A prospective study of squamous head and neck carcinoma immunologic aberrations in patients who develop recurrent disease

In a prospective study of squamous head and neck cancer, the pretreatment peripheral blood of 125 patients was examined for lymphocyte subclass and in vitro immunologic function. After 4 years of followup, 49 recurrences of disease were observed. Lymphocytes from patients with recurrent disease showed elevated interleukin-2 (IL-2) production and a tendency towards increased response to mitogens in comparison to those without recurrence. When disease-free survival is analyzed on the basis of IL-2 levels, patients with high relative IL-2 synthesis (21) had a 40% poorer prognosis than patients with low relative IL-2 levels (4). The difference is significant at a P value of 0.02. Since IL-2 synthesis occurs with antigenic stimulation, it is postulated that patients who have a high IL-2 synthesis in their pretreatment lymphocytes may have had prior stimulation by circulating tumor antigen. Such immune response by the host may be successful in destroying the antigenic tumor cells but may leave the undifferentiated, less antigenic tumor cells to grow and metastasize. Thus, elevated IL-2 synthesis in pretreatment lymphocytes predicts a poorer prognosis. S solid tumors, usually has a predictable biologic and clinical behavior. This carcinoma presumably begins with a precancerous condition and progresses to an invasive state manifested by local and regional involvement, followed subsequently by dissemination to distant organs.' In the initial stages of disease, surgery and/or radiation are curative methods of treatment. For advanced stages, these two modalities of treatment are insufficient to control the disease. The role of adjunctive chemotherapy is presently under close investigation. Many important factors have been observed to affect the outcome of treatment, namely, anatomic origin of the cancer, extent of the disease as determined by staging, biologic behaviors expressed either by the tempo of disease progression clinically, or invasiveness and metastatic potential as determined by resectability and early recurrence, age of the