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Review Open Access

Bone niche‑driven antitumor immune failure in osteosarcoma: Mechanisms and therapeutic implications (Review)

  • Authors:
    • Bolin Tang
    • Yuhuai Wu
    • Jianping Liu
    • Rui Pan
  • View Affiliations / Copyright

    Affiliations: School of Public Health, Dali University, Dali, Yunnan 671000, P.R. China, Department of Orthopedics, The Sixth Affiliated Hospital of Kunming Medical University, Yuxi, Yunnan 653100, P.R. China, Research and Science Department, People's Hospital of Yuxi City, Yuxi, Yunnan 653100, P.R. China, Department of Nutrition, The Sixth Affiliated Hospital of Kunming Medical University, Yuxi, Yunnan 653100, P.R. China
    Copyright: © Tang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 431
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    Published online on: July 29, 2026
       https://doi.org/10.3892/ol.2026.15786
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Abstract

Osteosarcoma (OS) remains a clinically challenging primary malignant bone tumor that occurs predominantly in children, adolescents and young adults. Despite standard multimodal therapy, recurrent, metastatic and chemotherapy‑refractory disease continues to have poor outcomes, and pulmonary recurrence remains a dominant cause of mortality. Tumor cell‑intrinsic alterations, including genomic instability, clonal heterogeneity, stem‑like plasticity and chemoresistance, explain important aspects of disease aggressiveness; however, they do not fully account for the limited responses to immune checkpoint blockade or engineered cellular therapies, nor for the high frequency of lung relapse after apparently adequate local control. The current review presents an evidence‑graded bone niche‑driven framework of layered antitumor immune failure in OS. In this model, the skeletal niche is not treated as a passive anatomical background but as a spatial and temporal organizer of immune‑cell trafficking, myeloid remodeling, treatment‑induced repair programs, systemic niche communication and pulmonary immune surveillance. Bone niche remodeling and myeloid‑cell enrichment constitute the most mature mechanistic anchors, whereas pulmonary niche conditioning, efferocytosis, extracellular vesicle (EV)‑mediated bone‑lung signaling, and physical or metabolic stress adaptation are presented as emerging or hypothesis‑generating modules. To prevent conceptual overextension, direct OS evidence is separated from contextual tumor‑biology evidence and aligned with each claim, along with its current gap and a falsifiable validation route. Translationally, the framework supports a timed sequence of niche reprogramming, immune activation, and pulmonary niche maintenance, to be tested through perioperative window studies, paired primary‑tumor and lung‑metastasis cohorts, functional perturbation experiments, spatial immune profiling, circulating EV/chemokine monitoring and predefined pulmonary recurrence endpoints.
View Figures

Figure 1

Bone niche-driven layered antitumor
immune failure in OS. The schematic summarizes four partially
overlapping layers: Structural restriction within mineralized or
osteoid-rich bone; myeloid cell-predominant remodeling; tolerogenic
processing of therapy-stressed or dying tumor cells; and systemic
communication that may support pulmonary niche conditioning. Solid
arrows indicate relatively better-supported OS-specific links,
dashed arrows indicate candidate or hypothesis-generating links and
the T-bar indicates inhibition or suppression. Figure created using
BioRender. EV, extracellular vesicle; TAM, tumor-associated
macrophage; IDO1, indoleamine 2,3-dioxygenase 1; ARG1, arginase 1;
CSF1R, colony-stimulating factor 1 receptor; TGF-β, transforming
growth factor-β; PGE2, prostaglandin E2; LOX-1,
lectin-like oxidised low-density lipoprotein receptor-1; MDSC,
myeloid-derived suppressor cell; Treg, regulatory T cell; ECM,
extracellular matrix; T cell, T lymphocyte; OS, osteosarcoma.

