Immune Function In Cancer Patients Research Articles

The relationship between anesthesia, surgery and postoperative immune function in cancer patients: a review.

This review comprehensively examines the impact of anesthesia and surgical interventions on the immune function of cancer patients postoperatively. Recent studies have shown that surgery and its accompanying anesthesia management can significantly influence immune function in cancer patients, potentially affecting their prognosis. This review synthesizes clinical studies and basic research to summarize the specific effects of anesthesia methods, drugs, postoperative analgesia, intraoperative transfusion, surgical techniques, and trauma extent on the immune function of cancer patients post-surgery. Additionally, this review discusses optimization strategies based on current research, aiming to refine anesthesia and surgical management to maximize the preservation and enhancement of postoperative immune function in cancer patients, with the potential to improve clinical outcomes.

Meta-analysis of the Regulatory Effects of Ginseng and Ginseng-like Drugs on the Quality of Life and Immune Function of Cancer Patients

Objective To evaluate the regulatory effects of ginseng and ginseng-like drugs in improving the quality of life and immune function of cancer patients by meta-analysis. Methods Using "Ginseng", "Ginseng Decoction", "Ginsenosides", "Ginseng Polysaccharides", "Korean Ginseng", "Shanshen", "Shenqi Fuzheng Injection", "Kangai Injection", "Aidi Injection", "Ginseng Yangrong Soup" and "Buzhong Yiqi Soup" as Chinese keywords, "Ginseng", "Ginseng Soup", "Ginsenosides", "Ginseng Polysaccharides" as English keywords, the Chinese knowledge was retrieved.

The Protective Effect of the COVID-19 Vaccine in Cancer Patients

The novel coronavirus pneumonia pandemic has led to bad engulf on public health worldwide. Widespread vaccination with SARS-CoV-2 vaccine (COVID-19 vaccine) has become one of the most potentially effective strategy of ending the epidemic and avoiding the public suffering from both physical and psychological pain. With weak autoimmunity and the complex body condition in different stages of treatment, cancer patients are more vulnerable and sensitive to infect in COVOD-19 pandemics. There are many data indicating that cancer patients usually obtain the higher mobidity, higher rate of the severe illness and higher fatality in COVID-19 pandemic. In that case, they are in greater need of protective measures, of which vaccination is the most convenient and widely accepted protective. Based on the existing clinical studies, this review aims to focus on the safety and efficacy of the COVID-19 vaccine in patients with cancer. After that the immunogenicity of the vaccine itself, adjuvant, doses, times of vaccinations and patient condition are listed to consider how they affet the effect of vaccine. Due to the complexity of the immune function of cancer patients, COVID-19 vaccination in cancer patients is extremely critical to protect from COVID-19 pneumonia, so large-scale clinical studies and real-world research data are still needed to develop a more refined and appropriate vaccination program to achieve better protection of oncology patients.

V\u03b39V\u03b42 T cells strengthen cisplatin inhibition activity against breast cancer MDA-MB-231 cells by disrupting mitochondrial function and cell ultrastructure

BackgroundBreast cancer ranks second of new cases and fifth of death in 2018 worldwide. Cis-platinum (CDDP) has been used as a chemotherapy to treat breast cancer for years. However, CDDP can adversely disrupt immune function of host. Thus, development of new protocol that can minimize side effect and meanwhile elevate clinical efficacy of CDDP will eventually benefit cancer patients. Since Vγ9Vδ2 T cells can up-regulate immune function of cancer patients, therefore, our hypothesis is that introduction of Vγ9Vδ2 T cells could potentiate CDDP efficacy against breast cancer.MethodsWe used breast cancer cell line MDA-MB-231 as model cell to test our hypothesis. The cancer cell viability in vitro in the context of different dose of CDDP was analyzed by flow cytometry. The cytoskeleton alteration was visualized by confocal microscopy, and the ultrastructure of cell membrane was observed by atomic force microscopy. The mitochondrial function of MDA-MB-231 cells was detected as well by flow cytometry.ResultsComparing to either Vγ9Vδ2 T cells or CDDP alone, Vγ9Vδ2 T cells plus CDDP could more strikingly induce MDA-MB-231 cell membrane ultrastructure disruption and cytoskeleton disorder, and more significantly enhance the inhibition of CDDP on proliferation of MDA-MB-231 cells. At the same time, Vγ9Vδ2 T cells strengthened CDDP-induced mitochondrial dysfunction of cancer cells.ConclusionThis work revealed that Vγ9Vδ2 T cells could synergistically enhance the inhibition activity of CDDP against breast cancer cells. Meanwhile, this in vitro proof-of-concept study implied the clinical prospect of the combining application of Vγ9Vδ2 T cells and CDDP in breast cancer therapy.

