Miguel Bronchud: Primary Tumor Surgery Lymphadenectomy?
Miguel Bronchud, Co-Founder & Advisory Board at Regenerative Medicine Solutions, shared on LinkedIn:
“Primary tumor Surgery Lymphadenectomy? How many lymph nodes should we remove? New scientific evidence suggests that not all lymph nodes ‘are the same’.
Some are probably ‘good lymph nodes’ being presented specific cancer antigens to react against them; whereas others are definitely ‘bad lymph nodes’, that contain malignant metastatic cells and eliciting immune suppression reactions. Though, perhaps, even under these desperate conditions, the immune system could still have some potentially good responses against cancer if adequately stimulated.
Lymph node-derived stem-like but not tumor-tissue-resident CD8+ T cells fuel anticancer immunity?
If so, should our surgical procedures and approaches take into account not only the presence or absence of metastatic lymph node cells in loco regional draining areas (like axillary nodes in breast cancer, for example), but also the absence or presence (detected by specific immune markers or circulating lymph cells) of good anti cancer T- and B-cells (or even antigen presenting cells), in these lymph nodes, before they are surgically removed?
In other words- The stem-like CD8+ T cell population in lymph nodes, unlike those already present in the tumor, can be the primary driver of effective anticancer immunity and response to immunotherapies.
Upon entry into the tumor, these stem-like CD8+ T cells can differentiate into several subsets, including those with effector functions.
This dichotomy observed in mouse models, between intratumoral and extratumoral TGFβ-restricted T cells, with precursor and resident characteristics, has also been observed in some human cancers.
Thus, the health and function of stem-like T cells in the lymph nodes are critical for sustained and effective antitumor immunity. Should we not consider that more biological information is desirable before surgery ?
As experienced clinicians we know well just how unpleasant (and at times painful) an enlarged regional metastatic lymph node can be. Especially, as they grow up together as large lumps and impinge upon other anatomical nearby structures causing lymphedema? Or nerve damage? Or leading to venous thrombosis because of venous obstruction?”
Title: Lymph-node-derived stem-like but not tumor-tissue-resident CD8+ T cells fuel anticancer immunity
Authors: Sharanya K. M. Wijesinghe, Lisa Rausch, Sarah S. Gabriel, Giovanni Galletti, Marco De Luca, Lei Qin, Lifen Wen, Carlson Tsui, Kevin Man, Leonie Heyden, Teisha Mason, Lewis D. Newland, Andrew Kueh, Yang Liao, David Chisanga, Julian Swatler, Emanuele Voulaz, Giuseppe Marulli, Valentina Errico, Agnese Losurdo, Gustavo R. Rossi, Fernando Souza-Fonseca-Guimaraes, Nicholas D. Huntington, Thomas Gebhardt, Daniel T. Utzschneider, Marco J. Herold, Wei Shi, Jan Schroeder, Enrico Lugli and Axel Kallies
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