A narrative overview of the prognostic significance of the immune cellular milieu in tumor draining lymph nodes in non-small cell lung cancer

Lung cancer is both the most common malignancy in the United States and the most fatal. Non-small cell lung cancer accounts for most lung malignancies and involves a complex immune response that has become the recent target of systemic therapy. Late-stage disease is now effectively treated with immunotherapy. As the role of immunotherapy expands, it is becoming increasingly important to understand the biology of the immune response in patients with non-small cell lung cancer and the association of this response with response to therapy and outcomes. In this narrative overview, we review the role of immune cells comprising tumor draining lymph nodes, the structure of tumor draining lymph nodes, and their role in the tumor microenvironment. To identify relevant immune cell interactions within the tumor draining lymph nodes, we reviewed published papers focusing on tumor draining lymph nodes and delineated the significance of the immune cells to the tumor microenvironment in both animal models and humans. This is the first comprehensive review of tumor-draining lymph nodes and their role in the tumor microenvironment and provides a foundation for further investigating the tumor microenvironment and the role of humoral and innate immune response mechanisms in non-small cell lung cancer.