Evaluation of therapeutic effect of transcutaneous electrical acupoint stimulation on bone metastasis pain and its influence on immune function of patients.

This study aimed to observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on bone metastasis pain, anxiety and immune function in cancer patients. A total of 127 patients with bone metastasis pain from malignant tumors were treated with TEAS or drugs. The TEAS group comprised of 62 patients, while the drug control group comprised of 65 patients. The differences in general indexes, baseline pain and anxiety between these two groups were not statistically significant. Compared with those before treatment, the visual analog scale (VAS) scores of patients in the TEAS group and drug control group decreased after treatment, and the differences were statistically significant. The degrees of pain relief after treatment were similar between the two groups. Anxiety improved in both the TEAS group and drug control group, and the difference between these two groups was not statistically significant. The differences in immune indexes, B cell and CD8 between the TEAS group and drug control group were statistically significant. TEAS treatment could improve the declining trend of CD8 in patients. TEAS treatment and drug treatment can effectively alleviate mild to moderate pain in patients, and the efficacy of these two groups is similar. The treatment for moderate and severe pain needs to be combined with drug treatment to achieve a control effect. TEAS can improve the anxiety and immune function of patients, and prevent the decrease in B cells and CD8 in patients treated with drugs alone.

The Influence of Different Triazole Antifungal Agents on the Pharmacokinetics of Cyclophosphamide.

Background: Cyclophosphamide is one of the most important chemotherapeutic drugs. Known as a widely accepted treatment strategy, chemotherapy may damage the immune function of cancer patients; as a result, invasive fungal infections (IFIs) occur. Triazole antifungal agents are the most acceptable drugs for IFI treatment, especially those infections caused by chemotherapy. Objective: We aimed to investigate the effects of different triazole antifungal drugs, including fluconazole, itraconazole, and ketoconazole, on the pharmacokinetics (PK) of cyclophosphamide. In addition, we also characterize the potential drug-drug interactions (DDIs) between cyclophosphamide and various triazole antifungal drugs. Methods: The necessary pharmacokinetic parameters and physicochemical data were obtained from published studies. Physiologically based pharmacokinetic (PBPK) models were developed and validated in virtual subjects using Simcyp software. The validated PBPK models were used to evaluate potential DDIs between cyclophosphamide and different triazole antifungal agents in cancer patients. Triazole antifungal agents were simulated by oral administration, whereas cyclophosphamide was simulated by intravenous administration. Results: Simulated plasma concentration-time curves of fluconazole, itraconazole, ketoconazole, and cyclophosphamide were in good consistency with the observed profiles. Our results suggested that the pharmacokinetic parameters of cyclophosphamide were increased by various extents when coadministered with different triazole antifungals. The area under the plasma concentration-time curve of cyclophosphamide was increased when combined with fluconazole, itraconazole, or ketoconazole. Conclusions and Relevance: Ketoconazole had the greatest effect on the PK of cyclophosphamide among the 3 triazole antifungals. Our study provides clues that the toxicity and adverse drug reactions that are associated with cyclophosphamide should be closely monitored when coadministered with ketoconazole.

Effect of Shanxian Granule on IFN -γ, TNF -β and IL-10 in peripheral blood of Lewis lung cancer bearing mice

