":\"2026-03-11 12:15:53\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1661616,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8551382/v1/e368effa-25c6-4c0a-beee-821e8b872b0d.pdf\"},{\"id\":101404821,\"identity\":\"45ea69b3-d0f9-4c0b-b040-71303787ef14\",\"added_by\":\"auto\",\"created_at\":\"2026-01-29 10:37:54\",\"extension\":\"jpg\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":88060,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cu\\u003e\\u003cstrong\\u003eSupplemental Fig. S1\\u003c/strong\\u003e\\u003c/u\\u003e Stratification of RFS, CSS, and OS with a cutoff value of 20 dissected LNs in patients with regional LN metastases (cN1-3M0, n = 38) using the Kaplan–Meier method\\u003c/p\\u003e\\n\\u003cp\\u003eRFS, recurrence-free survival; CSS, cancer-specific survival; OS, overall survival; HR, hazard ratio; CI, confidence interval; LN, lymph node\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"FigureS1clean.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8551382/v1/4be368e8358e6fe7e6eeab8a.jpg\"},{\"id\":101404815,\"identity\":\"29117b0b-da1e-4767-a606-5e6ccc4fa311\",\"added_by\":\"auto\",\"created_at\":\"2026-01-29 10:37:54\",\"extension\":\"jpg\",\"order_by\":2,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":71000,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cu\\u003e\\u003cstrong\\u003eSupplemental Fig. S2\\u003c/strong\\u003e\\u003c/u\\u003e (A–L) Comparison of the number of dissected LNs between institutions. “L” represents the academic institution defined as control. *: p \\u0026lt; 0.05\\u003c/p\\u003e\\n\\u003cp\\u003eLN; lymph node\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"FigureS2clean.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8551382/v1/2e71d299cdcc433d9d8b065d.jpg\"},{\"id\":101404817,\"identity\":\"bc4db77e-ffee-4b8f-a92a-651bc9c26145\",\"added_by\":\"auto\",\"created_at\":\"2026-01-29 10:37:54\",\"extension\":\"docx\",\"order_by\":3,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":21765,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"TableS1clean.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8551382/v1/61f02377ca449307e3c3bebd.docx\"},{\"id\":101404820,\"identity\":\"1f35d1a3-9459-4823-a4cd-b2cfb1562018\",\"added_by\":\"auto\",\"created_at\":\"2026-01-29 10:37:54\",\"extension\":\"docx\",\"order_by\":4,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":25283,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"TableS2clean.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8551382/v1/ada7b308a90823b2be70ced7.docx\"},{\"id\":101751691,\"identity\":\"508ee138-2b31-4686-a4d4-1891962d478c\",\"added_by\":\"auto\",\"created_at\":\"2026-02-03 10:22:26\",\"extension\":\"docx\",\"order_by\":5,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":21754,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"TableS3clean.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8551382/v1/691004c97fac2c835839ad37.docx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"The number of dissected lymph nodes contributes to good prognosis after robot-assisted radical cystectomy for muscle-invasive bladder cancer without lymph node metastasis at clinical staging\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eRadical cystectomy (RC) with pelvic lymph node (LN) dissection is a curative treatment option for patients with muscle-invasive bladder cancer (MIBC) or high-risk non-MIBC (NMIBC) without metastasis [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. The number of LNs dissected during RC is associated with cancer-specific survival (CSS) in patients without LN metastasis [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. On the basis of this report, 16 dissected LNs were defined as one of the oncological trifecta and pentafecta of RC for organ-confined urothelial carcinoma [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eRobot-assisted RC (RARC) has become the standard procedure because it offers a less invasive surgical approach than open or laparoscopic RC. A meta-analysis of randomized controlled trials demonstrated that RARC is less invasive than open RC in terms of reduced blood loss and perioperative blood transfusion [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. However, no differences in prognosis have been observed between RARC and open RC [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. Several reports suggested that the oncological pentafecta with \\u0026ge;\\u0026thinsp;16 dissected LNs is one of the useful tools for assessing the quality of RC in the \\u0026ldquo;RARC\\u0026rdquo; era [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eRecently, two prospective randomized trials revealed that extended LN dissection, which is defined as the dissection of LNs toward the cranial side of the bilateral common iliac region, in RC did not result in improved prognosis in patients with bladder cancer [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. Lerner et al. reported that extended LN dissection is associated with higher perioperative morbidity and mortality [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. These results suggest that the number of dissected LNs, rather than their anatomical extent, may contribute to a better prognosis in patients with bladder cancer undergoing RC.\\u003c/p\\u003e \\u003cp\\u003eWe previously reported that the FAN score, which consists of the fibrosis-4 (Fib-4) index, albumin\\u0026ndash;bilirubin (ALBI) score, and neutrophil\\u0026ndash;lymphocyte ratio (NLR), is a prognostic marker for patients with urothelial carcinoma [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eIn this study, we aimed to investigate the association between the number of dissected LNs without extended LN dissection in RARC and the prognosis of MIBC while accounting for other preoperative factors, including the FAN score.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStudy design\\u003c/h2\\u003e \\u003cp\\u003eWe included 535 patients with bladder cancer who underwent RARC at The University of Osaka Hospital and 12 affiliated institutions between April 2010 and March 2024. No patient underwent extended LN dissection during RARC. Among the enrolled patients, 304 had MIBC without metastasis (cT2\\u0026ndash;T4N0M0), 38 had regional LN metastasis (cN1\\u0026ndash;N3M0), and 8 had distant metastasis (cM1) (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). This study was approved by the Institutional Review Board of Osaka University Hospital (approval no. 23530).