Complex perioperative immuno-dysfunction in patients with renal cell carcinoma

Purpose: Patients with renal cell carcinoma have an impaired function of th e immune system, which is the basis for different approaches of immunothera py. We address perioperative changes of several parameters of the immune sy stem in these patients. Materials and Methods: Parameters of cellular and humoral immunity, includi ng differential blood count, T cell markers CD2, 3, 4 and 8, B cell markers CD19 and 20, monocyte markers CD13 and 14, natural killer cell marker CD16 , activation markers CD25, CD26 and HLA-DR, and cytokines interleukin-1 (IL -1) receptor antagonist, IL-2, soluble IL-2 receptor, IL-6, IL-10 and trans forming growth factor-beta, were measured in the venous blood of patients w ho underwent renal surgery extracorporeal shock wave lithotripsy (ESWL, Dor nier Medical Systems, Inc., Marietta, Georgia). Patients were grouped and a ge matched, and 37 underwent tumor nephrectomy, 20 open renal surgery for n onmalignant reasons and 24 ESWL. A group consisting of 39 controls received no treatment. Results: Little change was detected in controls and those patients who rece ived ESWL. Patients who underwent open renal surgery had increased leukocyt e and granulocyte counts until postoperative day 3 but had low T cell count s. The postoperative decrease in CD25 expressing cells corresponded to an i ncrease in the soluble IL-2-receptor. Cytokines IL-6 and 10, which also hav e immunosuppressive properties, were markedly increased postoperatively. Th ese changes were more noted (p <0.01) in those patients who underwent tumor nephrectomy than open renal surgery for nonmalignant reasons and remained detectable when paired patients with similar surgical trauma were compared. In tumor nephrectomy cases renal venous IL-6 was higher than peripheral ve nous levels. Conclusions: Patients with renal cell carcinoma suffer from selective immun o-dysfunction, indicating a rationale for perioperative immunomodulation.