Objective: To observe the effect of Shanxian Granule (SXG) on the proliferation of Lewis lung cancer cells and IFN-γ, TNFβand IL-10 in peripheral blood of Lewis lung cancer bearing mice, and explore the molecular mechanism of SXG in inhibiting tumors and improving the anti-tumor immunity of the body, so as to provide a profound theoretical basis for its clinical application. Methods: Lewis lung cancer cells were implanted into subaxillary skin to establish tumor bearing mice model, the mice were divided into control group, model group, chemotherapy group and SXG group, calculating the inhibition rate by weighing the tumor of Lewis lung cancer bearing mice, the changes of IFN -γ,TNF -β and IL-10 in peripheral blood were detected by ELISA. Results: 1. The inhibition rate of SXG group on Lewis lung cancer was 45.99%, significantly higher than that of chemotherapy group (P < 0.05); 2.IFN -γ and TNF -β in peripheral blood of mice in model group and chemotherapy group were significantly lower than those in control group (P < 0.05), while IL-10 was significantly higher (P < 0.05), and IFN -γ and TNF -β in peripheral blood of mice in SXG group were significantly higher than those in model group and chemotherapy group (P < 0.05), while IL-10 was significantly lower (P < 0.05). There was no significant difference in TNF -β and IL-10 between the two groups (P > 0.05). Conclusion: SXG can obviously inhibit the growth of tumor tissue in Lewis lung cancer bearing mice, increase IFN -γ and TNF -β and decrease IL-10 in peripheral blood, suggesting that the anti-tumor effect of SXG may be related to restoring the homeostasis of immune function of cancer patients, improving the immunity of the body and strengthening the immune surveillance function.

Recent Advances in Herbal Medicines for Digestive System Malignancies.

Herbal medicines, as an important part of traditional Chinese medicine (TCM), have been used to treat digestive system malignancies (DSM) for many years, and have gradually gained recognition worldwide. The role of herbal medicines in the comprehensive treatment of DSM is being improved from adjuvant treatment of the autologous immune function in cancer patients, to the treatment of both the symptoms and disease, direct inhibition of tumor cell growth and proliferation, and induction of tumor cell autophagy and apoptosis. Their specific mechanisms in these treatments are also being explored. The paper reviews the current anti-tumor mechanisms of TCM, including single herbal medicines, Chinese herbal formulations, Chinese medicine preparations and TCM extract, and their application in the comprehensive treatment of digestive system tumors, providing a reference for clinical application of TCM.

Whey Protein Supplementation Improves Nutritional Status, Glutathione Levels, and Immune Function in Cancer Patients: A Randomized, Double-Blind Controlled Trial.

Clinical side effects from medical therapy play an important role in causing malnutrition among cancer patients. Whey protein isolates (WPIs) have the potential to improve the nutritional status of cancer patients. The present study determined the effects of whey protein supplementation on nutritional status, glutathione (GSH) levels, immunity, and inflammatory markers in cancer patients in Thailand. A total of 42 cancer patients (41-63 years old) who received intravenous chemotherapy were randomized in a double-blind controlled trial at the National Cancer Institute in Thailand. Patients received 40 g of WPI plus zinc and selenium (intervention group, n = 23) or a maltodextrin oral snack (control group, n = 19) every day during the daytime for 12 weeks. Nutritional status, GSH levels, immunity, and inflammatory markers were assessed at baseline, 6, and 12 weeks. Whey protein supplementation significantly increased albumin (2.9%) and immunoglobulin G (4.8%) levels compared to the control group at week 12. Controls showed a significantly lower percent change in GSH levels (6.0%), whereas there was a significant time-dependent increase in the intervention group (11.7%). Whey protein supplementation improved nutrition status scores in the intervention group compared to the control. These data indicate that whey protein supplementation can increase GSH levels and improve nutritional status and immunity in cancer patients undergoing chemotherapy. These results will facilitate implementation of malnutrition risk prevention strategies and improve protein status, including immune function, during chemotherapy.

Study about the Efficacy of Metformin to Immune Function in Cancer Patients.

A study to evaluate the effect of metformin on the immune system was commenced in July 2014. Metformin is one of the most commonly prescribed drugs for type 2 diabetes, and previous studies have reported that metformin has an anti-tumor effect. The aim of this study is to evaluate the efficacy of metformin on the immune system in human cancer patients in vivo. The primary outcome parameter will be the rate change in the population of CD8＋ T cells, which produce multiple cytokines.