\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003eWe collected the clinical characteristics, preoperative laboratory data, and surgery-related and perioperative data of patients with MIBC without metastasis (n\\u0026thinsp;=\\u0026thinsp;304). The Fib-4 index was calculated as follows: age (years) \\u0026times; AST (U/L) / (platelet count [103/\\u0026micro;L] \\u0026times; (ALT [U/L] 0.5), where AST and ALT denote aspartate aminotransferase and alanine aminotransferase, respectively. The ALBI score was calculated using the following formula: log10 (T-bil [mg/dL] \\u0026times; 17.1) \\u0026times; 0.66\\u0026thinsp;+\\u0026thinsp;albumin [mg/dL] \\u0026times; 10(\\u0026minus;\\u0026thinsp;0.085), where T-bil is the total bilirubin. The cutoff values were Fib-4 index\\u0026thinsp;\\u0026gt;\\u0026thinsp;3.5, ALBI score\\u0026thinsp;\\u0026gt;\\u0026thinsp;\\u0026minus;\\u0026thinsp;2.6, and NLR\\u0026thinsp;\\u0026gt;\\u0026thinsp;5.0. Postoperative complications were graded according to the Clavien\\u0026ndash;Dindo classification. Regarding the prognosis after RARC, the regression-free survival (RFS), CSS, and overall survival (OS) were calculated using the Kaplan\\u0026ndash;Meier method. The association between several factors, including the number of dissected LNs and the prognosis, was explored using univariate and multivariate analyses.\\u003c/p\\u003e \\u003cp\\u003eWe explored a better cutoff value for the number of dissected LNs for prognostic stratification by comparing the hazard ratio (HR) and p value among each cutoff value. Prognosis and postoperative complications were compared between the two groups divided according to the cutoff value.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec4\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStatistical analysis\\u003c/h2\\u003e \\u003cp\\u003eThe univariate and multivariate analyses of the factors associated with RFS, CSS, and OS were performed using the Cox proportional hazards regression model. Between-group comparisons regarding RFS, CSS, and OS were performed using the log-rank test. Statistical analyses were performed using JMP Pro 15.0.0 (SAS Institute Inc., Cary, NC, USA), and p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05 was considered statistically significant.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003e \\u003cem\\u003eClinical characteristics, perioperative laboratory data, surgery-related data, and perioperative data of 304 patients who underwent RARC\\u003c/em\\u003e \\u003c/p\\u003e \\u003cp\\u003eTable\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e presents the clinical characteristics and preoperative laboratory data of the 304 patients. The median age was 74 years (range, 45\\u0026ndash;89), and the median body mass index (BMI) was 21.7 kg/m\\u003csup\\u003e2\\u003c/sup\\u003e (range: 12.4\\u0026ndash;30.4). A total of 225 (74.0%) patients were male. Among the patients, 263 (86.5%) had an Eastern Cooperative Oncology Group performance status (PS) of \\u0026le;\\u0026thinsp;1, whereas 37 (12.2%) had a PS of \\u0026ge;\\u0026thinsp;2. Eight patients (2.6%) had a history of radical nephroureterectomy. Regarding clinical T stage, 191 (62.8%) patients had cT2 disease, and 113 (37.2%) had\\u0026thinsp;\\u0026ge;\\u0026thinsp;cT3 disease. Neoadjuvant chemotherapy (NAC) was administered to 195 patients (64.1%).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003ePatient characteristics and preoperative laboratory data (n\\u0026thinsp;=\\u0026thinsp;304) BMI: body mass index; ECOG: Eastern Cooperative Oncology Group; PS: performance status; RNU: radical nephroureterectomy; NAC: neoadjuvant chemotherapy; eGFR: estimated glomerular filtration rate; NLR: neutrophil\\u0026ndash;lymphocyte ratio; MLR: monocyte\\u0026ndash;lymphocyte ratio; T-bil: total bilirubin; FAN, fibrosis-4 index, albumin\\u0026ndash;bilirubin score, and neutrophil\\u0026ndash;lymphocyte ratio\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"3\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eAge (years) median (range)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e74 (45\\u0026ndash;89)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eSex\\u003c/p\\u003e \\u003cp\\u003en (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e225 (74.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFemale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e79 (26.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eECOG PS\\u003c/p\\u003e \\u003cp\\u003en (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026le;\\u0026thinsp;1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e263 (86.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026ge;\\u0026thinsp;2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e37 (12.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUnknown\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e4 ( 1.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eBMI (kg/m\\u003csup\\u003e2\\u003c/sup\\u003e) median (range)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e21.7 (14.5\\u0026ndash;30.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003ePast history of RNU\\u003c/p\\u003e \\u003cp\\u003en (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8 ( 2.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e296 (97.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eClinical T stage\\u003c/p\\u003e \\u003cp\\u003en (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ecT2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e191 (62.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026ge; cT3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e113 (37.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eNAC\\u003c/p\\u003e \\u003cp\\u003en (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e195 (64.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e109 (35.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eeGFR (mL/min/1.73m\\u003csup\\u003e2\\u003c/sup\\u003e) median (range)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e55.6 (3.4-176.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003ePlatelet (10\\u003csup\\u003e4\\u003c/sup\\u003e/L) median (range)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e23.2 (4.3\\u0026ndash;76.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eNLR median (range)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2.630 (0.724\\u0026ndash;18.300)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eMLR median (range)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.321 (0.000\\u0026ndash;8.000)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eAlbumin (g/dL) median (range)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3.8 (1.9\\u0026ndash;4.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eAST (U/L) median (range)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e19 (6-124)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eALT (U/L) median (range)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e14 (3-115)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eT-bil (mg/dL) median (range)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.5 (0.1\\u0026ndash;2.