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Department of Internal Medicine (A.S.P., F.W.J.B., O.K.), Detroit, Michigan
Division of Hematology-Oncology, Department of Otolaryngology—Head and Neck Surgery (T.D.D., H.S.P., S.C.M., R.H.M.), Detroit, Michigan
Department of Radiation Oncology (F.H.S.), Detroit, Michigan
Wayne State University School of Medicine, Department of Pediatrics and Children’s Hospital of Michigan (J.K.), Detroit, Michigan
Address reprint requests to: Ananda Prasad, MD, PhD, MACN, University Health Center 5C, 4201 St. Antoine, Detroit, MI 48201
In this review, we provide evidence based on our studies, for zinc deficiency and cell mediated immune disorders, and the effects of protein and zinc status on clinical morbidities in patients with head and neck cancer. We investigated subjects with newly diagnosed squamous cell carcinoma of the oral cavity, oropharynx, larynx, and hypopharynx. Patients with metastatic disease and with severe co-morbidity were excluded. Nutritional assessment included dietary history, body composition, and prognostic nutritional index (PNI) determination. Zinc status was determined by zinc assay in plasma, lymphocytes, and granulocytes. Pretreatment zinc status and nutritional status were correlated with clinical outcomes in 47 patients. Assessment of immune functions included production of TH1 and TH2 cytokines, T cell subpopulations and cutaneous delayed hypersensitivity reaction to common antigens.
At baseline approximately 50% of our subjects were zinc-deficient based on cellular zinc criteria and had decreased production of TH1 cytokines but not TH2 cytokines, decreased NK cell lytic activity and decreased proportion of CD4+ CD45RA+ cells in the peripheral blood. The tumor size and overall stage of the disease correlated with baseline zinc status but not with PNI, alcohol intake, or smoking. Zinc deficiency was associated with increased unplanned hospitalizations. The disease-free interval was highest for the group which had both zinc sufficient and nutrition sufficient status.
Zinc deficiency and cell mediated immune dysfunctions were frequently present in patients with head and neck cancer when seen initially. Zinc deficiency resulted in an imbalance of TH1 and TH2 functions. Zinc deficiency was associated with increased tumor size, overall stage of the cancer and increased unplanned hospitalizations. These observations have broad implications in the management of patients with head and neck cancer.
Key words: zinc deficiency, head and neck cancer, immune dysfunction
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