From mechanism to therapy: advances in macrophage polarisation and targeted intervention in osteosarcoma

Osteosarcoma is the most common type of primary malignant bone tumour in children and adolescents. Despite advances in surgery and neoadjuvant chemotherapy, tumour metastasis and recurrence are still the main factors affecting patient prognosis. Recent research has shown that immune cells in the tumour microenvironment (TME), particularly tumour-associated macrophages (TAMs), play a crucial role in osteosarcoma progression. Macrophages exhibit high plasticity and can differentiate into the M1 type, which has anti-tumour functions, or the M2 type, which promotes tumour development. This paper provides a systematic review of the research on TAMs and their mechanisms in promoting osteosarcoma progression by driving tumour cell proliferation, mediating immune evasion and facilitating metastasis and angiogenesis. Additionally, it provides a systematic outline of potential therapeutic strategies for inhibiting osteosarcoma development by targeting and regulating macrophage polarisation. These strategies include drug interventions, nanotechnology and combined immunotherapy. This paper aims to elucidate the key mechanisms by which macrophage polarisation regulates the biological behaviour of osteosarcoma. This will provide a theoretical basis and strategic references for the precise immunotherapy of osteosarcoma.