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"4\\\" rowspan=\\\"5\\\"\\u003e \\u003cp\\u003eFAN score\\u003c/p\\u003e \\u003cp\\u003en (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e144 (47.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e119 (39.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e30 ( 9.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3 ( 1.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUnknown\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8 ( 2.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eThe median estimated glomerular filtration rate was 55.6 (range: 3.4\\u0026ndash;176.7) mL/min/1.73 m\\u003csup\\u003e2\\u003c/sup\\u003e. For peripheral blood count, the median platelet count was 23.2 (range: 4.3\\u0026ndash;76.8) \\u0026times; 10\\u003csup\\u003e4\\u003c/sup\\u003e/L, the median NLR was 2.630 (range: 0.724\\u0026ndash;18.300), and the median monocyte\\u0026ndash;lymphocyte ratio (MLR) was 0.321 (range: 0.000\\u0026ndash;8.000). The median serum levels of albumin, AST, ALT, and T-bil were 3.8 (range: 1.9\\u0026ndash;4.6) g/dL, 19 (range: 6\\u0026ndash;124) U/L, 14 (range: 3\\u0026ndash;115) U/L, and 0.5 (range: 0.1\\u0026ndash;2.1) g/dL, respectively. The FAN scores were 0, 1, 2, and 3 in 144 (47.4%), 119 (35.9%), 30 (9.9%), and 3 (1.0%) patients, respectively.\\u003c/p\\u003e \\u003cp\\u003eTable\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e presents the surgery-related and perioperative data of the 304 patients. Urinary diversion involved ileal conduit in 229 (75.3%) patients, neobladder in 17 (5.6%) patients, and ureterocutaneous fistula in 50 (16.5%) patients. Simultaneous nephroureterectomy was performed in 18 (5.9%) patients. The median surgical time was 466 min (range: 163\\u0026ndash;1,088 min), and the median blood loss was 365 mL (range: 0\\u0026ndash;4,650) ml. LN dissection was performed in 287 (94,4%) patients, with a median of 14 dissected LNs (range: 0\\u0026ndash;76). Pathologically, LN metastasis was identified in 54 (17.8%) patients, with a median of 0 metastatic LNs (range: 0\\u0026ndash;25). Postoperative complications of any grade, grade\\u0026thinsp;\\u0026ge;\\u0026thinsp;3, and grade\\u0026thinsp;\\u0026le;\\u0026thinsp;2 occurred in 146 (48.0%), 54 (17.8%), and 92 (30.2%) patients, respectively. A total of 175 (57.5%) patients required blood transfusions during their hospital stay. The median postoperative hospital stay was 22 days (range: 8\\u0026ndash;164) days. A total of 249 patients (81.9%) were discharged within 30 postoperative days. Adjuvant therapy, chemotherapy, nivolumab, and no treatment were administered to 28 (9.2%), 24 (7.9%), and 245 (80.6%) patients, respectively.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eSurgery-related and perioperative data (n\\u0026thinsp;=\\u0026thinsp;304)\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"3\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e \\u003cp\\u003eUrinary diversion\\u003c/p\\u003e \\u003cp\\u003en (%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIleal conduit\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e229 (75.3)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNeobladder\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e17 ( 5.6)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUreterocutaneous fistula\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e50 (16.5)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8 ( 2.6)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eSimultaneous nephroureterectomy\\u003c/p\\u003e \\u003cp\\u003en (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e18 ( 5.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e286 (89.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eSurgical time (min) median (range)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e466 (163-1,088)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eBlood loss (mL) median (range)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e365 ( 0\\u0026ndash;4,650)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eLN dissection\\u003c/p\\u003e \\u003cp\\u003en (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e287 (94.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e17 ( 5.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eNumber of dissected LNs median (range)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e14 (0\\u0026ndash;76)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eLN metastasis\\u003c/p\\u003e \\u003cp\\u003en (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e54 (17.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e250 (82.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eNumber of metastatic lymph node median (range)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0 (0\\u0026ndash;25)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eComplication\\u003c/p\\u003e \\u003cp\\u003en (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003cp\\u003e\\u0026ge;G3 / \\u0026le;G2 only\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e146 (48.0)\\u003c/p\\u003e \\u003cp\\u003e54 (17.8) / 92 (30.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e158 (52.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eBlood transfusion in hospital stay\\u003c/p\\u003e \\u003cp\\u003en (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e116 (38.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e175 (57.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUnknown\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e13 ( 4.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003ePostoperative hospital stay (day) median (range)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e22 (8-164)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eDischarge within 30 days\\u003c/p\\u003e \\u003cp\\u003en (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e249 (81.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e55 (18.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e \\u003cp\\u003eAdjuvant therapy\\u003c/p\\u003e \\u003cp\\u003en (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eChemotherapy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e28 ( 9.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNivolumab\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e24 ( 7.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e245 (80.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUnknown\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7 ( 2.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"3\\\"\\u003e\\u003cb\\u003eLN: lymph node\\u003c/b\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e\\n\\u003ch3\\u003eVarious preoperative and intraoperative factors related to prognosis after RARC\\u003c/h3\\u003e\\n\\u003cp\\u003eWe investigated the various preoperative and intraoperative factors associated with RFS (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e), CSS (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e), and OS (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab5\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e) by using univariate and multivariate analyses.