Assessment of the state of immunity in patients with tumors

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Бабаев S., Бектурдиев S., Рахимов N., Джалалова D., Юсупова D., & Шаханова S. (2021). Assessment of the state of immunity in patients with tumors. in Library, 21(2), 218–225. извлечено от https://inlibrary.uz/index.php/archive/article/view/14549
Саид Бабаев, Самаркандский медицинский институт

к.м.н., доцент кафедры офтальмологии

Шавкат Бектурдиев, Самаркандский медицинский институт

к.м.н., заведующая отделением офтальмологии

Нодир Рахимов, Самаркандский медицинский институт

доцент кафедры онкологии

Дильфуза Джалалова, Самаркандский медицинский институт

к.м.н., заведующая офтальмологическим отделением 1-й клиники

Дилдора Юсупова, Ташкентский государственный стоматологический институт

старший преподаватель кафедры болезней и травм челюстно-лицевой области

Шахноза Шаханова, Самаркандский медицинский институт

ассистент кафедры онкологии

0
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Scopus

Аннотация

Cellular immune status provides information on  the  relative  and  absolute  numbers  of  cell  populations (monocytes,  granulocytes  and  lymphocytes)  and subpopulations  of  lymphocytes  in  the  blood.  The  human body is equipped with a complex defence mechanism whose primary function is to distinguish foreign antigens from the body's  own  antigens  and  initiate  an  appropriate  immune response.  Historically,  innate  immunity  differs  from adaptive  immunity,  and  these  systems  work  closely together.  The  immune  response  is  mediated  by  both cellular  components  (B-  and  T-lymphocytes,  NK  cells, macrophages/monocytes,  granulocytes  and  antigen-presenting  cells)  and  humoral  components  (antibodies, complement  factors,  cytokines  and  other  soluble  effector molecules). [12,13].

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ASSESSMENT OF THE STATE OF IMMUNITY IN PATIENTS WITH

TUMORS

Said Abdurakhmanovich Babayev

Shavkat Satiboldievich Bekturdiev

Nodir Mahammatkulovich Rakhimov

Dilfuza Zuhriddinovna Jalalova

Dildora Zuhriddinovna Yusupova

Shakhnoza Shavkatovna Shakhanova

Received 15

th

Apr 2021,

Accepted 17

th

May 2021,

Online 6

th

June 2021

1

PhD, Associate Professor, Department

of Ophthalmology, Samarkand Medical
Institute, Uzbekistan

2

PhD, Head of the Department of

Ophthalmology at Samarkand Medical
Institute

3

Associate Professor of Oncology

Department of Samarkand Medical
Institute

4

PhD, Head of Ophthalmology

Department of the 1st Clinic of
Samarkand Medical Institute

5

Senior lecturer, Department of

diseases and traumas of maxillofacial
area of Tashkent

Institute of Dentistry

6

Assistant of Department of Oncology

of Samarkand Medical Institute

ABSTRACT

:

Cellular immune status provides information

on the relative and absolute numbers of cell populations
(monocytes,

granulocytes

and

lymphocytes)

and

subpopulations of lymphocytes in the blood. The human
div is equipped with a complex defence mechanism whose
primary function is to distinguish foreign antigens from the
div's own antigens and initiate an appropriate immune
response. Historically, innate immunity differs from
adaptive immunity, and these systems work closely
together. The immune response is mediated by both
cellular components (B- and T-lymphocytes, NK cells,
macrophages/monocytes,

granulocytes

and

antigen-

presenting cells) and humoral components (antibodies,
complement factors, cytokines and other soluble effector
molecules). [12,13].

Keywords

:

immunity, orbital tumors, leukocyte formula

CENTRAL ASIAN JOURNAL OF MEDICAL AND NATURAL SCIENCES

Volume: 02 Issue: 03 | May-June 2021

ISSN:2660-4159

www.cajmns.centralasianstudies.org/index.php


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Both external factors (climatic, physical, mechanical, etc.) and the state of the organism itself
(inflammatory processes, metabolic disorders, regulatory nervous influences, changes in connective
tissue) play a role in the emergence and development of neoplasms [1].

Tumor transformation of one or several cells causes the div to respond to the elimination of foreign
information. The div's response to a developing tumor is carried out using humoral and cellular
mechanisms, which can be determined by counting the number of peripheral blood leukocytes [2,3].

The leukocyte blood count is an indicator of the div's nonspecific response, which quite fully reflects
the typical processes in the immunity system in health and disease. Leukocytogram outside the
expanded immunogram can serve as an immunologically informative component and guideline for
determining the functional state of immunity in general and in some diseases: toxic infection, sepsis,
hypo- and avitaminosis, rheumatism, alimentary exhaustion, etc. [4].

