The Relationship Between the Ratio of Cribriform Pattern in Pathology and Biochemical Recurrence in Intermediate-Risk Prostate Cancer Patients Undergoing Robotic Radical Prostatectomy

Aim In patients with intermediate-risk prostate cancer, the presence of a cribriform pattern may lead to variable oncological outcomes. In this context, we aimed to investigate the association between the proportion of the cribriform pattern in radical prostatectomy specimens and the development of early biochemical recurrence (BCR) in patients with intermediate-risk prostate cancer undergoing robot-assisted laparoscopic radical prostatectomy (RALRP). Methods This study included patients who underwent RALRP between March 2018 and March 2023 and were classified as having intermediate-risk prostate cancer according to the D’Amico risk assessment system. All patients underwent standardized postoperative follow-up with serial PSA measurements at 1, 3, 6, 12, 18, and 24 months. Comprehensive statistical analyses—including univariable and multivariable Cox proportional hazards regression models—were conducted to quantify the independent association between the cribriform pattern ratio and the risk of biochemical recurrence, complemented by Kaplan–Meier survival estimates with log-rank testing to assess differences in recurrence-free survival across cribriform burden strata. Results A total of 170 patients were included, of whom 20 (11.8%) developed BCR during the follow-up period. The patients' mean follow-up period was 24 months. The median time from surgery to BCR was 6.0 (3.0–18.0) months. In the BCR-positive cohort, the proportion of pathological N1 disease was significantly higher (85% vs. 50%, p = 0.007), and the cribriform pattern ratio was markedly elevated (median 60% vs. 10%, p < 0.001). In the multivariable model, Both the N stage and the cribriform pattern ratio were statistically significant independent predictors of BCR. Lymph node positivity retained a strong independent association with BCR (adjusted HR 3.88, 95% CI 1.04–14.4, p = 0.043). Additionally, the cribriform pattern ratio remained an independent continuous predictor, with each 1% increase conferring a 4% rise in recurrence risk (adjusted HR 1.04, 95% CI 1.02–1.06, p < 0.001). Patients with a cribriform pattern ratio > 10% exhibited significantly shorter biochemical recurrence–free survival compared with those with a ratio ≤ 10% (log-rank p < 0.001). Conclusion In patients with intermediate-risk prostate cancer undergoing robot-assisted radical prostatectomy, a higher cribriform pattern ratio was independently associated with an increased risk of early BCR. The quantitative evaluation of cribriform architecture may yield significant prognostic information and enhance surgical risk classification in this heterogeneous patient group.