前列腺癌的病理分级是复发最强的预测指标。目前不清楚是将前列腺内所有癌变组合作为预测指标，还是以最高分级的病灶（指标）为预测指标更好。本研究的目的是确定是哪种分级更好地预测生化复发（BCR）。我们进行了回顾性分析，研究对象为2009年至2020年之间接受根治性前列腺切除术治疗本地前列腺癌的男性，其中报告了指标和组合分级。该研究中的指标分级被定义为任何肿瘤的最高分级，通常具有最高的分期，不考虑体积大小。我们采用多元分析和Kaplan-Meier图。共有2024人在研究期间接受了根治性前列腺切除术；我们分析了1605例组合分级为2或3的前列腺癌。术前中位前列腺特异性抗原（PSA）为5.9 ng/L，平均随访时间为56.8个月，54%为pT2，76%具有多灶性疾病，16%的指标和组合分级不符。指标分级组不符的患者复发的风险较高[危险比（HR）2.22，p＜0.0001]。不一致组中BCR的患病率在1、3、5和7年时较高（分别为4.7% vs 8.9%、8.3% vs 18.1%、14.5% vs 28.8%和22.5% vs 49.5%）。在不一致的情况下，更高的指标分级组与根治性前列腺切除术后BCR的发病率增加有关。应该使用指标分级组而不是组合分级组来告知男性手术后的预后和随访。版权所有 © 2023 Elsevier B.V. 发布。

The pathological grade of prostate cancer is the strongest predictor of recurrence. It is unclear whether the better predictor is the composite of all carcinomas within the prostate, or the highest grade lesion (index). The purpose of this study was to determine whether composite or index grade group better predicts biochemical recurrence (BCR). We undertook a retrospective analysis from a prospective institutional cohort study of men who underwent radical prostatectomy for localised prostate cancer between 2009 and 2020, in which an index and composite grade group was reported. The index grade in this study was defined as the highest grade of any tumour, usually with the highest stage, regardless of volume. Multivariate analysis and Kaplan-Meier plots were utilised. A total of 2024 men underwent radical prostatectomy during the study period; we analysed 1605 with composite grade group 2 or 3 prostate cancer. Median preoperative prostate specific antigen (PSA) was 5.9 ng/L, mean follow up was 56.8 months, 54% were pT2, 76% had multifocal disease and 16% had discordant index and composite grades. Patients with discordant index grade group had a higher risk of BCR [hazard ratio (HR) 2.22, p<0.0001]. The prevalence of BCR in the discordant group was higher at 1, 3, 5 and 7 years (4.7% vs 8.9%, 8.3% vs 18.1%, 14.5% vs 28.8% and 22.5% vs 49.5%, respectively). In cases of discordance, a higher index grade group is associated with increased rates of BCR after radical prostatectomy. Index rather than composite grade group should be used to counsel men post-operatively regarding prognosis and follow-up.Copyright © 2023. Published by Elsevier B.V.