Changes in the leukocyte formula in the dynamics of the pathological process, the level of leukocytes,
lymphocytogram contribute to assessing the severity of the patient's condition, determining the amount
of therapy, assessing the patient's response to surgery, predicting the effectiveness of therapy and the
course of the rehabilitation period [5].

The choice of the ratio of certain cellular elements is due to their closest functional relationship in the
system of cellular cooperation [6,7,8]

From the point of view of various authors, the most significant of the many integral hematological
indicators are: leukocyte index (LI), leukocyte intoxication index (LII), leukocyte shift index (LSI),
leukocyte to ESR ratio, lymphocyte-granulocyte index (LGI), general index (GI), the index of the
ratio of neutrophils and lymphocytes (IRNL), the index of the ratio of neutrophils to monocytes
(IRNM), the index of the ratio of lymphocytes to monocytes (IRLM), the index of the ratio of
lymphocytes and eosinophils (IRLE), the coefficient of redundancy (CR) [9, 10,11]

Objective

: to study changes in hematological indices in patients with various types of orbital tumors.

Materials and methods

:

Integral hematological parameters were determined in 179 patients with primary orbital tumors.

Men were 42.5%, women - 57.5%, mainly (42.9%) of the most working age: from 40 to 60 years.
Benign tumors accounted for 69.2%, malignant - 30.8% of cases.Among the primary benign tumors of
the orbit, tumors of neurogenic origin predominated - 19.5%. Vascular tumors accounted for 15.4%,
epithelial tumors (mainly of the lacrimal gland) - 9.4%. Less common were fibrous histiocytoma -
3.4%, fibroma - 1.5%, osteoma and lipoma - 1.2% each, etc. Congenital cysts and false tumors
considered in the group of primary tumors were observed in 16.5% and 32, 2% of cases (Diagram 1).

Table 1 Patient characteristics

Parameter

Numbers of patients Percentage (%)

Age

mean

50 year

-

Range

25–85 year

-

Gender

male

76

42,5

female

103

57,5

Tumortype

malignant

56

31,2

benigntumors 123

68,8


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Diagram 1 distribution of patients with benign tumors

Among malignant neoplasms, lymphomas prevailed
rhabdo-myosarcomas - 4.80% are much less common.
(adenocarcinoma, adenocarcinoma in pleomorphic adenoma) were observed in 22.80%, malignant
paraganglioma - 4.70%, malignant histiocytoma

Diagram 2 distribution of patients with malignant tu

All patients underwent standard clinical and instrumental studies, including visometry, biomicroscopy,
ophthalmoscopy, exophthalmometry, perimetry. Removed neoplasms were examined by
morphological methods.

39.50%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

MALIGNANT NEOPLASMS

Lymphomas

adenocarcinoma

19.50%

15.40%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

BENIGN NEOPLASMS

Volume: 02 Issue: 03 | May

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Diagram 1 distribution of patients with benign tumors

Among malignant neoplasms, lymphomas prevailed - 39.50%, undifferentiated sarcomas

4.80% are much less common. Malignant tumors of the lacrimal gland

(adenocarcinoma, adenocarcinoma in pleomorphic adenoma) were observed in 22.80%, malignant

4.70%, malignant histiocytoma - 3.8%, etc. (Diagram 2).

Diagram 2 distribution of patients with malignant tumors

All patients underwent standard clinical and instrumental studies, including visometry, biomicroscopy,
ophthalmoscopy, exophthalmometry, perimetry. Removed neoplasms were examined by

11.20%

4.80%

22.80%

4.70%

1

MALIGNANT NEOPLASMS

undifferentiated sarcomas

rhabdo-myosarcoma

malignant paraganglioma

histiocytoma

15.40%

9.40%

3.40% 1.50% 1.20%

1

BENIGN NEOPLASMS

May-June2021

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Diagram 1 distribution of patients with benign tumors

39.50%, undifferentiated sarcomas - 11.20%,

Malignant tumors of the lacrimal gland

(adenocarcinoma, adenocarcinoma in pleomorphic adenoma) were observed in 22.80%, malignant

mors

All patients underwent standard clinical and instrumental studies, including visometry, biomicroscopy,
ophthalmoscopy, exophthalmometry, perimetry. Removed neoplasms were examined by

3.80%

myosarcoma

Neurogenic tumors

Vascular tumors

Epithelial tumors

histiocytoma

fibroma

lipoma


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Research results

.Based on the calculation of the leukocyte formula, it was found that LII

significantly (P <0.05) increases in all patients with orbital tumors, regardless of genesis, indicating
the development of endogenous intoxication of a nonspecific nature.

