T lymphocytes in bladder and prostatic cancer patients

Evaluation of cell-mediated immunity and circulating immune complexes as prognostic indicators in cancer patients

Cell-mediated immunity (CMI) and circulating immune complexes (CIC) were estimated in 55 cancer patients and 25 control volunteers to evaluate their prognostic significance. Cancer patients comprised head and neck cancer (11), breast cancer (13), gastrointestinal cancer (10), genitourinary cancer (11), and lymphomas and sarcomas (10). CMI was tested in vitro by early rosette-forming cells (ARFC) and total rosette-forming cell (TRFC) counts. ARFC count in control group was 758.1 +/- 78.09 cells/cumm. In advancing clinical stages of cancer (I-IV), ARFC counts were decreased (i.e., 601.12 +/- 74.96 [p < 0.01]; 494.8 +/- 71.83 [p < 0.001]; 432.44 +/- 36.05 [p < 0.001], and 438.55 +/- 69.99 [p < 0.001] cells/cumm, respectively). TRFC count in control group was 1029 +/- 88.39 cells/cumm. In cancer stages I through IV, these counts decreased significantly (i.e., 699.63 +/- 66.24; 597.55 +/- 82.9; 505.11 +/- 52.56; and 501.55 +/- 69.99 cells/cumm, respectively [p < 0.001]. Dinitrochlorobenzene cutaneous reactivity in vivo was 100% positive in control group, 62.5% positive in cancer stage I, 5% positive in stage II, and negative in stages III and IV. CIC of intermediate size were estimated by polyethylene glycol precipitation (PEG pptn) technique, which detects CIC in the ratio of 2:1 (Ag2Ab). Mean PEG index in control group was 39.5 +/- 4.65; sequential increase in CIC was observed in advancing clinical stages of cancer (I-IV)(i.e., 49 +/- 7.03 [p < 0.01]; 75.38 +/- 44.01 [p < 0.001]; 93.38 +/- 44.57 [p < 0.001]; and 216.00 +/- 147.05 [p < 0.001], respectively). Latex agglutination inhibition (LAI) titer was done to detect CIC as small as 8s, which constitute the opposite polar end of CIC spectrum. LAI titers in control group were nil. However, LAI titers in cancer stages I through IV were 1 +/- 2.64; 8.6 +/- 5.6 (p < 0.001); 12.00 +/- 8.11 (p < 0.001); and 25.77 +/- 9.06 (p < 0.001), respectively. Decrease in CMI and subsequent increase in CIC indicate unfavorable prognosis in cancer patients, and also precede clinical manifestation of increased tumor mass in vivo.

E-rosettes in aging: meta-analysis of the literature

In this meta-analysis of the literature, it is affirmed that aging is associated with a small but significant decline in peripheral E-rosette-forming cells while high affinity E-rosettes (active or early rosettes) increase. The author speculates that this differential age effect may reflect the abnormal capping behaviour of E-rosettes or a change in the cell surface charge properties. A type II error is a common trait of the reviewed studies and could well explain the great number of reports concluding that E-rosette-forming cells are unaltered in the elderly.

Leukocyte concentrations in discrimination of benign from malignant lung lesions

Malignant lung lesions are associated with significant changes in leukocyte concentrations. However, overlap of values between normal subjects and patients with cancer has limited the clinical utility of this determination. To decrease the overlap, 2,000 cells per differential determination were counted, and replicate automated cell counts were performed in blood samples obtained on different mornings between 7 and 9 A.M. Seventy-five patients who presented with undiagnosed lung lesions were analyzed. Benign and malignant lung lesions could be accurately distinguished by either relative granulocyte or lymphocyte counts. With 65.5 percent granulocytes as the cutoff, 86 percent of patients (38 of 44) proved to have lung cancer had higher values, and 97 percent of patients (30 of 31) with benign lesions had lower values. Likewise, with 28 percent lymphocytes as the cutoff, 87 percent of patients with lung cancer (39 of 44) had lower values, and 94 percent of patients (29 of 31) with benign disease had higher values. Relative monocyte counts were not different. Absolute leukocyte concentrations, although different for each group, had considerable overlap and thus were poor discriminators. These data suggest that precise analytical techniques and the use of relative leukocyte concentrations can improve the clinical utility of the leukocyte count as a discriminator of benign and malignant lung lesions.

