An increase in the percentage of HLA-DR-positive peripheral leukocytes predicts a poor prognosis in patients with squamous cell carcinoma of the lung.

Immunologic factors that predict survival in patients with lung cancer have not been established. We examined the relationship between the percentage of HLA-DR-positive peripheral leukocytes [HLA-DR+ (%)] and survival of patients with squamous cell carcinoma of the lung. Before initiating therapy, peripheral blood was taken from 105 patients with squamous cell carcinoma of the lung. HLA-DR positivity was determined by flow cytometry. Patients were divided into 2 groups; a high and a low percentage group. The significance of the intergroup difference in the Kaplan-Meier survival curves was determined by the log rank test. Multivariate analysis was performed using the Cox proportional hazards model. The average HLA-DR+ (%) was 25.9 +/- 10.6% (mean +/- SD). Survival in the high percentage group (HLA-DR+ (%) > or =25.9%, n=44) was much worse than that in the low percentage group (HLA-DR+ (%) <25.9%, n=61; p=0.0002). The 5-year survival rate in the high percentage group was only 7.4%, while that in the low group was 54.3%. Multivariate analysis identified a significant association between survival and lymph node metastasis (p=0.0028) and HLA-DR+ (%) (p=0.0004). Survival of patients with stages I, II, and IIIA was worse in the high percentage group (n=32) than that in the low percentage group (n=43; p<0.0001). However, survival of patients with more advanced disease, stages IIIB and IV, was similar in the high percentage (n=12) and low percentage groups (n=18; p=0.7610). The peripheral HLA-DR+ (%) predicts survival of patients with resectable squamous cell carcinoma of the lung.