Table 2 Comparative characteristics of leukoformula indicators for various orbital tumors

Malignant
tumor

Benign tumor

Parameter

HR (95% CI)

HR (95% CI)

Leukocyte index (LI)

1,088 (0,745 -
1,589)

0,895 (0.77-1,02)

Leukocyte intoxication index (LII)

1,244 (0,928 -
1,669)

1,18 (0,86-1,5)

Leukocyte shift index (LSI)

1,921 (1,19 3–
3,092)

3,155 (2,168 -
4,591)

Lymphocyte – granulocyte index (LGI)

2,492 (1,876 -
3,310)

1,715 (1.200 -
2.451)

Lymphocyte to eosinophil ratio (LTER)

1,558 (1,190 -
2,040)

1,385 (1,049 -
1,829)

Lymphocyte to Monocyte Ratio Index (LTMR)

0,81 (0,70-0,92)

1,352 (1,037 -
1,764)*

Index of the ratio of neutrophils and lymphocytes (IRNL)

1,676 (1,271 -
2,209)

1,392 (1,045 -
1,855)

Neutrophil to monocyte ratio (NTMR)

0,5 (0,34-0,7)

1,348 (0,954 -
1,904)*

General index (GI)

0,924 (0,712–
1.200)

0,67 (0,51-0,83)

Index of the ratio of leukocytes and ESR (erythrocyte
sedimentation rate, sed rate)

3,54 (2,85 – 4,22) 2,93 (2,56-3,3)

Abbreviations: CI, confidence interval; Heart rate, hazard coefficient.

* Significantly (p <0.05).

An increase in LII in pseudotumor by 1.5 times is associated with an inflammatory reaction in the
tissues. A significant 1.8-fold increase in this indicator in individual patients (16%) with malignant
tumors of the orbit (malignant lymphoma-lymphoma-lymphocytic type and rhabdomyosarcomas) is, in
our opinion, a sign of an increase in the process of tissue decay of tumors.

An increase in LIESR in malignant ones up to - 3.54 ± 0.45 compared with benign neoplasms - 2.93 ±
0.32 - indicates an increase in the concentration of antibodies and autointoxication associated with the
autoimmune process. This is also confirmed by an increase in GI by 1.4 times in patients with
malignant tumors (malignant lymphomas, adenocarcinomas).

The simultaneous increase in LII and LIESR, revealed by us, speaks of the depletion of the T-
lymphocytic link of immunity. The absence of changes in the indicators of LI and IRNL (the ratio of
lymphocytes and segmental-nuclear neurophils), indicating a positive correlation of their content in the
peripheral blood, may be associated with damage to the specific and nonspecific defense of the div,
regardless of the type of tumor. The data of changes in the integral hematological parameters in
patients with orbital tumors are presented in Table 2.

A significant 2-2.5-fold increase in NTMR in all types of tumors is considered by us as an increase in
the activity of the microphage system against the background of a pronounced effector response. A


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1.2-fold increase in LTER, which is more typical for patients with benign orbital tumors, is considered
by us as a manifestation of delayed-type hypersensitivity.

An increase in LSI (by 2.2-2.6 times), also more pronounced in benign tumors, indicates, as we
believe, the predominance of the affector link in the immunological process. CI is a generalizing
indicator of the quantitative composition of peripheral blood leukocytes increased by 1.2-1.1 times
compared to the norm, which, in our opinion, speaks of the adaptation of the div to the tumor process
in the orbit. As our studies have shown, in the leukocytogram of patients who applied in the initial
period of development of malignant tumors (1-3 months) and in the period from 2 to 4 years, the
highest LIESR is noted, and with a long-term illness - more than 10 years - these indicators decrease to
normal level, which may be associated with the chronization of the process and adaptation of the
organism, or with the characteristics of a long-existing tumor.

With pseudo tumor, the indicators of LIESR, LSI, GI reach the norm in patients who are sick for more
than a year, with benign tumors - more than 2-4 years, that is, during this period, according to these
indicators, pseudotumor and benign tumors differ from malignant neoplasms, which also indicates, in
our opinion, on the adaptation of the div, but at an earlier date.

We did not reveal a significant difference in indicators in the groups of patients with various types of
orbital tumors depending on age, only in patients over 60 years old with malignant tumors we noted a
decrease in LI and an increase in CI, which apparently characterizes a decrease in the activity of
polynuclears and the development of breakdown in the peripheral blood cell system. In benign
tumors, we found an increase in ISLM, with pseudotumor, an increase in addition to ISLM, and
ISNM, which is associated with inhibition of the macrophogenic and effector links of immunity.We
did not reveal any gender dependence in patients with malignant tumors in comparison with the initial
data, but in women LIESR and GI were higher in benign tumors, LII and LSI in pseudotumor, which,
in our opinion, indicates a decrease in the cellular component of immunity in these types tumors in
female patients.