Immunological studies of patients with tumours of the prostate and bladder (a retrospective analysis)

A total of 25 patients with bladder tumour and 35 with prostatic tumour were tested for humoral and cellular immune responsiveness in 1977. Information on the subsequent course of disease was collected 5 years later and confronted with the results of these tests. The most marked deviations in the values of acute-phase proteins, complement and lymphocyte transformation tests were found in those patients who had died within the first year of the investigations. The results approached or attained the normal values parallel with the survival times. The parameters studied thus seem to lend themselves to diagnostic and monitoring purposes.

The prognostic value of T-lymphocyte levels in malignant melanoma. A five-year follow-up

Serial immunologic tests (active E-rosettes = T-Ea; total E-rosettes = T-Et; total lymphocytes and null cells) were performed every 3 months for 5 years on 113 melanoma patients. A significant reduction in absolute T-Ea, T-Et, null cells, and total lymphocytes was noted in the patients who died, by comparison with those who are still alive. The latter presented a significant reduction in absolute T-Et only, plus a significant increase in null cells when compared with normals. The 38 patients without metastases, at the end of the study, presented a reduction in T-Et and an increase in null cells compared with the normals, while the 75 patients with metastases presented a reduction in T-Et, null cells and total lymphocytes when compared with the patients without metastases and a reduction in T-Ea, T-Et, and total lymphocytes when compared with the normals. Null cells show a linear decrease in patients who died and a linear increase in those who survived. A total of 80.2% of patients with a fall in T-Et displayed metastases usually within 2 to 10 months (mean, 6.8). Patients with normal T-Ea, T-Et, and total lymphocyte values showed a significant prolonged survival when compared to those with lower values. In addition, survival seemed to be always a function of immunologic test values, irrespective of the tumor site.

E-rosette forming cells (E-RFC) in squamous cell carcinoma of the larynx and laryngopharynx

The percentages of early and late E-RFC were measured in 25 proven cases of squamous cell carcinoma of the larynx and laryngopharynx. Both counts were depressed significantly in the patients compared to the controls (p less than 0.001). There was also a significant correlation of these counts with the severity of the disease, but there was no correlation between the counts and the duration of the disease.

Immunological profile of patients with transitional cell carcinoma of the bladder

The immunological profile of 58 patients with various stages of transitional cell carcinoma of the bladder was determined by using the local xenogeneic graft versus host reaction (GVHR) test, by skin testing with 3 recall antigens (candida, trichophyton, streptokinase-streptodornase) and by quantification of T-lymphocytes. Thirty-two patients with low grade low stage tumours (Group A) showed only a slight impairment of the immunological profile with a slight decrease in T-lymphocytes, 4.4% negative GVHR tests and 31.2% negative skin tests. Ten patients with highly invasive inoperable tumours (Group B) showed a severe impairment of the immunological profile with a significant decrease in T-lymphocytes, 100% negative GVHR and 80% negative skin tests. A marked improvement in the immunological profile was noted while comparing 9 patients who were examined within 6 months after cystectomy (Group CI) (severe decrease in T-lymphocytes 44.4% negative GVHR tests and 66.6% negative skin tests) with 7 patients who were examined 18 months or more after operation (Group CII) (slight decrease in T-lymphocytes 0% negative GVHR and 42.8% negative skin tests). Incubation of T-lymphocytes with a thymic hormone (THF) caused an increase in the extent of the graft versus host reaction in 10 out of 14 patients with low grade low stage bladder tumours. This may represent an improvement in the functional activity of the T-lymphocytes with a possible therapeutic use in the future.

Immunologic aspects of the prostate

Our experiments involving the use of the Dunning R3327 adenocarcinoma as an animal model of prostatic cancer as well as clinical studies on the immunocompetence of prostatic cancer patients are described. Utilizing the Dunning tumor, we have demonstrated that this transplantable adenocarcinoma of the rat prostate was similar to human prostatic cancer with respect to its macroscopic and microscopic appearances, growth rate, growth differential in male and female recipients, and some of its metastatic potential. Cryosurgery was capable of destroying the primary tumor as it can in man. Both antibody and cellular immune responses could be produced against antigens associated with the tumor cells. Tumor-bearing rats treated by cryosurgery in combination with BCG were capable of producing an antitumor immunity that protected them from rechallenge. Clinical studies of prostatic cancer patients showed a diminished in vitro immunity, but the responses of the cancer patients were not significantly different from those of patients with benign prostatic disease.

The immune response to prostate cancer: an evaluation and a review

The effects of stage and therapy of prostate cancer on the immune response were evaluated in 193 patients with an histologic diagnosis of prostatic malignancy. There was little or no effect, as measured by these generally non-specific tests, on the immune response. The host-tumor immune interaction is difficult to evaluate in prostate cancer. The complexities of measuring prostate tumor immunity are discussed and the literature is reviewed.

Restoration of E-rosette formation by bestatin in patients with bladder cancer

Incubation of peripheral blood lymphocytes from patients with bladder cancer in bestatin (specific inhibitor of aminopeptidase B and leucine aminopeptidase) solution resulted in a significant increase in the proportion of E-rosette-forming lymphocytes. The increase in the proportion of E-rosette-forming lymphocytes was abolished after reincubation with 100% autochthonous serum. The fraction of E-rosette-forming lymphocytes from patients with bladder cancer which had restored receptors for sheep erythrocytes (SRBC) by incubation with bestatin also expressed receptors for the Fc portion of IgG and IgM. The proportion of EAC-forming lymphocytes remained unchanged after the incubation with bestatin. When 600 mg of bestatin was administered for 1 day to patients with bladder cancer, restorative effect on the proportion of E-rosette forming lymphocytes was also demonstrated. The proportion of EAC-forming lymphocytes, however, did not change significantly.

The follow-up study of skin reactivity to recall antigens and E- and EAC-RFC profiles in blood in asbestos workers

We have determined cutaneous DTH reactions to SK-SD and PPD and peripheral blood lymphocyte profiles in a group of asbestos workers in two consecutive surveys. It was found that asbestosis and, to a lesser extent, the presence of ANA are significantly correlated with the lack of response to the above antigens. 83% of asbestos workers when tested at a 4 year interval fell into the same two categories of responsiveness (lack of response or response at least to one antigen). The asbestosis cases had lower total lymphocyte count as well as proportions and absolute number of E-RFC as compared to asbestos workers without asbestosis and/or ANA. Furthermore, the latter group showed the lower percentages and absolute number of E-RFC than the matched controls. The presence of ANA is also correlated with lower proportions of E-RFC. However, this is related at least in part to asbestosis.

Genetic associations of transitional cell carcinoma

A series of 101 cases of transitional cell carcinoma (TCC) was contrasted with a control series for several genetic parameters. Three genetic associations were demonstrated with the TCC patients having A gene frequencies, HLA B5 and HLA CW4 genes all higher than might be expected by chance. A classification of the natural history of the disease is used to show that the HLA frequencies vary with the more or the less severe forms of the disease.

Restoration by levamisole of E-rosette formation and its abrogation by autochthonous serum from patients with bladder cancer

Incubation in vitro of lymphocytes from bladder cancer patients with levamisole (40 microgram/ml) resulted in a rise of the number of E-rosette forming cells from 39.2 +/- 11.8% to 57.5 +/- 11.3% (p less than 0.005). The same effect was observed when levamisole was administrated 150 mg/day for 3 days to the patients. The stimulatory effect of levamisole was abrogated when the lymphocytes were first incubated with levamisole and afterwards with 50% autochthonous serum from the patient. With more diluted serum concentrations (from 0.5% to 1%), the response decreased, and the response was not observed with allogeneic serum. When lymphocytes from healthy donors were incubated with 50% serum from bladder cancer patients, there were no significant changes in numbers of E-rosette forming cells. It was presumed that the suppression of E-rosette forming cells from the patients with bladder cancer was caused by blocking the receptor sites for sheep red blood cells by autochthonous serum components and that levamisole eliminated such substances from the cryptic sites on the surface of the lymphocytes.

Cell-mediated immune competence in patients with prostatic carcinoma

The immune competence of 65 patients with prostatic cancer was evaluated by 2 in vivo and 2 in vitro tests to study the contribution of host factors to the progress of the disease. Patients with benign prostatic hypertrophy served as controls. Our results indicate that the delayed skin hypersensitivity response to common microbial recall antigens (streptokinase/streptodornase, purified protein derivative, dermatophytin 0 and dermatophytin) is unaltered in advanced stages of malignancy. The ability to be sensitized by dinitrochlorobenzene declines significantly in patients with metastatic disease. Blastogenic response of peripheral blood lymphocytes to phytohemagglutinin stimulation is not depressed in late stages of malignancy, although in the circulating T cells per cent and absolute values are somewhat lower in patients with metastases. Herein we show that immune competence (measured by the 4 tests) of patients with prostatic carcinoma does not decrease markedly even in the late stages of the disease. Primary sensitization to dinitrochlorobenzene is the only test showing a decline in responsiveness related to the tumor stage.

