Abstract
Recently, there have been encouraging findings suggesting that myeloid-derived suppressor cells (MDSCs) may be a good target for studying immune suppression in ovarian cancer. MDSCs are an abundance of immature myeloid cells that have demonstrated the ability to decrease tumor-infiltrating immune cells, increase the accrual of tumor-associated macrophages and regulatory T cells, as well as secrete various pro-inflammatory mediators and growth stimulating cytokines. Most studies on this topic utilized murine models, but there are limited reports in human subjects which have important limitations. With the majority of ovarian cancer patients presenting with distant metastases and a corresponding 5-year relative survival rate of < 30%, continued efforts are obligatory toward identifying potential prognostic factors. Given the difficulty of studying exposures in this patient population, as well as the existing immunologic characteristics of this cancer, there is growing interest in further identifying genetic and immunologic associations with patient survival. Furthermore, prognostic factors that may necessitate therapeutic intervention may significantly alter disease outlook. In this review paper, we address the current literature on MDSCs and their immunosuppressive behavior in ovarian cancer patients. While the previous studies on these cells in ovarian cancer have demonstrated some potential prognostic significance, there are many limitations to such studies including small sample sizes, inconsistent staging and histology, as well as inconsistent surface markers for the identification of MDSCs. Additionally, such studies include minimal patient characteristics involved with the clinical course of ovarian cancer. Here, we have proposed improving on studies analyzing MDSCs as a potential prognostic factor in ovarian cancer patients, as well as further identifying the potential of this novel prognostic factor in future care, through the use of a comprehensive epidemiologic model.
Highlights
Ovarian cancer is a rare, yet fatal disease
tumor-associated macrophages (TAMs) are a subset of activated macrophages that become tumor-promoting in the tumor microenvironment (TME) via polarization from a functional, anti-tumor M1-like into an M2-like macrophage
Further studies on this topic using mouse models have demonstrated the ability of IL-10 production by myeloid-derived suppressor cells (MDSCs), suggesting that IL-10 may be a product of these cells via changes in CD62L and lymphocyte acting gene, LAG-3
Summary
Ovarian cancer is a rare, yet fatal disease. This cancer is found to be more prevalent in Caucasian women, with a median age at diagnosis of 63 [1]. This is important to acknowledge as the majority of women with this disease (60%) have progressive disease with distant metastasis at initial presentation This is largely due to the vague characteristics of symptoms for this disease, including, but not limited to: bloating, dyspepsia, early satiety, changes in urinary habits, and generalized pelvic pain and discomfort [2, 3]. While many women will have a good initial response to tumor debulking and chemotherapy treatments, many women will have disease recurrence, develop treatment-resistant disease, and eventually succumb to their disease For these reasons, it remains of high importance to continue exploring potential risk factors, as well as prognostic factors, for EOC. An area of research with increased interest has been the role of immune suppression in EOC etiology and prognosis
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