Tumor draining lymph nodes in non-small cell lung cancer: underrecognized role in biomarker discovery and therapeutic innovation

Recent advances have furthered our understanding of the role of the tumor draining lymph node (TDLN) in the immune response to thoracic malignancies. This review synthesizes the rapidly expanding evidence that tumor draining lymph nodes (TDLNs) are not passive conduits of metastasis but dynamic immunologic organs that shape anti-tumor immunity in non–small cell lung cancer (NSCLC). Across cytokine, cellular, genomic, transcriptomic, and metabolic domains, the TDLN microenvironment becomes progressively remodeled towards immune suppression. These changes influence tumor growth and early metastasis, and may dictate responsiveness to various treatment modalities. The TDLN is also a practical and clinically relevant site for biomarker discovery and therapeutic innovation as a target of drug delivery and immunomodulation.