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eRelated factors with RFS (n\\u0026thinsp;=\\u0026thinsp;304)\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"6\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eUnivariate\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e \\u003cp\\u003eMultivariate\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eHazard ratio (95% CI)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eP value\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eHazard ratio (95% CI)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eP value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSex\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMale vs Female\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.926 (0.595\\u0026ndash;1.442)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.734\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026le;\\u0026thinsp;1 vs\\u0026thinsp;\\u0026ge;\\u0026thinsp;2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.295 (0.184\\u0026ndash;0.473)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.400 (0.235\\u0026ndash;0.680)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eBMI (Continuous)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.000 (1.000-1.022)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.193\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eClinical T stage\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ecT2 vs\\u0026thinsp;\\u0026ge;\\u0026thinsp;cT3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.515 (0.347\\u0026ndash;0.764)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.001*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.513 (0.336\\u0026ndash;0.786)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.002*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNAC\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo vs Yes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.777 (1.196\\u0026ndash;2.639)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.004*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.528 (0.993\\u0026ndash;2.351)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.054\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFAN score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026le;\\u0026thinsp;1 vs\\u0026thinsp;\\u0026ge;\\u0026thinsp;2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.356 (0.229\\u0026ndash;0.552)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.467 (0.260\\u0026ndash;0.837)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.011*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eNumber of dissected LNs (Continuous)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.971 (0.951\\u0026ndash;0.991)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.005*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.973 (0.952\\u0026ndash;0.993)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.010*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"6\\\"\\u003e\\u003cb\\u003eRFS: recurrence-free survival; CI: confidence interval; PS: performance status; BMI: body mass index; NAC: neoadjuvant chemotherapy; LN: lymph node; FAN: fibrosis-4 index, albumin\\u0026ndash;bilirubin score, and neutrophil\\u0026ndash;lymphocyte ratio\\u003c/b\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eRelated factors with CSS (n\\u0026thinsp;=\\u0026thinsp;304)\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"6\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eUnivariate\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e \\u003cp\\u003eMultivariate\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eHazard ratio (95% CI)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eP value\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eHazard ratio (95% CI)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eP value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSex\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMale vs Female\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.822 (0.487\\u0026ndash;1.388)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.464\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026le;\\u0026thinsp;1 vs\\u0026thinsp;\\u0026ge;\\u0026thinsp;2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.347 (0.191\\u0026ndash;0.630)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.001*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.540 (0.270\\u0026ndash;1.079)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.081\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eBMI (Continuous)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.000 (1.000-1.023)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.610\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eClinical T stage\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ecT2 vs\\u0026thinsp;\\u0026ge;\\u0026thinsp;cT3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.450 (0.278\\u0026ndash;0.727)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.001*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.405 (0.241\\u0026ndash;0.679)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.001*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNAC\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo vs Yes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.586 (1.035\\u0026ndash;2.428)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.034*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.684 (1.003\\u0026ndash;2.827)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.049*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFAN score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026le;\\u0026thinsp;1 vs\\u0026thinsp;\\u0026ge;\\u0026thinsp;2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.200 (0.107\\u0026ndash;0.376)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.001*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.381 (0.184\\u0026ndash;0.789)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.009*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eNumber of dissected LNs (Continuous)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.963 (0.937\\u0026ndash;0.987)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.004*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.964 (0.938\\u0026ndash;0.989)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.007*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"6\\\"\\u003e\\u003cb\\u003eCSS: cancer-specific survival; CI: confidence interval; PS: performance status; BMI: body mass index; NAC: neoadjuvant chemotherapy; LN: lymph node; FAN: fibrosis-4 index, albumin\\u0026ndash;bilirubin score, and neutrophil\\u0026ndash;lymphocyte ratio\\u003c/b\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab5\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 5\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eRelated factors with OS (n\\u0026thinsp;=\\u0026thinsp;304)\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"6\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eUnivariate\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e \\u003cp\\u003eMultivariate\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eHazard ratio (95% CI)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eP value\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eHazard ratio (95% CI)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eP value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSex\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMale vs Female\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.788 (0.491\\u0026ndash;1.262)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.321\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026le;\\u0026thinsp;1 vs\\u0026thinsp;\\u0026ge;\\u0026thinsp;2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.414 (0.256\\u0026ndash;0.670)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.001*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.562 (0.307\\u0026ndash;1.029)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.062\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eBMI (Continuous)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.000 (1.000\\u0026ndash;1.000)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.068\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.897 (0.833\\u0026ndash;0.967)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.005\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eClinical T stage\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ecT2 vs\\u0026thinsp;\\u0026ge;\\u0026thinsp;cT3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.508 (0.328\\u0026ndash;0.785)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.002*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.588(0.364\\u0026ndash;0.953)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.031*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNAC\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo vs Yes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2.044 (1.320\\u0026ndash;3.162)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.002*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.796 (1.126\\u0026ndash;2.867)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.014*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFAN score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026le;\\u0026thinsp;1 vs\\u0026thinsp;\\u0026ge;\\u0026thinsp;2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.187 (0.107\\u0026ndash;0.326)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.001*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.283 (0.150\\u0026ndash;0.532)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eNumber of dissected LNs (Continuous)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.963 (0.940\\u0026ndash;0.986)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.002*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.964 (0.941\\u0026ndash;0.988)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.003*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"6\\\"\\u003e\\u003cb\\u003eOS: overall survival; CI: confidence interval; PS: performance status; BMI: body mass index; NAC: neoadjuvant chemotherapy; LN: lymph node; FAN: fibrosis-4 index, albumin\\u0026ndash;bilirubin score, and neutrophil\\u0026ndash;lymphocyte ratio\\u003c/b\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eIn the univariate analysis, RFS was significantly associated with PS (\\u0026le;\\u0026thinsp;1 vs. \\u0026ge;2, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), clinical T stage (cT2 vs. \\u0026ge;cT3, p\\u0026thinsp;=\\u0026thinsp;0.001), NAC (no vs. yes, p\\u0026thinsp;=\\u0026thinsp;0.004), FAN score (\\u0026le;\\u0026thinsp;1 vs. \\u0026ge;2, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), and number of dissected LNs (continuous, p\\u0026thinsp;=\\u0026thinsp;0.005). In the multivariate analysis, RFS was significantly associated with PS (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), clinical T stage (p\\u0026thinsp;=\\u0026thinsp;0.002), FAN score (p\\u0026thinsp;=\\u0026thinsp;0.011), and number of dissected LNs (p\\u0026thinsp;=\\u0026thinsp;0.010).\\u003c/p\\u003e \\u003cp\\u003eIn the univariate analysis, CSS was significantly associated with PS (\\u0026le;\\u0026thinsp;1 vs. \\u0026ge;2, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), clinical T stage (cT2 vs. \\u0026ge;cT3, p\\u0026thinsp;=\\u0026thinsp;0.001), NAC (no vs. yes, p\\u0026thinsp;=\\u0026thinsp;0.034), FAN score (\\u0026le;\\u0026thinsp;1 vs. \\u0026ge;2, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), and number of dissected LNs (continuous, p\\u0026thinsp;=\\u0026thinsp;0.004). In the multivariate analysis, CSS was significantly associated with clinical T stage (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), NAC (p\\u0026thinsp;=\\u0026thinsp;0.049), FAN score (p\\u0026thinsp;=\\u0026thinsp;0.009), and number of dissected LNs (p\\u0026thinsp;=\\u0026thinsp;0.007).\\u003c/p\\u003e \\u003cp\\u003eIn the univariate analysis, OS was significantly associated with PS (\\u0026le;\\u0026thinsp;1 vs. \\u0026ge;2, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), clinical T stage (cT2 vs. \\u0026ge;cT3, p\\u0026thinsp;=\\u0026thinsp;0.002), NAC (no vs. yes, p\\u0026thinsp;=\\u0026thinsp;0.002), FAN score (\\u0026le;\\u0026thinsp;1 vs. \\u0026ge;2, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), and number of dissected LNs (continuous, p\\u0026thinsp;=\\u0026thinsp;0.002). In the multivariate analysis, OS was significantly associated with BMI (continuous, p\\u0026thinsp;=\\u0026thinsp;0.005), clinical T stage (p\\u0026thinsp;=\\u0026thinsp;0.031), NAC (p\\u0026thinsp;=\\u0026thinsp;0.014), FAN score (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), and number of dissected LNs (p\\u0026thinsp;=\\u0026thinsp;0.003).\\u003c/p\\u003e\\n\\u003ch3\\u003eBetter cutoff value for dissected LNs for the prognostic stratification\\u003c/h3\\u003e\\n\\u003cp\\u003eWe explored the optimal cutoff value for the number of dissected LNs for prognostic stratification by comparing the HR and p value among each cutoff value (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). When the cutoff value was 20, the HR (95% confidence interval) and p value were 0.624 (0.396\\u0026ndash;0.982) and 0.041 in RFS, respectively; 0.495 (0.275\\u0026ndash;0.892) and 0.019 in CSS, respectively; and 0.535 (0.317\\u0026ndash;0.904) and 0.019 in OS, respectively.