Morphine and ketamine inhibit immune function of gastric cancer patients by increasing percentage of CD4+CD25+Foxp3+ regulatory T cells in vitro

BackgroundThere is conflicting evidence regarding effects of anesthetic and analgesic drugs on immune function of cancer patients. This study was designed to observe changes of T cell subpopulations in the gastric cancer (GC) patients and to assess effects of morphine and ketamine on the CD4+ T cells, CD8+ T cells, and regulatory T cells (Tregs) populations obtained from the GC patients in vitro. MethodsThe peripheral blood samples from 20 GC patients and 20 healthy volunteers were obtained. The peripheral blood mononuclear cells were isolated and incubated in a solution containing phorbol-myristate-acetate and ionomycin (2 μL/mL) in the presence or absence of morphine (50 ng/mL) or different-concentration ketamine (25, 50, and 100 μM). The CD4+ T cells, CD8+ T cells, and Tregs were determined using the flow cytometric assay. ResultsThe percentages of CD8+ T cells were significantly decreased, but the ratio of CD4+/CD8+ T cells and Tregs populations was significantly increased in the GC control group compared with the normal control group (P < 0.05). The ratio of CD4+/CD8+ T cells was significantly increased in the groups M and K3 compared with the control group (P < 0.05) but was significantly decreased in the group K1 compared with the group K3. The percentage of Tregs was significantly increased in the groups M, K1, K2, and K3 compared with the control group. With the increased concentrations, ketamine increased the number of Tregs. ConclusionsGC shifts the balance of CD4+/CD8+ T cells toward CD4+ T cells and increases the Tregs populations by inducing immune responses. Morphine increases the ratio of CD4+/CD8+ T cells and Tregs populations. Ketamine affects the ratio of CD4+/CD8+ T cells and Tregs populations in a dose-dependent model.

Histone deacetylase inhibitor valproic acid affects plasmacytoid dendritic cells phenotype and function

ObjectivePlasmacytoid dendritic cells (PDC) represent a rare subset of dendritic cells specialized in the production of type I IFN in response to microbial pathogens. Recent data suggested that histone deacetylase (HDAC) inhibitors possess potent immunomodulatory properties both in vitro and in vivo. In this study, we assayed the ability of the HDAC inhibitor, valproic acid (VPA), to influence the phenotype and functional properties of human PDC isolated from peripheral blood. Methods and resultsWe showed that VPA inhibited the production of IFN-α and the proinflammatory cytokines TNF-α and IL-6 by CpG-activated PDC. VPA also affected the phenotype of PDC by reducing the expression of costimulatory molecules induced by CpG activation. Moreover, VPA reduced the capacity of CpG-stimulated PDC to promote CD4+ T cell proliferation and IFN-γ production, while enhancing the proportion of IL-10 positive T cells. ConclusionThese results suggest that HDAC inhibition by VPA alters essential human PDC functions, highlighting the need for monitoring immune functions in cancer patients receiving HDAC inhibitors, but also making these drugs attractive therapies in inflammatory, and autoimmune diseases implicating PDC.

Evaluation of host quality of life and immune function in breast cancer patients treated with combination of adjuvant chemotherapy and oral administration of Lentinula edodes mycelia extract

PurposeAnthracycline-based chemotherapies for breast cancer are well known to have adverse effects and can also negatively affect host immune function. There is therefore a necessity for an adjuvant that maintains the quality of life (QOL) and immune function of cancer patients receiving anthracycline-based chemotherapies.Patients and methodsThe present study investigated the effectiveness of the concomitant use of Lentinula edodes mycelia extract (LEM), an oral immunomodulator, with FEC75 (5-fluorouracil + epirubicin + cyclophosphamide) therapy on host QOL and immune function in breast cancer patients with nodal metastases. Ten breast cancer patients with nodal metastases receiving surgery were enrolled in this study. Treatment with 5-fluorouracil (500 mg/m2), epirubicin (75 mg/m2), and cyclophosphamide (500 mg/m2) was performed every 21 days for two courses, and LEM (1800 mg/day by mouth) was administered during the second course.ResultsIn the first course, hematological toxicity was observed and host QOL and immune function were exacerbated. In the second course, however, the number of white blood cells and lymphocytes did not decrease and host QOL was maintained. Furthermore, the cytotoxic activities of natural killer (NK) and lymphokine-activated killer cells and the proportion of activated NK and NK T-cells in lymphocytes were maintained in the second course.ConclusionIt has been suggested that the concomitant use of LEM with FEC75 therapy can maintain host QOL and immune function, and offer important implications for an application of LEM as a useful oral adjuvant to anthracycline-based chemotherapies.