Integral hematological indices of benign tumors were significantly higher than normal (P <0.05), with
the exception of LI, ILH, IRNL; in patients with false and malignant do not differ from the norm LI,
ILH, LTER; the rest of the indices were significantly higher than the norm.

Significant differences (P <0.05) between benign and false tumors are noted in the LII and LTER
indicators, between benign and malignant there are differences in the NTMR and ISLM indicators (P
<0.05). There were no statistically significant differences (P> 0.05) in hematological parameters
between false and malignant tumors. The correlation coefficient between LII, LTER, NTMR and
ISLM and the diagnosis “benign tumor” is 0.291, 0.265, 0.238 and 0.197, respectively; between the
indicated indices and the diagnosis “false tumor” - 0.114, 0.276, 0.192 and 0.278, respectively, and
between the listed indices and the diagnosis “malignant tumor” the correlation coefficient was 0.363,
0, 273, 0.269 and 0.283, that is, between the indicated indices and the diagnosis, according to our data,
mainly a weak correlation.

Discussion.

To predict a marker of infection and inflammation, the indicators of total and differential

leukocyte count are historically considered. Despite this, its role has gone beyond the assessment of
infectious processes, and today it is used as a prognostic marker to measure the results of the course
and treatment of a tumor. The association between inflammation and tumors has long been known,
compelling recent evidence suggesting a strong association between peripheral inflammatory cells
before treatment and prognosis in different types of tumors [12,13,14,15].

Inflammatory processes lead to a chronic oxidative process and generate oxygen free radicals that
stimulate the emergence, development and progression of tumors [16]. Here, we retrospectively


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studied orbital tumors, based on medical records, to assess the prognostic values of the total number
of leukocytes, neutrophils, lymphocytes, monocytes in a comparative aspect with other clinical factors.
Our results confirmed the conclusions that factors such as the lymphocyte-to-monocyte ratio (ISRM
and the neutrophil-to-monocyte ratio (ISNR)) were associated with benign tumors, while the leukocyte
intoxication index (LII) was an unfavorable prognosis for patients with orbital tumors. More
importantly, we found that an increased ratio of neutrophil lymphocytes and monocyte counts were
significantly associated in benign tumors, while at the same time in malignant processes had a poor
prognosis, which is confirmed by SaurabhBobdey (2017) with lower overall survival and did not
depend on other variables to predict prognosis for patients with oral cancer [11].

These results are consistent with other published studies that indicate a role for monocyte counting
(Tsai et al, n = 213) [12] and Perisanidis et al, n = 97 in predicting oral cancer patients [17].

There is evidence that in advanced cancer, the systemic host immune response is an important
independent predictor of outcome, and measurements of the systemic inflammatory immune response
before treatment can be used to independently predict cancer survival [17].

Sasaki A (2007) and colleagues studied the preoperative absolute monocyte count in patients who
underwent liver resection for hepatocellular carcinoma and in patients who underwent liver surgery for
colorectal metastasis and found that the absolute monocyte count before treatment was independent a
prognostic indicator of tumor recurrence and survival [18].The monocyte index as an independent
prognostic indicator has been obtained in breast cancer [19], Hodgkin's lymphoma [20], rectal cancer
[18], and ovarian cancer [21].

Some authors have reported that neutrophils and other cells such as macrophages secrete factors that
promote tumor growth, including vascular endothelial growth factor [22], IL-8 [23], matrix
metalloproteinases and elastaseare likely to contribute to stimulation of the tumor microenvironment.

Conclusion

Thus, on the basis of calculating the ratios of the elements of the general blood test in patients with
orbital tumors, it was revealed that, regardless of the origin of the neoplasm in the patient's div,
against the background of suppression of the functions of effector cells, complex disorders of the
microphage-macrophage system, endogenous intoxication develops, accompanied by delayed-type
hypersensitivity. The duration of the tumor process, the age and gender of the patients have no
significant effect on the level of integral hematological indices. A correlation has been established
between some indices and a tumor diagnosis (benign, false, malignant), which allows us to
recommend the determination of integral hematological indices as additional diagnostic tests for
various types of orbital tumors, especially benign and malignant ones.

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Библиографические ссылки

Wei-Hsin Y., LiA.F, Yu Sh.Y, Chen Y.Y et all. (2020) Evaluate the Differences in CT Features and Serum IgG4 Levels between Lymphoma and Immunoglobulin G4-Related Disease of the Orbit// J Clin Med.-9(8): 2425.Published online 2020 Jul. 29.doi:10.3390/jcm9082425).

Gonzalez H., Hagerling C., Werb.Z.(2018) Roles of the immune system in cancer: from tumor

initiation to metastatic progression// Genes Dev;32( 19-20):1267-1284. doi: 10.1 IOI/gad.314617.118.

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