NUTRITIONAL-STATUS AND THE NONSPECIFIC CELLULAR AND HUMORAL IMMUNE-RESPONSE IN ESOPHAGEAL-CARCINOMA

Abstract

In carcinoma of the esophagus, 2 major factors are operative; both are capable of suppressing the immune response, i.e., starvation and the presence of a malignant tumor. Patients (20) who were treated by palliative intubation for unresectable carcinoma of the esophagus were investigated. All patients were suffering from protein-calorie malnutrition and were in negative N 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 [dinitrochlorobenzene] skin test was negative, absolute lymphocyte counts and [thymus-derived]lymphocyte numbers were significantly depressed and the mitogenic response to phytohemagglutinin (PHA) stimulation significantly depressed. Immunoglobulin A levels were significantly elevated but serum complement [c] concentrations were normal. Reversal of the negative N balance resulted in a significant increase in absolute and T-lymphocyte numbers and a significant increase in the mitogenic response to PHA. The DNCB test remained nonreactive. Nutritional repletion also significantly increased serum C3, C4 and C3PA concentrations. Reversal of negative N balance may reverse in vitro evidence of immunoparesis and produce an increase in C concentrations, without therapeutic reduction in the tumor load.