Objective To investigate the risk factors associated with recurrence of high-grade non-functioning pituitary neuroendocrine tumors (NF-PitNETs) following total resection. Methods A retrospective study was conducted on the clinical data of 252 patients with high-grade NF-PitNETs who underwent surgical treatment at the Department of Neurosurgery, Beijing Tiantan Hospital from January 2012 to December 2023, and met the inclusion criteria. High-grade NF-PitNETs included Knosp 3A, 3B, and 4-grade subtypes. Kaplan-Meier curves and Log-rank tests were employed to compare the progression-free survival (PFS) of Knosp 3A, 3B, and 4-grade patients. Cox regression analysis was applied to identify the risk factors associated with the recurrence of high-grade NF-PitNETs. Receiver operating characteristic (ROC) curve was used to calculate the area under the curve (AUC) of each recurrence-related factor to evaluate the diagnostic efficiency. Results Survival analysis revealed that there were significant differences in PFS among Knosp 3A, 3B, and 4-grade patients (P<0.001). The PFS of Knosp 3A was significantly better than that of grade 3B and 4-grade (P<0.05), while there was no significant difference between Knosp 3B and 4-grade (P=0.118). After integrating the three groups into Knosp 3A group and 3B-4 group, there were significant differences in PFS and some clinical features between the two groups (P<0.05). Cox regression analysis indicated that age <55 years old (HR=2.883, 95%CI 1.253-6.634; P=0.013), T₂ heterogeneous signal (HR=1.842, 95%CI 1.061-3.197; P=0.030), Knosp 3B-4 (HR=2.190, 95%CI 1.069-4.488; P=0.032), and Ki-67 ≥3% (HR=2.266, 95%CI 1.265-4.061; P=0.006) were risk factors related to tumor recurrence. ROC curve analysis showed that the AUCs of the above-mentioned risk factors were 0.682, 0.706, 0.709 and 0.750, respectively, and the AUC of the multi-factor combined model (age+T₂ signal+Knosp grade+Ki-67) was 0.838, which was significantly larger than that of each single risk factor (P<0.05). Conclusion High-grade NF-PitNETs patients with age <55 years old, T₂ heterogeneous signal, Knosp 3B-4 and Ki-67≥3% have a higher recurrence risk. The combined application of multiple risk factors can improve the predictive value of recurrence.