Oncology · Surgery · 1 h ago
PRADO Analysis Links Younger Age and Radiographic Growth to Lymph Node Dissection
A secondary analysis of 99 patients in the phase II PRADO trial examined factors associated with therapeutic lymph node dissection after neoadjuvant ipilimumab and nivolumab for stage III melanoma. Younger age and radiographic tumor growth were associated with undergoing dissection, but the analysis does not establish who benefits from immediate surgery.
- Analysis included 99 patients from the PRADO phase II trial.
- Thirty-six patients underwent therapeutic lymph node dissection.
- Age under 40 and radiographic tumor growth were associated with dissection.
- Associations do not establish benefit from immediate dissection.
The multicenter phase II PRADO trial treated patients with macroscopic stage III melanoma using neoadjuvant ipilimumab and nivolumab, then assessed response by resecting a marked index lymph node. Patients without a major pathological response generally underwent therapeutic lymph node dissection (TLND). In this secondary analysis, investigators used trial data from 99 patients to examine baseline and preoperative factors associated with TLND.
Thirty-six patients underwent TLND: 20 (56%) had a pathological nonresponse, eight (22%) a partial response, and eight (22%) other indications, including recurrence, extranodal extension, suspicious imaging, or infeasible index-node resection. Age younger than 40 years was associated with TLND (odds ratio 7.91; 95% CI 1.35–46.30; P=0.022), as was radiographic increase in tumor size (odds ratio 1.15; 95% CI 1.07–1.24; P<0.001).
The findings suggest these features may help identify patients more likely to undergo TLND after neoadjuvant treatment. They do not show that immediate TLND improves outcomes or establish a threshold for choosing surgery. The analysis was based on a small cohort, and the confidence interval for age was wide; the reported associations should be considered exploratory.
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Annals of Surgical Oncology: Predictors of Immediate Therapeutic Lymph Node Dissection Instead of Index Lymph Node After Neoadjuvant Checkpoint Inhibitors: Lessons Learned from the PRADO Trial ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.