title: Survival of malnourished head and neck cancer patients can be predicted by human leukocyte antigen-DR expression and interleukin-6/tumor necrosis factor-alpha response of the monocyte.
abstract: BACKGROUND
  Patients with advanced stages of head and neck cancer are often characterized by malnutrition and by an impaired immune system. Because some of the suppressed immune parameters were shown to be of prognostic importance in trauma and sepsis, we investigated whether these would also correlate with survival in head and neck cancer.
  
  
  METHODS
  Severely malnourished head and neck cancer patients undergoing ablative and reconstructive surgery were followed prospectively and their perioperative immune parameters were related to long-term survival.
  
  
  RESULTS
  Forty-nine patients with a preoperative weight loss of more than 10% were followed up for a period of at least 16 months after surgery. Analyses of variance revealed that preoperative human leukocyte antigen-DR (HLA-DR) expression on monocytes and endotoxin-induced production of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) were different between patients who survived and patients who died. Proportional hazards identified a weight loss of more than 12%, the presence of coexistent disease, and an HLA-DR expression on monocytes below the cutoff points (mean fluorescence index < 15, peak channel index < 9) to be of significant influence on survival.
  
  
  CONCLUSIONS
  In addition to known prognostic parameters such as tumor stage, coexistent disease, and weight loss, the immune parameters HLA-DR expression on monocytes and endotoxin-induced cytokine production may carry prognostic value in cancer patients. Immunomodulating therapies leading to improvement of these parameters might in the future lead to increased options for treatment.
authors.affiliation: Department of Dietetics, University Hospital Vrije Universiteit, Amsterdam, The Netherlands. M.vanBokhorst@azvu.nl
authors.lastname: van Bokhorst-de van der Schuer
authors.forename: B M
authors.initials: BM
authors.lastname: von Blomberg-van der Flier
authors.forename: D J
authors.initials: DJ
authors.lastname: Kuik
authors.forename: P E
authors.initials: PE
authors.lastname: Scholten
authors.forename: M P
authors.initials: MP
authors.lastname: Siroen
authors.forename: G B
authors.initials: GB
authors.lastname: Snow
authors.forename: J J
authors.initials: JJ
authors.lastname: Quak
authors.forename: P A
authors.initials: PA
authors.lastname: van Leeuwen
mesh_terms: D000276:Adjuvants, Immunologic; D005260:Female; D006684:HLA-DR Antigens / Q000096:biosynthesis*; D006258:Head and Neck Neoplasms / Q000150:complications / Q000276:immunology / Q000401:mortality* / Q000601:surgery; D006801:Humans; D015850:Interleukin-6 / Q000096:biosynthesis*; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology*; D009748:Nutrition Disorders / Q000150:complications* / Q000276:immunology; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D014409:Tumor Necrosis Factor-alpha / Q000096:biosynthesis*
chemical_list: D000276:Adjuvants, Immunologic; D006684:HLA-DR Antigens; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha