{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T03:13:39Z","timestamp":1769570019212,"version":"3.49.0"},"reference-count":30,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Urology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Cell\u2010free DNA (cfDNA) is a potential biomarker of surgical invasiveness, but its relationship with postoperative outcomes remains unclear. This study evaluated whether total cfDNA levels measured immediately after robot\u2010assisted radical prostatectomy (RARP) predict postoperative outcomes, including surgical stress markers, pain, and complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 80 patients who underwent RARP at Hirosaki University Hospital. Total cfDNA levels were measured preoperatively and immediately postoperatively. Postoperative pain intensity was assessed on postoperative days 1\u20133 using the numerical rating scale (NRS). Patients were categorized into mild pain (NRS &lt;\u20094) and moderate\u2010to\u2010severe pain (NRS \u2265\u20094) groups. Associations between cfDNA and NRS were evaluated and compared with conventional surgical stress markers (operative time, estimated blood loss, white blood cell count, C\u2010reactive protein, and oxidative stress).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The cfDNA ratio was higher in the NRS \u2265\u20094 group than in the NRS &lt;\u20094 group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.029). In adjusted analyses, cfDNA \u2265\u20092.00 was associated with greater odds of moderate\u2010to\u2010severe pain (odds ratio 2.90, 95% confidence interval 1.09\u20137.72). Conventional markers\u2014including CRP, white blood cell count, operative time, and blood loss\u2014were not associated with pain. Oxidative\u2010stress indices showed only weak correlations with NRS and were not correlated with cfDNA. Limitations include the retrospective, single\u2010center design, and modest sample size.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Immediate postoperative cfDNA is significantly associated with postoperative pain severity and may serve as a rapid, sensitive biomarker for early pain prediction. The cfDNA ratio could support the development of personalized perioperative pain\u2010management strategies. A prospective validation is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/iju.70297","type":"journal-article","created":{"date-parts":[[2025,11,22]],"date-time":"2025-11-22T01:33:21Z","timestamp":1763775201000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Immediate Postoperative\n                    <scp>cfDNA<\/scp>\n                    Elevation Predicts Pain After Robot\u2010Assisted Radical Prostatectomy"],"prefix":"10.1111","volume":"33","author":[{"given":"Noritaka","family":"Ishii","sequence":"first","affiliation":[{"name":"Department of Urology Hirosaki University Graduate School of Medicine  Hirosaki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tohru","family":"Yoneyama","sequence":"additional","affiliation":[{"name":"Department of Glycotechnology Hirosaki University Graduate School of Medicine  Hirosaki 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