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003eTable\\u0026nbsp;\\u003cspan refid=\\\"Tab6\\\" class=\\\"InternalRef\\\"\\u003e6\\u003c/span\\u003e shows the comparison of surgery-related data between patients with \\u0026lt;\\u0026thinsp;20 dissected LNs (n\\u0026thinsp;=\\u0026thinsp;201) and those with \\u0026ge;\\u0026thinsp;20 (n\\u0026thinsp;=\\u0026thinsp;103). The patients with \\u0026ge;\\u0026thinsp;20 dissected LNs demonstrated significantly longer surgical time (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), lower blood loss (p\\u0026thinsp;=\\u0026thinsp;0.041), lower rate of complications of any grade or grade\\u0026thinsp;\\u0026le;\\u0026thinsp;2 (p\\u0026thinsp;=\\u0026thinsp;0.005, 0.009, respectively), and greater number of metastatic LNs (p\\u0026thinsp;=\\u0026thinsp;0.030) than those with \\u0026lt;\\u0026thinsp;20 dissected LNs. There were no significant differences in the rates of grade 3 postoperative complications or pathologically identified LN metastases between the two groups. Supplemental Table \\u003cspan refid=\\\"MOESM1\\\" class=\\\"InternalRef\\\"\\u003eS1\\u003c/span\\u003e shows the detailed information on postoperative complications. The patients with \\u0026ge;\\u0026thinsp;20 dissected LNs demonstrated a significantly lower rate of grade\\u0026thinsp;\\u0026le;\\u0026thinsp;3 lymphocele (p\\u0026thinsp;=\\u0026thinsp;0.021) and higher rates of ureteral stenosis of any grade and grade\\u0026thinsp;\\u0026ge;\\u0026thinsp;3 (p\\u0026thinsp;=\\u0026thinsp;0.048, both). Supplemental Table \\u003cspan refid=\\\"MOESM2\\\" class=\\\"InternalRef\\\"\\u003eS2\\u003c/span\\u003e shows a summary of the comparisons of other data between the two groups. The patients with \\u0026ge;\\u0026thinsp;20 dissected LNs were significantly younger (p\\u0026thinsp;=\\u0026thinsp;0.021), had a greater rate of PS\\u0026thinsp;\\u0026le;\\u0026thinsp;1 (p\\u0026thinsp;=\\u0026thinsp;0.045) and had\\u0026thinsp;\\u0026ge;\\u0026thinsp;cT3 (p\\u0026thinsp;=\\u0026thinsp;0.014) compared with those with \\u0026lt;\\u0026thinsp;20 dissected LNs. There were no significant differences in the other factors between the two groups.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab6\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 6\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eComparison of surgery-related data between groups divided by number of dissected LNs (n\\u0026thinsp;=\\u0026thinsp;304)\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eLNs\\u0026thinsp;\\u0026lt;\\u0026thinsp;20\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eLNs\\u0026thinsp;\\u0026ge;\\u0026thinsp;20\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eP value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eSurgical time (min) median (range)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e447 (163-1,088)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e505 (261\\u0026ndash;852)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eBlood loss (mL) median (range)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e410 ( 0\\u0026ndash;3,073)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e340 ( 0\\u0026ndash;4,650)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.041*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eComplications\\u003c/p\\u003e \\u003cp\\u003en (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAll grade\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e108 (53.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e38 (36.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.005*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eGrade\\u0026thinsp;\\u0026ge;\\u0026thinsp;3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e39 (19.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e15 (14.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.296\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eGrade\\u0026thinsp;\\u0026le;\\u0026thinsp;2 only\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e69 (34.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e23 (22.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.009*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eLymph node metastasis n (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e31 (15.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e23 (22.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.254\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eNumber of metastatic LNs median (range)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0 (0\\u0026ndash;13)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0 (0\\u0026ndash;25)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.030*\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"5\\\"\\u003e\\u003cb\\u003eLN: lymph node\\u003c/b\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eFigure\\u0026nbsp;\\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e shows the comparisons of the prognosis between the two groups. The patients with \\u0026ge;\\u0026thinsp;20 dissected LNs had significantly better RFS (p\\u0026thinsp;=\\u0026thinsp;0.041), CSS (p\\u0026thinsp;=\\u0026thinsp;0.019), and OS (p\\u0026thinsp;=\\u0026thinsp;0.019) than those with \\u0026lt;\\u0026thinsp;20 dissected LNs.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eThis study revealed that the number of dissected LNs contributed to a good prognosis after RARC for MIBC without LN metastasis at clinical staging. A meta-analysis of 25 previous reports showed that a greater number of dissected LNs was associated with more favorable outcomes in patients treated with RC [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. In a previous report, \\u0026ge;\\u0026thinsp;16 dissected LNs during RC was associated with CSS [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]; therefore, \\u0026ge;\\u0026thinsp;16 dissected LNs was considered as an important factor of RC [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. In the current study, a cutoff value of 20 enabled better prognostic stratification than a cutoff value of 16. This difference may be caused by chronological improvements in surgical procedures or the difference between RARC and open/laparoscopic RC.