Impact of valproic acid on dendritic cells function

ObjectiveRecent data suggested that histone deacetylase (HDAC) inhibitors possessed potent anti-inflammatory and immunomodulatory properties both in vitro and in vivo. This study assayed the ability of the HDAC inhibitor, valproic acid (VPA), to influence the differentiation and functional properties of dendritic cells (DCs) generated from circulating peripheral blood monocytes. Methods and resultsCulture of monocytes in the presence of 0.5mM of VPA did not impair DC differentiation. However, on the phenotypic level, in mature DCs, CD40, CD80 and CD86 were downregulated in the presence of VPA, compared to mature DCs generated in the absence of VPA. VPA led also to a significant down-regulation of CD83 and HLA-DR expression on mature DCs. Moreover, VPA treatment significantly inhibited IL-10 and IL-12p70 production by mature DCs. IL-10 and IL-12p70 altered secretion was observed whether DCs were matured with LPS alone or with LPS and IFN-gamma. In an allogeneic mixed lymphocyte reaction, the proportion of IFN-gamma+CD4+ T cells was decreased (26% vs. 51%, p=0.005) when T cells were stimulated with DCs exposed to VPA. Also, CD8+ T cells stimulated with DCs treated with VPA, exhibited a significant decrease of Granzyme B expression. ConclusionThese results suggest that HDAC inhibition by VPA alters essential human DC functions, highlighting the need for monitoring of immune functions in cancer patients receiving HDAC inhibitors, but also making these drugs attractive therapies in inflammatory, and autoimmune diseases.

Decline of T cell-related immune functions in cancer patients and an attempt to restore them through infusion of activated autologous T cells

We developed a scoring system that can combine several immunological parameters and express the immune status of individuals as a simple numeral. T cell immune score was obtained by using 5T cell-related parameters: number of T cells, ratio of CD4+T cells to CD8+T cells, number of naïve T cells, ratio of naïve T cells to memory T cells, and T cell proliferative index (TCPI). TCPI was calculated by using number of T cells and their proliferative activity. We assessed T cell immune score in 103 patients with colorectal cancer and 51 healthy age-matched controls.The results were as follows: (1) T cell-immune score of patients in stages I–IV before surgery was significantly decreased as compared with controls. (2) The number of regulatory T cells in patients in stages I–IV gradually increased with disease progression. (3) T cell immune score was strongly suppressed after surgery, but were recovered to the initial level within a month. (4) Furthermore, restoration of immunological function was attempted in cancer patients by infusion of activated autologous T cells. The effectiveness was confirmed by an increase of TCPI in many cancer patients.

Toll-like Receptor Modulation in Head and Neck Cancer

Toll-like receptors (TLRs) are the archetypal pattern recognition receptors that have emerged as key mediators of immune functions. Activation of TLRs is a first line of defense of the immune system, leading to the activation and recruitment of different types of immune cells to sites of infection and malignant cell growth. Cells of human cancers, such as head and neck squamous cell carcinoma (HNSCC), are known to develop numerous molecular strategies to escape from efficient antitumor immune responses. It is supposed that tumor production of various immunosuppressive mediators contributes to impaired and altered immune functions in cancer patients. The molecular mechanisms responsible for these immunomodulatory processes and the biosynthesis of the immunosuppressive HNSCC microenvironment remain mostly unknown. Recently, different studies have shown that tumor cells are able to modulate the expression and function of TLR proteins in different kinds of immune cells. In this review, we present recent progress in these studies on the modulation of TLR expression and signaling through malignant head and neck cancer.

Interferons, immunity and cancer immunoediting leading to impaired immune function in cancer patients

Interferons, immunity and cancer immunoediting leading to impaired immune function in cancer patients

Antitumoral Activity of Interferon-&amp;#947; Involved in Impaired Immune Function in Cancer Patients

Insufficient immunosurveillance is an important aspect in early tumorigenesis and in the pathogenesis of malignant disease. In the later course of cancer, the development of immunodeficiency is considered the major reason for disease progression and death. Within the anti-tumoral host defense reaction, Th1-type cytokine interferon-gamma (IFN-gamma) is of particular relevance. IFN-gamma stimulates several anti-proliferative and thus tumoricidal biochemical pathways in macrophages and other cells and also in tumor cell lines. These include inducible nitric oxide synthase, indoleamine (2, 3)-dioxygenase, an enzyme degrading the essential amino acid tryptophan, and the production of reactive oxygen species and neopterin in human macrophages and dendritic cells. Although the anti-proliferative strategy of the immune system aims to inhibit the growth of malignant cells, it can also affect T-cell response and thus contribute to the development of immunodeficiency. Accelerated degradation of tryptophan and increased production of neopterin were found to parallel the course of malignant diseases. Moreover, a higher degree of these metabolic changes characterizes poor prognosis and is associated with the development of anemia, weight loss and depressive mood in patients. Available data suggest that immunodeficiency in cancer patients may develop as a long-term side-effect of the antiproliferative and pro-apoptotic mechanisms elicited within Th1-type immune response, and enhanced production of pro-inflammatory cytokine IFN-gamma seems to be critically involved.

