title: Cytokine patterns in cancer patients: A review of the correlation between interleukin 6 and prognosis.
abstract: OBJECTIVE
  In tumor patients, IL-6 appears to be one component of a consistent cancer-associated cytokine network resulting in both a systemic immune stimulation and a microenvironment of cancer-induced immune suppression that ultimately protects the cancer cells. IL-6 has been associated with prognosis in cancer patients, but so far a systemical analysis has not been carried out.
  
  
  METHODS
  The present meta-analysis studies the relation between IL-6 serum levels and the prognosis of cancer patients in the available clinical literature of 100 articles published between 1993 and 2013 comprising 11,583 patients.
  
  
  RESULTS
  The IL-6 serum level was described as significantly correlating with survival in 82/101 series comprising 85.6% of patients (9917/11,583) with 23 different cancer types. A total of 64 studies dichotomized patient cohorts according to various cut-off IL-6 serum levels: in 59/64 of these series corresponding to 94.5% of the reported patients (7694/8142) significant correlations between IL-6 serum level and survival were seen. The median survival of cancer patients had been determined above various cut-off levels of serum IL-6 in 24 dichotomized studies (26 cohorts). There was a highly significant inverse correlation between median survival of the cohorts with IL-6 serum level above cut-off (1272 patients) and their corresponding IL-6 cut-off values (Spearman R -0,48 p= < 0.001) following a linear regression when both parameters were log-transformed (p < 0.001). A significant correlation between increasing serum IL-6 and tumor stage or metastases was described in 39/44 studies and 91% of published patients (4221/4636) where clinical parameters had been specified.
  
  
  CONCLUSIONS
  Closely associated with the patient's clinical condition and independent of the cancer histology, the increased IL-6 serum level uniformly appears to correlate with survival as paraneoplastic condition in later cancer stages independent of the cancer type. Modifications of this paraneoplastic immune reaction may offer new therapeutic options in cancer.
authors.affiliation: Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Sjukhuset, Karolinska Institutet , Stockholm, Sweden.
authors.forename: Bodo E
authors.initials: BE
authors.lastname: Lippitz
authors.affiliation: Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Sjukhuset, Karolinska Institutet , Stockholm, Sweden.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Harris
keywords: Cancer; IL-6; Interleukin 6; Paraneoplastic; Sweden; cytokines; prognosis