Activated immune system in associated with poor prognosis in ovarian cancer

Prognostic value of preoperative neopterin, a marker for macrophage activat ion, was investigated in 225 patients with epithelial ovarian cancer. About 50% of patients showed neopterin concentrations above the cut-off level of 275 mu mol/mol creatinine. Interestingly, those patients with elevated uri nary neopterin concentration, and thus displaying a sign of activation of c ell-mediated immunity, had a shorter overall an disease-flee survival than those with a normal concentration. Applying a multivariate analysis, the on ly independent parameters predicting patient survival were residual disease and neopterin. This surprising finding could be explained by stronger immu nogenicity of poor differentiated tumors which may not result in a better r ecognition of the immune system. Moreover, activated macrophages produce hi gh amounts of growth or angiogenic factors, that can either stimulate tumor proliferation directly or support blood supply, which in turn ameliorates tumor nutrition.