Evidence map›Paper›PMID 42218345›Full record

Trial reportAnnals of surgical oncology2026

Accuracy of Index Lymph Node Pathology in Predicting Overall Response to Neoadjuvant Immunotherapy for Clinical Stage III Melanoma: Results From the Prospective NeoACTIVATE Arm C (NCT03554083) Substudy.

Tina J Hieken, Thomas J Flotte, David Zahrieh, Jeffrey E Johnson, Mara A Piltin, Kendall K Tasche, Garth D Nelson, Carrie A Strand, James W Jakub, Phillip Pirgousis and 3 more

Abstract readClinical Trial, Phase IIMulticenter Study
PubMed Publisher
In one paragraph

Trial report in Annals of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0cells of the map it votes in
0citing papers in PubMed
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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Tina J HiekenDivision of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA. hieken.tina@mayo.edu.ORCID http://orcid.org/0000-0002-4277-8692
Thomas J FlotteMayo Clinic Comprehensive Cancer Center, Rochester, MN, USA.
David ZahriehDepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
Jeffrey E JohnsonDivision of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Mara A PiltinDivision of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Kendall K TascheDepartment of Otolaryngology, Mayo Clinic, Rochester, MN, USA.
Garth D NelsonDepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
Carrie A StrandDepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
James W JakubDepartment of Surgery, Mayo Clinic, Jacksonville, FL, USA.
Phillip PirgousisDepartment of Otorhinolaryngology, Mayo Clinic, Jacksonville, FL, USA.
Samir S KhariwalaDepartment of Otolaryngology, University of Minnesota, Minneapolis, MN, USA.
Todd TuttleDivision of Surgical Oncology, Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
Matthew S BlockMayo Clinic Comprehensive Cancer Center, Rochester, MN, USA.

Funding

Center for Clinical and Translational Science, Mayo Clinic 92541640-2020/Mayo ClinicStand Up To Cancer SU2C-AACR-CT1017
6 · The paper itself

Abstract

backgroundFor patients with clinical stage III melanoma, a potentially surgically curable disease, neoadjuvant immunotherapy improves event-free survival. Substantial pathologic complete response (pCR) rates in the affected nodal basin have raised interest in response-directed care including de-escalation of the extent of operation and adjuvant therapies. This study prospectively assessed the fidelity of index lymph node (ILN) pathology in predicting pathologic response across the entire nodal basin.

methodsThe ILN substudy was a preplanned prospective investigation within the multicenter NeoACTIVATE Arm C trial testing neoadjuvant doublet immunotherapy with atezolizumab and tiragolumab followed by therapeutic lymph node dissection (TLND). Eligible patients had resectable clinical stage III nodal disease. Patients were required to have a sonographically visible clip placed in the ILN at diagnosis. Surgeons marked the ILN, which was assessed separately in addition to pathologic assessment of the entire nodal basin using International Neoadjuvant Melanoma Consortium criteria.

resultsAmong 34 enrolled patients, 30 underwent TLND per protocol. Two patients (6.7%) demonstrated discordance between ILN and nodal basin pathology, both with a pCR in the ILN but residual disease in non-ILNs. The false-negative rate of an ILN pCR was 13.3%. Among eight patients with a single involved lymph node at baseline, the pathologic major response rate was 75% and concordance was 100%.

conclusionsIn this prospective substudy, ILN pathology did not fully reflect nodal basin status for all the patients. This finding supports caution in de-escalating treatment based solely on ILN response and highlight the need for prospective trials evaluating oncologic outcomes after limited nodal resection.

Indexed as

Antineoplastic Combined Chemotherapy ProtocolsImmunotherapyLymph Node ExcisionLymph NodesMelanomaNeoadjuvant TherapySkin NeoplasmsAdultAgedFemaleFollow-Up StudiesHumansLymphatic MetastasisMaleMiddle AgedNeoplasm StagingClinical trialImmunotherapyLymph node surgeryMelanomaNeoadjuvant therapy

Identifiers

PMID42218345

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.