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.