虽然在进行根治性前列腺切除术（RP）的男性中，精囊（SVI）和淋巴结侵犯（LNI）都被认为是不良预后因素，但这些特征对随后的肿瘤学结果的相对影响尚未明确定义。我们评估了LNI对RP患有SVI的患者长期肿瘤学结果的影响。我们对19519名接受RP的患者进行了回顾性研究，并发现其中2043例患有SVI。对于SVI患者，根据盆腔淋巴结转移的存在和数量，估计了无转移生存期（MFS）、仅癌症相关生存期（CSS）和总生存期（OS）。应用Cox比例风险模型，评估了SVI患者中转移节点数量和淋巴结密度与肿瘤学结果的独立关联，同时控制年龄、手术年份、切缘状况、术前PSA、病理格里森分级、前列腺外扩展和辅助治疗的使用。 在中位随访12.1年（IQR 7.0,18.6）后，有548名患者出现转移性疾病并且1331名患者死亡，其中包括406名死于前列腺癌（PCa）的患者。我们发现，在SVI患者中，单个阳性淋巴结的存在与RP时没有淋巴结转移相比，并不导致进一步不利的肿瘤学结果，其中10年的MFS、CSS和OS分别为81.3%与78.3%（p = 0.18），86.5%与89.8%（p = 0.32）和72.8%与76.7%（p = 0.53）。相反，在多变量分析中，≥2个转移节点的存在和20%淋巴结密度截断仍然与更差的生存率相关。 SVI代表一种不良的病理特征，单个盆腔淋巴结的存在不会进一步不利地影响预后。与此同时，大量受累节点与生存率降低相关。这些发现可能有助于对此类高危患者进行风险分层和临床试验设计。

While both seminal vesicle (SVI) and lymph-node invasion (LNI) have been identified as adverse prognostic variables among men undergoing radical prostatectomy (RP), the relative impact of each of these features on subsequent oncologic outcomes has not been well defined. We assessed the impact of LNI on long-term oncologic outcomes among patients with SVI at RP.We reviewed 19,519 patients who underwent RP and identified 2043 with SVI. Metastasis-free (MFS), cancer-specific (CSS), and overall survival (OS) were estimated for patients with SVI, stratified by the presence and number of pelvic lymph node metastases. Cox proportional hazards models were used to evaluate the independent association of the number of metastatic nodes and lymph node density with oncologic outcomes among patients with SVI, controlling for age, year of surgery, margin status, preoperative PSA, pathologic Gleason score, extraprostatic extension, and use of adjuvant therapies.At a median follow up of 12.1 years (IQR 7.0,18.6), 548 patients developed metastatic disease and 1331 died, including 406 who died from prostate cancer (PCa). We found that, among patients with SVI, the presence of a single positive lymph node was not associated with incrementally adverse oncologic outcomes compared to no nodal metastasis at RP, with 10-year MFS, CSS, and OS rates of 81.3% versus 78.3%(p = 0.18), 86.5% versus 89.8%(p = 0.32), and 72.8% versus 76.7%(p = 0.53), respectively. In contrast, on multivariable analyses, the presence of ≥2 metastatic nodes and a 20% lymph-node density cut off remained independently associated with worse survival.SVI represents an adverse pathologic feature such that the presence of a single positive pelvic lymph node did not further adversely impact prognosis. Meanwhile, a significant number of involved nodes was associated with decreased survival. These findings may aid in risk-stratification as well as clinical trial design for such high-risk patients following surgery.© 2023. The Author(s), under exclusive licence to Springer Nature Limited.