title: Decreased total lymphocyte counts in pancreatic cancer: an index of adverse outcome.
abstract: OBJECTIVE
  An impaired host immunity might concur in determining the dismal prognosis of patients with pancreatic cancer (PC). Our aim was to ascertain whether the immunophenotype pattern of blood lymphocytes in PC correlates with tumor stage, grade, or survival.
  
  
  METHODS
  We studied 115 patients with PC, 44 with chronic pancreatitis (CP), 23 with tumors of the pancreatico-biliary tract, and 34 healthy controls (CS). Survival data were available for 77 patients with PC. Lymphocyte subsets were determined by fluorescent activated cell sorter (FACS) analysis.
  
  
  RESULTS
  In patients with PC, total lymphocyte counts were lower than in CP or CS, and CD8 lymphocyte subset levels were higher with respect to CS. Lower circulating lymphocytes were found in advanced PC stages (IIB-IV; chi2 = 11.55, P < 0.05) compared with stages 0 to IIA. Cox regression analysis, made considering total lymphocyte counts and tumor stage as covariates, was found to be significant for both tumor stage (P < 0.001) and total lymphocyte counts (P < 0.05).
  
  
  CONCLUSIONS
  The reduction of total lymphocytes in blood is the main immunologic change in advanced PC. The survival of these patients depends mainly on tumor stage, but it is also affected by the number of circulating lymphocytes, suggesting that the immune system plays an important role in pancreatic adenocarcinoma immunosurveillance and immunoediting.
authors.affiliation: Department of Medical and Surgical Sciences, University of Padova, Padova, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Fogar
authors.forename: Cosimo
authors.initials: C
authors.lastname: Sperti
authors.forename: Daniela
authors.initials: D
authors.lastname: Basso
authors.forename: Maria C
authors.initials: MC
authors.lastname: Sanzari
authors.forename: Eliana
authors.initials: E
authors.lastname: Greco
authors.forename: Carla
authors.initials: C
authors.lastname: Davoli
authors.forename: Filippo
authors.initials: F
authors.lastname: Navaglia
authors.forename: Carlo-Federico
authors.initials: CF
authors.lastname: Zambon
authors.forename: Claudio
authors.initials: C
authors.lastname: Pasquali
authors.forename: Enzo
authors.initials: E
authors.lastname: Venza
authors.forename: Sergio
authors.initials: S
authors.lastname: Pedrazzoli
authors.forename: Mario
authors.initials: M
authors.lastname: Plebani
mesh_terms: D000230:Adenocarcinoma / Q000276:immunology / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005706:Gallbladder Neoplasms / Q000276:immunology / Q000401:mortality; D006801:Humans; D018655:Lymphocyte Count; D008212:Lymphocyte Depletion; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000276:immunology* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D012016:Reference Values; D012044:Regression Analysis; D016019:Survival Analysis; D016176:T-Lymphocyte Subsets / Q000276:immunology