Munn et al proposed that the tumour draining lymph node is a uniq

Munn et al proposed that the tumour draining lymph node is a unique immunological environment where the presence of regulatory T cells could mediate a suppressive effect on anti-tumour immune responses [26]. Indeed, depletion of Tregs enhances effector T cell responses in tumour draining lymph nodes [27]. Recent data also indicated that the presence of Foxp3+ T cells in tumour draining lymph nodes of colorectal cancer patients correlated with disease progression [28]. Given the associations between Treg infiltration in primary colorectal tumours and patient outcome [18], we questioned whether Tregs in the regional

lymph nodes could be predictive of patient survival. Our data is in contrast to Khort et al [20], who described a population of CD4 cells in the axillary lymph node could predict outcome in breast cancer patients. Although our sample was smaller, there were no apparent trends in the data to indicate that a larger sample would be likely to mTOR cancer yield AZD5153 solubility dmso significant results.

In fact, given the amount of variation in immunological activity that we observed in lymph nodes taken from the same patient, the use of lymph nodes for prognostic purposes would seem to be extremely challenging. Even if a difference in activation existed between patients with “”good”" Rabusertib and “”poor”" prognosis, detection of a statistically significant difference would require collection of large numbers of both patients and nodes. For per-patient prognosis, the inter-node variability would make accurate prediction almost impossible, with the good and poor responders likely to be indistinguishable from one another. This is likely due to the background of non tumour-specific T cell overshadowing the presence of tumour specific responses – indeed, the majority of studies looking at T cells as predictors of outcome in this disease have been restricted to the tumour tissue [11, 12, 17, 18, 21, 29]. We did not identify the sentinel nodes, which are believed to be the primary priming site for the anti-tumour immune Orotidine 5′-phosphate decarboxylase response, however data exists to indicate that there is often more than one sentinel node and it’s spatial relationship to the

tumour can vary considerably [30]. Immunotherapy of cancer patients is difficult due to the specific nature of the adaptive immune response and the absence of easily identifiable tumour specific antigens. The current study looked only at total T cell populations in the lymph node, and it may be that tumour specific T cell populations were present in different frequencies in patients with and without recurrence, but not able to be identified as such. A further complication is the lack of healthy control tissue. Studies comparing immune response in colorectal cancer patients have used blood of healthy patients [14, 15]; however the scope of our study was to investigate the role of lymph nodes for predicting patient outcome, and mesenteric lymph nodes from healthy controls were not obtainable.

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