\\u003c/p\\u003e \\u003cp\\u003eWe also investigated the association of various preoperative and intraoperative factors, including the number of dissected LNs, with the prognosis of patients with bladder cancer and regional LN metastasis (n\\u0026thinsp;=\\u0026thinsp;38, Supplemental Table \\u003cspan refid=\\\"MOESM3\\\" class=\\\"InternalRef\\\"\\u003eS3\\u003c/span\\u003e). The number of dissected LNs was not significantly associated with the prognosis in this group. In the univariate analysis, NAC was significantly associated with CSS (p\\u0026thinsp;=\\u0026thinsp;0.002) and OS (p\\u0026thinsp;=\\u0026thinsp;0.003), and FAN score (\\u0026le;\\u0026thinsp;1 vs. \\u0026ge;2) was significantly associated with RFS (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), CSS (p\\u0026thinsp;=\\u0026thinsp;0.036), and OS (p\\u0026thinsp;=\\u0026thinsp;0.049). Moreover, the cutoff value of 20 dissected LNs did not enable prognostic stratification in the group (Supplemental Fig. \\u003cspan refid=\\\"MOESM1\\\" class=\\\"InternalRef\\\"\\u003eS1\\u003c/span\\u003e). Although the number of cases was small, the results suggest that the number of dissected LNs did not contribute to an improvement in the prognosis of patients with regional LN metastases who underwent RARC. Neoadjuvant systemic treatment might result in improved survival, similar to that reported in recent studies [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThe clinical significance of LN dissection in patients with NMIBC remains controversial. A report using the National Cancer Database of the United States demonstrated that LN dissection in patients with cT1 NMIBC resulted in the pathological identification of LN metastasis in 13.3% of cases and better OS than patients who did not undergo LN dissection [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. In another study, LN dissection was not a significant prognostic factor in patients preoperatively diagnosed with NMIBC [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]. Owing to the difficulty in accurately diagnosing NMIBC, we did not analyze LN dissection during RARC in patients with NMIBC in this cohort.\\u003c/p\\u003e \\u003cp\\u003eAlthough the scale of this study was comparatively large, it had certain limitations. First, this study had a retrospective design and limited patient information. Incomplete records or selection bias may have affected the data collection. The indicators for performing RC or LN dissection in patients with bladder cancer depend on the treatment strategy of each institution, which may lead to selection bias. Moreover, the number of dissected LNs may depend on the pathologist at each institution. There were significant differences in the number of dissected LNs among the institutions (Supplemental Fig. \\u003cspan refid=\\\"MOESM2\\\" class=\\\"InternalRef\\\"\\u003eS2\\u003c/span\\u003e). It is important to standardize the surgical techniques and perioperative management strategies in each institution for a more accurate analysis of the prognosis and complications. Finally, the geographical area investigated in this study was limited to Osaka, Japan. Further studies with larger cohorts are required to validate these results.\\u003c/p\\u003e \\u003cp\\u003eIn conclusion, the number of dissected LNs contributed to good prognosis after RARC for MIBC without LN metastasis at clinical staging and without a higher rate of postoperative complications. A cutoff value of 20 enabled clear prognostic stratification in this study.\\u003c/p\\u003e\"},{\"header\":\"Statements and Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgments\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors would like to thank the patients and their families for participating in this study as well as the staff for supporting this study. We would like to thank Editage (www.editage.jp) for the English language editing.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors did not receive support from any organization for the submitted work.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll authors declare that they have no conflicts of interest.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthics approval\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;and consent to participate\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;This study was approved by the Institutional Review Board of Osaka University Hospital (No. 23530), and the need for consent to participate was waived. This study was conducted in accordance with the Declaration of Helsinki.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData availability\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; All data generated\\u0026nbsp;or analyzed during this study are included in this published article and its supplementary information files.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eClinical trial number\\u003c/strong\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent to publish declaration\\u003c/strong\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor\\u0026rsquo;s contribution\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eT.H.: Data collection, Data analysis, Manuscript writing. A.K.: Project development, Data collection, Data analysis, Manuscript editing. M.T.: Data collection. T.T.: Data collection. O.M.: Data collection. K.Y.: Data collection. Y.O.: Data collection. H.T.: Data collection. T.T.: Data collection. K.N.: Data collection. H.K.: Data collection. H.I.: Data collection. K.K.: Data collection. A.N.: Data collection. Y.I.: Manuscript editing. Y.Y.: Manuscript editing. T.K.: Manuscript editing. K.H.: Manuscript editing. N.N.: Project development.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n \\u003cli\\u003eAlfred Witjes J, Max Bruins H, Carri\\u0026oacute;n A et al. (2024) European Association of Urology guidelines on muscle-invasive and metastatic bladder cancer: Summary of the 2023 guidelines. Eur Urol 85:17\\u0026ndash;31. https://doi.org/10.1016/j.eururo.2023.08.016\\u003c/li\\u003e\\n \\u003cli\\u003eGontero P, Birtle A, Capoun O et al. (2024) European Association of Urology guidelines on non-muscle-invasive bladder cancer (TaT1 and carcinoma in situ)-A summary of the 2024 guidelines update. Eur Urol 86:531\\u0026ndash;549. https://doi.org/10.1016/j.eururo.2024.07.027\\u003c/li\\u003e\\n \\u003cli\\u003eMay M, Herrmann E, Bolenz C et al. (2011) Association between the number of dissected lymph nodes during pelvic lymphadenectomy and cancer-specific survival in patients with lymph node-negative urothelial carcinoma of the bladder undergoing radical cystectomy. World J Urol 33:1945\\u0026ndash;1950. https://doi.org/10.1245/s10434-010-1538-6\\u003c/li\\u003e\\n \\u003cli\\u003eAziz A, Gierth M, Rink Met al. (2015) Optimizing outcome reporting after radical cystectomy for organ-confined urothelial carcinoma of the bladder using oncological trifecta and pentafecta. Ann Surg Oncol 18:2018-2025. https://doi.org/10.1007/s00345-015-1572-x\\u003c/li\\u003e\\n \\u003cli\\u003eKhetrapal P, Wong JKL, Tan WP et al. (2023) Robot-assisted radical cystectomy versus open radical cystectomy: A systematic review and meta-analysis of perioperative, oncological, and quality of life outcomes using randomized controlled trials. Eur Urol 