title: Chemotherapy-induced apoptosis of lymphocytes in esophageal cancer worsens outcome.
abstract: OBJECTIVE
  Chemotherapy has been shown to induce apoptosis in esophageal cancer. However, no windows of opportunity exist to selectively kill tumor cells without killing host cells. Due to the concern that tumor-infiltrating lymphocytes may be killed by chemotherapy, we examined the significance of the effect of treatment on the density of tumor-infiltrating lymphocytes and apoptosis in the tumor itself and in the tumor-infiltrating lymphocytes.
  
  
  METHODS
  In 93 patients with esophageal cancer including 50 with neoadjuvant chemotherapy, esophagectomy specimens were examined for density of tumor-infiltrating lymphocytes and for apoptosis in both tumor cells and tumor-infiltrating lymphocytes.
  
  
  RESULTS
  Apoptotic index was increased by neoadjuvant chemotherapy only in tumor-infiltrating lymphocytes, apoptotic index was > or = 4 only in chemotherapy patients. The density of tumor infiltrating lymphocytes was a significant positive prognostic factor in chemotherapy and non-chemotherapy groups, and the high apoptotic index in tumor-infiltrating lymphocytes was an independent negative prognostic factor in the chemotherapy group.
  
  
  CONCLUSIONS
  Apoptosis in tumor-infiltrating lymphocytes was induced by chemotherapy in some patients in association with a poor prognosis. Unexpectedly, chemotherapy did not increase apoptosis in tumor cells. Both findings suggest a need for improved regimes and individualized treatment.
authors.affiliation: First Department of Surgery, School of Medicine, Kumamoto University, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Yasunaga
authors.forename: Y
authors.initials: Y
authors.lastname: Tabira
authors.forename: T
authors.initials: T
authors.lastname: Okuma
authors.forename: N
authors.initials: N
authors.lastname: Kitamura
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D017209:Apoptosis / Q000187:drug effects*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000601:surgery; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D006801:Humans; D008214:Lymphocytes / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis