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Tumor size and lymph-node status in pancreatic carcinoma - is there a correlation to the preoperative immune
F A Wenger1, C A Jacobi, J Zieren
1Department of General, Visceral, Vascular and Thoracic Surgery, Charité Campus Mitte, Humboldt-University Berlin, Schumannstr. 20/21, D-10098 Berlin, Germany.
Background And Aims:
It has not been clarified whether there is a correlation between the tumor size and the preoperative immune function in pancreatic carcinoma.
Patients/Methods:
In a prospective trial, the influence of tumor size and lymph-node status on different immune system factors [interleukins (IL)-6 and -10, tumor necrosis factor (TNF)-alpha, CD3-, CD4-, and CD8-lymphocytes, and human leukocyte antigen (HLA)-DR-monocytes] was analyzed in 28 patients with pancreatic carcinoma and compared with a control group (n=20). There were 3 pancreatic carcinomas of the T1-tumor type, 20 T2- and 5 T3-tumors; 14 patients were in stage N1.
Results:
In comparison with the control group, tumor patients preoperatively showed a significant increase of leukocytes (P=0.02), monocytes (P=0. 04), and granulocytes (P=0.03). The total count of lymphocytes, the number of CD3-, CD4- and CD8-lymphocytes, and the expression of HLA-DR on monocytes were significantly decreased as a sign of immunosuppression in tumor patients. A multivariate analysis proved that only tumor size (T-stage) but not lymph-node status correlates with the deficiency of immune competence. Progressive tumor size correlated with decreasing expression of HLA-DR on monocytes, CD3- (P=0.04) and CD8- (P=0.02) lymphocytes. In contrast IL-6, IL-10 (P=0. 04) and TNF-alpha (P=0.02) increased with progressive tumor size.
Conclusion:
Regarding the negative prognosis after resection, the preoperative immune status could be an additional help for decision between a resection or a preoperative immune stimulation in pancreatic carcinoma.