在根治性前列腺切除淋巴清扫术中，转移性淋巴结数量（+LN）和密度（LND）都可以预测前列腺癌患者的死亡率，但每个指标对总体死亡率（OM）的独立影响尚不明确。我们从全国癌症数据库中选取了2004年至2013年间接受前列腺切除淋巴清扫术的男性病例进行研究。使用多变量Cox比例风险分析和受限制立方样条分析LND和+LN计数的非线性关系，评估其与OM之间的关系。在我们的样本中，229,547名男性中有3%（n = 7507）患有+ LN，其中89%的人有1-3个+ LN，11%的人有≥4个+ LN。在所有患者中进行多变量Cox分析，发现每增加一个+ LW，OM会随之增加，最多达到四个+ LN（HR 1.14，95% CI 1.06-1.23）节点），超过4个+ LN之后没有增加。 LND是OM的独立预测因子（HR 1.09，95% CI 1.06-1.12每增加10％）。但是，在排除淋巴结取样不充分（<5个淋巴结检查）的患者后，对于具有≤3个+ LN的患者，LND解释OM的变异很小。在具有1、2和3个+ LN的男性中，与4或5个+ LNs的男性相比，每增加10％的LND，OM分别增加了0.28％，0.02％和0.50％，而前列腺癌患者的死亡率由此上升了1.9％和1.6％。尽管+LN计数和LND可独立预测OM，但LND对于具有≤3个+ LN的男性（这些男性占+LN患者的绝大多数）的影响很小。因此，病理淋巴结分期应主要依赖于+LN计数而不是LND。 © 2023年。作者（根据Springer Nature Limited的独家许可）

While both the number (+LN) and density (LND) of metastatic lymph nodes on radical prostatectomy lymphadenectomy predict mortality in prostate cancer, the independent impact of each on overall mortality (OM) is unknown.We sampled men who underwent radical prostatectomy and lymphadenectomy between 2004 and 2013 from the National Cancer Database. Multivariable Cox proportional hazards analysis with restricted cubic spline was used to assess the non-linear association of +LN count and LND with OM.Of 229,547 men in our sample, 3% (n = 7507) had +LNs, of which 89% had 1-3 +LN and 11% had ≥4 +LN. In multivariable Cox analysis across all patients, OM increased with each additional +LN up to four (HR 1.14, 95%CI 1.06-1.23 per node), with no increase beyond 4 +LN. LND was an independent predictor of OM (HR 1.09, 95%CI 1.06-1.12 per 10% increase). However, after excluding patients with inadequate nodal sampling (<5 LN examined), the variation in OM explained by LND was negligible for patients with ≤3 +LN. In men with 1, 2, and 3 +LN, there was a 0.28%, 0.02%, and 0.50% increase in OM for each 10% increase in LND, compared with 1.9% and 1.6% for men with 4 or 5+ LNs.While +LN count and LND independently predict OM, the impact of LND is negligible in men with ≤3 +LN, who comprise the vast majority of men with +LN. Pathological nodal staging should primarily rely on LN count rather than LND.© 2023. The Author(s), under exclusive licence to Springer Nature Limited.