INTRODUCTION: Oral cavity cancer is treated surgically, with radiotherapy, chemotherapy, and a combination of all. There is increasing evidence of the impact that immunity status of patients, besides alcohol and tobacco, has on the incidence of oral cavity cancer. Compared to healthy individuals, patients with oral cavity cancer exhibit lower values of individual lymphocyte populations. However, each therapy applied to cure a disease, worsens the initial conditions, which can affect the outcome of the treatment.
PURPOSE: Our intention was to establish the impact of surgical treatment and radiotherapy on specific immunity indicators, on the basic values of complete blood count, and on nutritional status of patients with oral cavity cancer.
METHOD: 110 patients with oral cavity cancer as their first diagnosed and not yet treated malignoma were included in our prospective study. Patients were subsequently divided into those treated only surgically, and those who post-operatively received also radiotherapy. Samples of peripheral blood were taken prior to each treatment and a year after the completion of the treatment. The impact of treatment was defined in relation to the measured parameters. We calculated survival for all patients included in our study cohort and defined the prognostic factors.
RESULTS: The average values of measured parameters in patients prior to the beginning of the treatment did not deviate from reference values. Surgical procedure caused statistically significant anaemia, leucocytosis, thrombocytosis, and an increase of reactive C protein (CRP). A year after the completed surgical treatment most of the measured parameters returned to pre-operative levels, with the exception of higher values in natural killer cells. In patients who were treated also with radiotherapy, this caused a statistically significant drop in the values of leucocytes; B lymphocytes, T lymphocytes, helper T cells, cytotoxic T lymphocytes, naïve and memory T lymphocytes. The CD4/CD8 index was halved. A year after the radiotherapy treatment, the values of memory T lymphocytes, naïve T lymphocytes, cytotoxic T lymphocytes, helper T cells and CD4/CD8 index remained unchanged relative to post-radiotherapy values. Overall 5 year survival of patients from the study cohort was 56%, and disease specific 5 year survival 81%. Univariate Cox regression analysis confirmed statistically significant impact of pre-operative values of erythrocytes, CRP, erythrocytes sedimentation rate (ESR) and albumins on survival, whereas the stage of disease, number of positive neck lymph nodes, penetration through lymph node capsule (ECS) and perineural invasion were confirmed as pathohystological criteria that impacted on survival. The mentioned impact was lost in multivariate regression analysis, which confirmed only the impact of the number of positive lymph nodes, relative to the total number of the dissected lymph nodes.
CONCLUSION: In patients who were treated only surgically, the operative procedure caused a short-term increase of acute inflammatory response parameters, which returned to pre-operative values a year after the treatment completion. In patients who underwent additional radiotherapy, all subpopulations of T lymphocytes and B lymphocytes were lower for statistically significant values, and the CD4/CD8 index remained halved in relation to its initial values. A year after a statistically significant decrease of values in relation to the values prior to the treatment, remained. We have proven a significant impact of the following factors on survival: the stage of the disease, perivascular, perineural invasion, and the penetration of tumor cells through lymph node capsule. Among the measured blood parameters, the pre-operative values of albumins, CRP, ESR, and the total number of erythrocytes were proven to have impact on survival.