Activated immune system in associated with poor prognosis in ovarian cancer

Prognostic value of preoperative neopterin, a marker for macrophage activation, was investigated in 225 patients with epithelial ovarian cancer. About 50% of patients showed neopterin concentrations above the cut-off level of 275 mu mol/mol creatinine. Interestingly, those patients with elevated urinary neopterin concentration, and thus displaying a sign of activation of cell-mediated immunity, had a shorter overall an disease-flee survival than those with a normal concentration. Applying a multivariate analysis, the only independent parameters predicting patient survival were residual disease and neopterin. This surprising finding could be explained by stronger immunogenicity of poor differentiated tumors which may not result in a better recognition of the immune system. Moreover, activated macrophages produce high amounts of growth or angiogenic factors, that can either stimulate tumor proliferation directly or support blood supply, which in turn ameliorates tumor nutrition.