Figure 2

Proposed bone-circulation-lung axis
linking primary OS niche remodeling to pulmonary premetastatic
conditioning and recurrence progression. The schematic depicts
primary bone niche remodeling, export of circulating
EVs/chemokines, lung-niche conditioning, micrometastatic
maintenance and metastatic outgrowth. Solid links indicate
relatively better-supported OS evidence, dashed links indicate
OS-supported candidate mechanisms, and dotted links indicate
contextual extrapolation requiring functional validation. Figure
created using BioRender. MDSC, myeloid-derived suppressor cell; EV,
extracellular vesicle; CCL5, C-C motif chemokine ligand 5; CXCL10,
C-X-C motif chemokine ligand 10; lncRNAs, long non-coding RNAs;
ECM, extracellular matrix; Mφ, macrophage; MMP, matrix
metalloproteinase; DTC, disseminated tumor cell; MDSC,
myeloid-derived suppressor cell; OS, osteosarcoma; TAM,
tumor-associated macrophage; NK, natural killer; miRNA,
microRNA.

Figure 3

Conceptual three-step therapeutic
sequence aligned with the proposed bone-lung immune axis in OS.
Niche reprogramming during the neoadjuvant/perioperative window
aims to relieve structural, myeloid, stromal, EV-related, or
metabolic constraints; immune activation follows partial niche
relief through checkpoint, B7-H3, CAR-T/CAR-NK or other engineered
approaches; and pulmonary niche maintenance during postoperative
minimal-residual-disease surveillance focuses on lung-directed
immune support, EV/chemokine monitoring, NK cell-supportive
platforms and relapse monitoring. The sequence is evidence-staged
and should not be interpreted as an established clinical algorithm.
Figure created using BioRender. TAM, tumor-associated macrophage;
MDSC, myeloid-derived suppressor cell; EV, extracellular vesicle;
ECM, extracellular matrix; TME, tumor microenvironment; Gas6,
growth arrest-specific 6; MERTK, MER proto-oncogene tyrosine
kinase; AXL, AXL receptor tyrosine kinase; TGF-β, transforming
growth factor-β; CAR, chimeric antigen receptor; ICB, immune
checkpoint blockade; PD-1, programmed cell death protein 1; B7-H3,
B7 homolog 3; NK, natural killer; OS, osteosarcoma.
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Copy and paste a formatted citation
Spandidos Publications style
Tang B, Wu Y, Liu J and Pan R: Bone niche‑driven antitumor immune failure in osteosarcoma: Mechanisms and therapeutic implications (Review). Oncol Lett 32: 431, 2026.
APA
Tang, B., Wu, Y., Liu, J., & Pan, R. (2026). Bone niche‑driven antitumor immune failure in osteosarcoma: Mechanisms and therapeutic implications (Review). Oncology Letters, 32, 431. https://doi.org/10.3892/ol.2026.15786
MLA
Tang, B., Wu, Y., Liu, J., Pan, R."Bone niche‑driven antitumor immune failure in osteosarcoma: Mechanisms and therapeutic implications (Review)". Oncology Letters 32.4 (2026): 431.
Chicago
Tang, B., Wu, Y., Liu, J., Pan, R."Bone niche‑driven antitumor immune failure in osteosarcoma: Mechanisms and therapeutic implications (Review)". Oncology Letters 32, no. 4 (2026): 431. https://doi.org/10.3892/ol.2026.15786
Copy and paste a formatted citation
x
Spandidos Publications style
Tang B, Wu Y, Liu J and Pan R: Bone niche‑driven antitumor immune failure in osteosarcoma: Mechanisms and therapeutic implications (Review). Oncol Lett 32: 431, 2026.
APA
Tang, B., Wu, Y., Liu, J., & Pan, R. (2026). Bone niche‑driven antitumor immune failure in osteosarcoma: Mechanisms and therapeutic implications (Review). Oncology Letters, 32, 431. https://doi.org/10.3892/ol.2026.15786
MLA
Tang, B., Wu, Y., Liu, J., Pan, R."Bone niche‑driven antitumor immune failure in osteosarcoma: Mechanisms and therapeutic implications (Review)". Oncology Letters 32.4 (2026): 431.
Chicago
Tang, B., Wu, Y., Liu, J., Pan, R."Bone niche‑driven antitumor immune failure in osteosarcoma: Mechanisms and therapeutic implications (Review)". Oncology Letters 32, no. 4 (2026): 431. https://doi.org/10.3892/ol.2026.15786
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