Adenosine deaminase activity in patients with carcinoma of the bladder

Adenosine deaminase is an important enzyme in purine metabolism, and patients with abnormal lymphocyte and erythrocyte adenosine deaminase levels have been shown to have impaired immune competence. Since immune factors have been shown to be important in patients with transitional cell carcinoma of the bladder we studied adenosine deaminase activity in the hemic cells of 48 patients with this tumor. Lymphocyte adenosine deaminase levels were elevated in patients with transitional cell carcinoma and correlated with stage, activity, clinical course and tumor resection but not with tumor grade. Erythrocyte adenosine deaminase levels also were elevated in patients with transitional cell carcinoma but did not correlate with other disease parameters. Lymphocyte adenosine deaminase activity in patients with transitional cell carcinoma may be a sensitive indicator of disease activity and further studies may provide insight into the host-tumor relationship at the enzyme level.

Re-evaluation of hydrostatic pressure treatment for malignant bladder lesions

We reviewed 50 cases of bladder cancer treated with the hydrostatic pressure technique. Results were encouraging when 1) single or multiple papillary tumors were not located around the ureteral orifice, with a presumed depth of tumor infiltration within T2, I) there was no history of open operations, 3) there was observed activity of immunological surveillance, for example a positive reaction to a tuberculin test, and 4) management of anesthesia was satisfactory. Hydrostatic pressure therapy is not palliative treatment for far-advanced cases of bladder cancers but should be the first choice for new cases beyond the scope for transurethral operations and when indications in tumor and host condition are satisfied.

Commentary on the immunobiology of bladder cancer

This review is an attempt to integrate the conflicting studies that constitute the literature on immunobiology of bladder cancer and to indicate areas that need further investigation. It is clear that immune reactivity directed at antigens expressed on bladder cancer cells and general host immunologic competence decline with progressive tumor growth. This immunodepression correlates with patient prognosis, even within a given stage of disease. The mechanisms underlying this decline in host immune reactivity are poorly understood. A better understanding of these mechanisms may provide fundamental insight into the host-tumor relationship that possibly could be exploited for preventive, diagnostic and therapeutic purposes.

General immunocompetence and tumour-directed, cell-mediated hypersensitivity in vitro in patients with renal carcinoma

Thirteen patients with renal carcinoma were examined for tumour-directed, cell-mediated hypersensitivity (TCMH) by means of the leucocyte migration technique, and for general immunocompetence (GIC) by means of quantitation of T- and B-cells in peripheral blood and studies of lymphocyte transformation in vitro using a panel of antigens and mitogens. Eight out of 13 patients had evidence of TCMH, six out of 13 had abnormal GIC. Any correlation between the presence of TCMH and normal/abnormal GIC was not found. There was a trend towards a positive correlation between the absence of distant metastases and evidence of TCMH. If both TCMH and GIC were considered, significant correlation between the presence of distant metastases, lack of TCMH and/or abnormal GIC was demonstrated. It is concluded that the defect TCMH usually found in patients with renal carcinoma and disseminated disease cannot be explained exclusively by defects in GIC.

Serum proteins in prostatic cancer. III. Relationship of levels of immunoglobulins and complement to clinical stage of disease

The relationship between the level of the three major serum immunoglobulins, IgG, IgA, and IgM and of the third component of complement (C')C'3(B1A-globulin) and the clinical Stage of prostatic cancer was evaluated. While, statistically significant (P less than 0.05) differences in the levels of these proteins compared with their levels in patients with benign prostatic hypertrophy (applied only to the study of C'3) and healthy adults were observed, the levels of these proteins in each of the Stages evaluated were not significantly different from each other. The absence of a correlation between the Stage of disease and the levels of these humorally mediated effectors of immunologic responsiveness is in keeping with observations of cell-mediated effectors of immunologic responsiveness in prostatic cancer patients. Observation of the association of prostatic cancer with a deficiency of B-cell function and of C'3 is noted.