Abstract
OBJECTIVE: To explore the predictive value of the ratio of high grade cores and other preoperative factors in predicting lymph node metastasis and biochemical recurrence (BCR) in high-risk prostate cancer patients. PATIENTS AND METHODS: This retrospective research was focus on high-risk prostate cancer patients that undergoing RP and PLND at The Affiliated Hospital of Qingdao University between January 2018 and March 2023 (n=99). Firth regression was employed to identify predictive factors for lymph node metastasis, and receiver operating characteristic (ROC) curves with area under the curve (AUC) and maximum Youden index were used to assess model performance; ROC differences were compared using the DeLong test. Biochemical recurrence (BCR)-free survival was estimated by the Kaplan–Meier method, and Cox regression analysis evaluated the impact of preoperative factors on BCR.Statistical significance was set at two-sided p < 0.05. RESULTS: Among 99 patients, 19.6% had lymph node metastasis. Univariable analysis identified cTstage (p=0.031), FPSA(p=0.038) and the ratio of high grade cores (p < 0.001) as significant predictors; however, only the ratio of high grade cores remained significant in the firth regression model (p < 0.001), Chi-square testing further demonstrated that a ratio of high grade cores >50% had a correlation coefficient of 0.55 with lymph node metastasis (p < 0.001). Regarding BCR analysis, a total of 74 patients completed follow-up, Cox regression analysis indicated that a ratio of high grade cores >0.3 (p < 0.001)，PI-RADS score = 5 (p=0.036) was a significant predictor of BCR (p < 0.001). Logistic regression analysis further demonstrated that the ratio of high grade cores was significantly associated with BCR within 12 months (p = 0.014). CONCLUSIONS: The ratio of high grade cores is an independent preoperative predictor of both lymph node metastasis and BCR in prostate cancer patients. Specifically, a ratio of high grade cores >50% showed a correlation with lymph node metastasis (r = 0.55, p < 0.001), while a ratio of high grade cores >0.3 was significantly associated with BCR. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12894-025-01999-x.