Seizing the fate of lymph nodes in immunotherapy: To preserve or not?

• Published in: Cancer letters 2024-04, Vol.588, p.216740-216740, Article 216740
• Main Authors: Xu, Zhen-Yu, Li, Zi-Zhan, Cao, Lei-Ming, Zhong, Nian-Nian, Liu, Xuan-Hao, Wang, Guang-Rui, Xiao, Yao, Liu, Bing, Bu, Lin-Lin
• Format: Article
• Language: English
• Subjects: Humans; Immunotherapy; Lymph node; Lymph Node Excision; Lymph node metastasis; Lymph Nodes - pathology; Lymphatic Metastasis - pathology; Omission of lymph node dissection; Prognosis
• ISSN: 0304-3835; 1872-7980
• DOI: 10.1016/j.canlet.2024.216740

Lymph node dissection has been a long-standing diagnostic and therapeutic strategy for metastatic cancers. However, questions over myriad related complications and survival outcomes are continuously debated. Immunotherapy, particularly neoadjuvant immunotherapy, has revolutionized the conventional paradigm of cancer treatment, yet has benefited only a fraction of patients. Emerging evidence has unveiled the role of lymph nodes as pivotal responders to immunotherapy, whose absence may contribute to drastic impairment in treatment efficacy, again posing challenges over excessive lymph node dissection. Hence, centering around this theme, we concentrate on the mechanisms of immune activation in lymph nodes and provide an overview of minimally invasive lymph node metastasis diagnosis, current best practices for activating lymph nodes, and the prognostic outcomes of omitting lymph node dissection. In particular, we discuss the potential for future comprehensive cancer treatment with effective activation of immunotherapy driven by lymph node preservation and highlight the challenges ahead to achieve this goal. •Lymph nodes are pivotal for triggering and maintaining an immunotherapy response.•Progress in non-invasive diagnosis contributes to the preservation of lymph nodes.•Modalities that unleash preserved lymph nodes contribute to an improved prognosis.•Challenges in preservation need to be resolved before clinical translation.