Influence of preoperative treatment and surgical operation on immune function of patients with esophageal carcinoma

Multiple immunological parameters, including total lymphocyte count, lymphocyte subpopulations (CD2⁺, CD19⁺, CD3⁺, CD4⁺ and CD8⁺), phytohemagglutinin (PHA) response, and natural killer (NK) activity, were measured in 66 patients with previously untreated esophageal carcinoma. The influence of preoperative treatment and/or surgical operation on the immune function were evaluated in 40 patients. The PHA response and NK activity of the patients with esophageal carcinoma were 229 ± 103 S.I.% and 18.5 ± 11.9% lysis, respectively, and were significantly depressed as compared with the control. The CD4⁺/CD8⁺ ratio, PHA response, and NK activity in stage IV were also significantly depressed compared to that in stages I‐III. Preoperative treatment induced significant reductions in the total lymphocyte count (1,994 ± 644 to 670 ± 274/mm³), PHA response (219 ± 77 to 159 ± 59 S.I.%), and NK activity (19.7 ± 13.2 to 11.1 ± 10.3% lysis) as well as a significant gradual decrease in the CD4⁺/CD8⁺ ratio (2.09 ± 1.42 to 0.69 ± 0.48), while the surgical operation significantly influenced only the total lymphocyte count. This study demonstrates that preoperative treatment induces a more pronounced influence on the immune function than surgical operation alone, in patients with esophageal carcinoma in which the immune function is disturbed prior to these treatments.