Nutritional status and the nonspecific cellular and humoral immune response in esophageal carcinoma

In carcinoma of the esophagus, two major factors are operative, both of which are capable of suppressing the immune response, namely starvation and the presence of a malignant tumor. Twenty patients who were treated by palliative intubation for unresectable carcinoma of the esophagus were investigated. All patients were suffering from protein-calorie malnutrition and were shown to be in negative nitrogen balance. Lymphocyte counts and the nonspecific cellular and humoral immune response were evaluated before and after correction of the nutritional deficit. No attempt was made to reduce tumor bulk. The cellular immune response was compromised in all patients. The DNCB skin test was negative, absolute lymphocyte counts and T-lymphocyte numbers were significantly depressed, and the mitogenic response to phytohaemagglutinin (PHA) stimulation also significantly depressed. Immunoglobulin A levels were significantly elevated but serum complement concentrations were normal. Reversal of the negative nitrogen balance resulted in a significant increase in absolute and T-lymphocyte numbers, and a significant increase in the mitogenic response to PHA. The DNCB skin test, however, remained nonreactive. Nutritional repletion also significantly increased serum C(3), C(4) and C(3)PA concentrations. Reversal of negative nitrogen balance may reverse in vitro evidence of immunoparesis and produce an increase in complement concentrations, without therapeutic reduction in the tumor load.