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Published on: January 26, 2024
Unleashing the therapeutic potential of tumor-draining lymph nodes: spotlight on bladder cancer
Xin Yang1, Xiangyu Wu1, Xuyang Hao1
1Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Abstract:
Tumor-draining lymph nodes (TDLNs) are often involved during the metastasis of bladder cancer (BC), which is associated with a poor prognosis. Recent studies have shown that TDLNs are a major source of host anti-tumor immunity, which can impede tumor progression and favor tumor immunotherapy. However, during tumor progression, various tumor-derived mediators modulate the TDLN microenvironment, impairing their protective function. Ultimately, TDLNs provide the soil for the proliferation and dissemination of tumor cells. Therefore, surgical removal of TDLNs is commonly recommended in various solid tumors to prevent metastasis, but this poses significant challenges for leveraging TDLNs in immunotherapy. Additionally, lymph node dissection (LND) has not shown survival benefits in some tumors. Hence, the decision to remove TDLNs in oncological treatment needs to be reconsidered. Herein, we spotlight the TDLNs of BC and introduce how BC cells modulate stromal cells and immune cells to shape an immunosuppressive TDLN microenvironment for BC progression. We summarize the existing therapeutic strategies to reinvigorate anti-tumor immunity in TDLNs. Furthermore, we discuss whether to preserve TDLNs and the role of LND during oncological treatment.
Insights
Tumor-draining lymph nodes (TDLNs) in bladder cancer (BC) become immunosuppressive, aiding metastasis. Strategies to restore anti-tumor immunity in TDLNs are crucial for effective immunotherapy and reconsidering lymph node dissection.
Area of Science:
- Oncology
- Immunology
- Cancer Metastasis
Background:
- Tumor-draining lymph nodes (TDLNs) are critical in bladder cancer (BC) metastasis and prognosis.
- TDLNs are a key source of anti-tumor immunity but become immunosuppressive during tumor progression.
- Bladder cancer cells manipulate the TDLN microenvironment, impairing immune function and promoting tumor spread.
Purpose of the Study:
- To analyze the role of TDLNs in bladder cancer progression and metastasis.
- To explore how bladder cancer cells create an immunosuppressive TDLN microenvironment.
- To review therapeutic strategies for reinvigorating anti-tumor immunity within TDLNs and discuss lymph node dissection (LND).
Main Methods:
- Review of current literature on TDLN function in bladder cancer.
- Analysis of mechanisms by which bladder cancer cells modulate TDLN stromal and immune cells.
- Synthesis of therapeutic approaches to enhance anti-tumor immunity in TDLNs.
Main Results:
- Bladder cancer cells actively shape an immunosuppressive TDLN microenvironment.
- TDLNs, despite initial anti-tumor roles, ultimately support tumor cell proliferation and dissemination.
- Existing therapies aim to reverse TDLN immunosuppression and boost anti-tumor responses.
Conclusions:
- The role of TDLNs in bladder cancer necessitates a re-evaluation of lymph node dissection (LND) strategies.
- Preserving or modulating TDLNs may offer new avenues for effective bladder cancer immunotherapy.
- Understanding TDLN modulation is key to overcoming immunosuppression and improving patient outcomes.