84:393\\u0026ndash;405. https://doi.org/10.1016/j.eururo.2023.04.004\\u003c/li\\u003e\\n \\u003cli\\u003eParekh DJ, Reis IM, Castle EP et al. (2018) Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): An open-label, randomised, phase 3, non-inferiority trial. Lancet 391:2525\\u0026ndash;2536. https://doi.org/10.1016/S0140-6736(18)30996-6\\u003c/li\\u003e\\n \\u003cli\\u003eCatto JWF, Khetrapal P, Ricciardi F et al. (2022) Effect of robot-assisted radical cystectomy with intracorporeal urinary diversion vs open radical cystectomy on 90-day morbidity and mortality among patients with bladder cancer: A randomized clinical trial. JAMA 327:2092\\u0026ndash;2103. https://doi.org/10.1001/jama.2022.7393\\u003c/li\\u003e\\n \\u003cli\\u003eCacciamani GE, Winter M, Medina LG et al. (2020) Radical cystectomy pentafecta: a proposal for standardisation of outcomes reporting following robot-assisted radical cystectomy. BJU Int 125:64\\u0026ndash;72. https://doi.org/10.1111/bju.14861\\u003c/li\\u003e\\n \\u003cli\\u003eMastroianni R, Tuderti G, Ferriero M et al. (2023) Open versus robot-assisted radical cystectomy: pentafecta and trifecta achievement comparison from a randomised controlled trial. BJU Int 132:671\\u0026ndash;677. https://doi.org/10.1111/bju.16134\\u003c/li\\u003e\\n \\u003cli\\u003eGschwend JE, Heck MM, Lehmann J et al. (2019) Extended Versus Limited Lymph Node Dissection in Bladder Cancer Patients Undergoing Radical Cystectomy: Survival Results from a Prospective, Randomized Trial. Eur Urol 75:604\\u0026ndash;611. https://doi.org/0.1016/j.eururo.2018.09.047\\u003c/li\\u003e\\n \\u003cli\\u003eLerner SP, Tangen C, Svatek RS et al. (2024) Standard or Extended Lymphadenectomy for Muscle-Invasive Bladder Cancer. N Engl J Med 391:1206\\u0026ndash;1216. https://doi.org/10.1056/NEJMoa2401497\\u003c/li\\u003e\\n \\u003cli\\u003eKawashima A, Yamamoto Y, Sato M et al. (2021) FAN score comprising fibrosis-4 index, albumin-bilirubin score and neutrophil-lymphocyte ratio is a prognostic marker of urothelial carcinoma patients treated with pembrolizumab. Sci Rep 11:21199. https://doi.org/10.1038/s41598-021-00509-x\\u003c/li\\u003e\\n \\u003cli\\u003eIshizuya Y, Kawashima A, Horibe Y et al. (2025) FAN score predicts prognosis after platinum-based first-line chemotherapy in patients with metastatic urothelial carcinoma. Sci Rep 15:4640. https://doi.org/10.1038/s41598-025-86212-7\\u003c/li\\u003e\\n \\u003cli\\u003eLi F, Hong X, Hou L et al. (2016) A greater number of dissected lymph nodes is associated with more favorable outcomes in bladder cancer treated by radical cystectomy: a meta-analysis. Oncotarget 7:61284\\u0026ndash;61294. https://doi.org/10.18632/oncotarget\\u003c/li\\u003e\\n \\u003cli\\u003eCrocerossa F, Autorino R, Carbonara U et al. (2022) Extent of lymph node dissection and impact on survival in radical cystectomy for advanced bladder cancer. Curr Opin Urol 32:607\\u0026ndash;613. https://doi.org/10.1097/MOU.0000000000001035\\u003c/li\\u003e\\n \\u003cli\\u003evon Deimling M, Furrer M, Mertens LS et al (2024) Impact of the extent of lymph node dissection on survival outcomes in clinically lymph node-positive bladder cancer. BJU Int 133:341\\u0026ndash;350. https://doi.org/10.1111/bju.16210\\u003c/li\\u003e\\n \\u003cli\\u003eMoldovan M, Nam P, Satpathy Y et al. (2024) Oncological and Survival Outcomes of Pelvic Lymph Node Dissection in Patients with Nonmuscle Invasive Bladder Cancer Undergoing Radical Cystectomy Using the National Cancer Database. Clin Genitourin Cancer 22:102197. https://doi.org/10.1016/j.clgc.2024.102197\\u003c/li\\u003e\\n \\u003cli\\u003eSazuka T, Taoka R, Miki J et al. (2025) Impact of lymph-node dissection during radical cystectomy for non-muscle-invasive bladder cancer: Japanese multicenter retrospective study. Int J Clin Oncol 30:1417\\u0026ndash;1425. https://doi.org/10.1007/s10147-025-02778-2\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"robot-assisted radical cystectomy, lymph node dissection, bladder cancer, number of dissected lymph nodes, prognosis, FAN score, postoperative complications\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8551382/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8551382/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003ePurpose: \\u003c/strong\\u003eRobot-assisted radical cystectomy (RARC) with lymph node (LN) dissection is a curative treatment for muscle-invasive bladder cancer (MIBC). We aimed to investigate the association between the number of dissected LNs in RARC and the prognosis of MIBC.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods:\\u003c/strong\\u003e We retrospectively assessed 304 patients with cT2–T4N0M0 MIBC who underwent RARC between 2018 and 2024. Associations between the number of dissected LNs and regression-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were analyzed using a Cox proportional hazards regression model. We explored a better cutoff number by comparing the hazard ratio (HR) and p value for each cutoff.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults: \\u003c/strong\\u003eThe median number of dissected LNs was 14 (range: 0–76). Among 304 cases, 54 had LN metastases (17.7%). The number of dissected LNs was significantly associated with RFS, CSS, and OS (p = 0.010, 0.007, and 0.003, respectively) after adjusting for performance status and preoperative laboratory data. When the cutoff value was 20, the HR (95% confidence interval) and p value were 0.624 (0.396–0.982) and 0.041 in RFS, respectively; 0.495 (0.275–0.892) and 0.019 in CSS, respectively; and 0.535 (0.317–0.904) and 0.019 in OS, respectively. The postoperative complication rate did not increase with an increasing number of dissected LNs. Patients with ≥20 dissected LNs demonstrated a significantly lower complication rate (P = 0.009).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusion: \\u003c/strong\\u003eThe number of dissected LNs contributed to good prognosis after RARC for MIBCwithout LN metastasis at clinical staging. A cutoff value of 20 enabled the clear stratification of the prognosis.\\u003c/p\\u003e\",\"manuscriptTitle\":\"The number of dissected lymph nodes contributes to good prognosis after robot-assisted radical cystectomy for muscle-invasive bladder cancer without lymph node metastasis at clinical staging\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-01-29 10:37:47\",\"doi\":\"10.21203/rs.3.rs-8551382/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"8cb22eba-760f-4016-b4b3-b04721e24aa8\",\"owner\":[],\"postedDate\":\"January 29th, 2026\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-04-28T13:23:17+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-01-29 10:37:47\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8551382\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8551382\",\"identity\":\"rs-8551382\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}