高风险前列腺癌包括异质性人群，其结果有所不同。本研究旨在比较单独的高风险因素预后能力，如由国家综合癌症网络（NCCN）风险分层所定义，对接受根治性前列腺切除术的前列腺癌患者进行研究。我们查询了2004年至2018年的国家癌症数据库，筛选非转移性高风险前列腺癌经过根治性前列腺切除术的患者，并将其分为H组1：仅前列腺特异性抗原（PSA）> 20ng / ml，H组2：仅cT3a期，和H组3：根据NCCN指南定义的格里森分级（GG）4/5组。比较不同组之间的组织病理学特征和辅助治疗率。应用倒概率加权（IPW）校正的Kaplan-Meier曲线比较H组1和H组2与H组3的总生存率（OS）。总之，共有61,491名高风险前列腺癌患者被识别出来，他们被分类为H组1（n = 14,139），H组2（n = 2,855）和H组3（n = 44,497）。与H组1或H组2相比，组织病理学GG组> 3（p <0.001），病理分期pT3b或更高（p <0.001），淋巴结阳性（pN1）（p <0.001）和辅助治疗率（p <0.001）在H组3中显着。IPW校正的Kaplan-Meier曲线显示，与H组3相比，H组1的5年OS显着更好[95.1％与93.3％，p <0.001]，H组2与H组3相比[94.4％与92.9％，p <0.001]。单独的PSA> 20ng / ml或cT3a期具有更好的肿瘤学和生存结果，与GG> 3疾病和“高风险”类别的子分层相比，可能会导致更好的患者预测。©2023年作者，独家授权施普林格自然有限公司。

High-risk prostate cancer includes heterogenous populations with variable outcomes. This study aimed to compare the prognostic ability of individual high-risk factors, as defined by National Comprehensive Cancer Network (NCCN) risk stratification, in prostate cancer patients undergoing radical prostatectomy.We queried the National Cancer Database from 2004 to 2018 for patients with non-metastatic high-risk prostate cancer who underwent radical prostatectomy and stratified them as Group H1: Prostate specific antigen (PSA) > 20 ng/ml alone, Group H2: cT3a stage alone and Group H3: Gleason Grade (GG) group 4/5 as per NCCN guidelines. The histopathological characteristics and rate of adjuvant therapy were compared between different groups. Inverse probability weighting (IPW)-adjusted Kaplan-Meier curves were utilized to compare overall survival (OS) in group H1 and H2 with H3.Overall, 61,491 high-risk prostate cancer patients were identified, and they were classified into Group H1 (n = 14,139), Group H2 (n = 2855) and Group H3 (n = 44,497). Compared to group H1 or H2, pathological GG group > 3 (p < 0.001), pathological stage pT3b or higher (p < 0.001), lymph nodal positive disease (pN1) (p < 0.001) and rate of adjuvant therapy (p < 0.001) were significantly in Group H3. IPW-adjusted Kaplan-Meier curves showed significantly better 5-year OS in group H1 compared to group H3 [95.1% vs 93.3%, p < 0.001] and group H2 compared to group H3 [94.4% vs 92.9%, p < 0.001].PSA > 20 ng/ml or cT3a stage in isolation have better oncologic and survival outcomes compared to GG > 3 disease and sub-stratification of 'High-risk' category might lead to better patient prognostication.© 2023. The Author(s), under exclusive licence to Springer Nature Limited.