Autoreactivity against interleukin 6 as a risk factor in elderly patients with colorectal carcinoma

Hypothesis: Aging results in both decreased immunity to exogenous antigens and increased autoreactivity. We suggest that the increased autoreactivity against tumor-releasing cachectic cytokine and postsurgical hypercytokinemi a are involved in the cause of increased morbidity and mortality in elderly patients with colorectal cancer. Design, Setting, and Patients: Eighty-three patients with colorectal cancer admitted to a university hospital were studied prospectively. Interventions: Surgical specimens of primary colorectal cancer were harvest ed and peripheral venous blood samples were obtained perioperatively. Main Outcome Measures: The tissue concentrations of interleukin (IL) 1 beta and IL-6 were determined. Serial determinations of serum concentrations of IL-6, IL-6 soluble receptor, and C-reactive protein were performed. Nutrit ional status was assessed by the creatinine height index. Results: The tumor IL-6 content was the independent factor that influenced the creatinine height index in the elderly patients, whereas Dukes classifi cation was the only independent factor that influenced the creatinine heigh t index in the younger patients. The elderly patients showed an exaggerated C-reactive protein response and increased IL-6 soluble receptor consumptio n independent of the tumor IL-6 content and postoperative IL-6 response. Th is immunologic disturbance was followed by a significant (P = .03) delay in the normalization of activated neutrophils, which seemed to be associated with postoperative fatal complications in the elderly patients. Conclusions: Autoreactivity against intrinsic IL-6 was increased and seemed to be associated with poor clinical Outcomes in elderly patients. To preve nt fatal complications, adequate nutritional support early in treatment and attenuation of the neutrophil-related hyperinflammatory sequence by contro lling the IL-6 soluble receptor affinity should be advocated.