Decreased total lymphocyte counts in pancreatic cancer: An index of adverse outcome

Objectives: 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; chi(2) = 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.