Perioperative IFN-alpha to avoid surgically induced immune suppression in colorectal cancer patients.

Surgical treatment of colorectal cancer is associated with postoperative immunosuppression, which might facilitate dissemination of tumor cells and outgrowth of minimal residual disease/(micro) metastases. Minimal residual disease has been shown to be of prognostic relevance in colorectal cancer. Therefore, stimulation of (anti-tumor) immune responses may be beneficial in the prevention of metastases formation. Important anti-tumor effector cells, which serve this function, are natural killer (NK) cells, CD8+ lymphocytes (CTL), dendritic cells (DC) and macrophages. In this review the immunomodulating properties of IFN-alpha are discussed, with a particular focus on perioperative stimulation of immune function in cancer patients. IFN-alpha is known to enhance innate immune functions such as stimulation of NK cells, transition from innate to adaptive responses (activation of DC) and regulating of CD8+ CTL activity and memory. Moreover, it exerts direct antitumor effects by regulating apoptosis and cell cycle. In several clinical trials, perioperative administration of IFN-alpha has indeed been shown to improve T cell responsiveness, prevent impairment of NK cell cytotoxicity and increase expression of activation markers on NK, T and NKT cells. In a clinical pilot study we showed in colorectal cancer patients that received perioperative IFN-alpha enhanced activation markers on T cells and NK cells, combined with better-preserved T cell function as indicated by phytohemaggluttinin skin tests. In the liver of these patients significantly more CD8+ T cells were found. In conclusion, IFN-alpha provides an effective adjuvant in several forms of cancer and improves several postoperative immune functions in perioperative administration. However, larger clinical trials are necessary to investigate effects on disease-free and overall survival.

The effect of tramadol on serum cytokine response in patients undergoing pulmonary lobectomy

Study Objective To investigate the effect of tramadol on the production of serum interleukin (IL) 6, IL-10, and IL-2 and soluble (s) IL-2 receptor (R), thereby evaluating its effects on the proinflammatory and anti-inflammatory responses and immune function in cancer patients undergoing conventional pulmonary lobectomy. Design Randomized, double-blinded, placebo-controlled study. Setting University hospital. Patients Forty ASA physical status I and II adult patients scheduled for conventional pulmonary lobectomy. Interventions Patients were randomly divided into 2 groups (n = 20 in each group). Both groups received general anesthesia with enflurane combined with epidural blockade. At 5 minutes before skin incision, patients were given either tramadol 1.5 mg/kg intravenously (IV), followed by a continuous infusion of 0.5 mg/kg per hour until the end of surgery (group I), or IV normal saline (group II). Measurements and Main Results Venous blood samples for the measurement of serum cytokine concentrations were taken before anesthesia and at set intervals until 24 hours after operation. Serum levels of IL-6 and IL-10 in both groups were increased significantly during and after operation compared with baseline levels ( P < .05). No statistical differences between groups in terms of IL-6 and IL-10 were observed. Levels of IL-2 were elevated significantly at 4 hours after operation in group I as compared with baseline levels ( P < .001), whereas they remained low at 4 and 24 hours after operation in group II ( P < .01). There were significant increases in levels of sIL-2R at 4 and 24 hours after operation in group II as compared with baseline levels ( P < .05) and at 24 hours after operation in group I ( P < .01). Levels of IL-2 were higher at 4 and 24 hours after operation in group I than in group II ( P < .01). Levels of sIL-2R were lower at 4 hours after operation in group I than in group II ( P < .01). Conclusions IV infusion of tramadol does not seem to alter IL-6/IL-10 cytokine response to pulmonary lobectomy. As tramadol was associated with increased IL-2 and delayed enhancement of sIL-2R in our study, it may attenuate to some extent an impaired immune response in pulmonary lobectomy.