Immunocompetence, immunosuppression, and human breast cancer. II. Further evidence of initial immune impairment by integrated assessment effect of nodal involvement (N) and of primary tumor size (T)

Abstract

Comprehensive immune function by integrated score was assessed in 158 operable, 55 inoperable, and 52 metastatic breast cancer patients relative to 107 healthy controls. The score was derived from in vivo response to PPD and DNCB and in vitro lymphocyte stimulation by PPD and PHA. Proportion of E-RFC was significantly lower in patients than in controls but was not found to correlate directly with the above functional criteria. Fifty-one percent of the patients with early, operable tumors were shown to be at least partially immunosuppressed by integrated score achievement vs. 11% of controls. This proportion rises to 68% of inoperable and 89% of metastatic patients. Quantitative analysis by graded response revealed an additional, significant degree of immune impairment in the respective patient groups by all testing parameters. Depression of immune function in operable patients was not related to age nor influenced by surgery. Immunocompetence of patients with mammary dysplasia did not differ from controls. Increasing size of primary tumor (T) was not found to be matched by progressive degree of immunosuppression, excepting that associated with large T4 tumors. Patients with lymph node involvement (N+) were not significantly immunologically inferior to those without (No) where the larger operable T2-:, tumors are concerned. In the smallest, T, tumors, nodal involvement (N +) is accompanied by remarkable immnnosuppres-sion relative to T,No cases. This finding suggests a pre-existing immune defect inherent in TIN+ patients. It supports the hypothesis that the immunosuppression associated with early breast cancer is primary, patient related, Secondary tumor-induced depression of immune response characterizes advanced and metastatic human breast cancer.

A Logistic Regression Model to Predict Nodal Malignancy among Cases With Lymphadenopathy

“…6 From our study, it seems that if a lymph node has a hard consistency, then a negative Mantoux test and a positive abdominal ultrasound are more useful in predicting nodal malignancy. Negative Mantoux test has been shown to be associated with malignant conditions such as lymphomas, 7 cervical cancers with lymphadenopathy, 8 metastatic breast cancer 9 and colon and stomach cancer. 10 In causes of benign lymphadenopathy, like tuberculosis, studies have shown a very high positive rate of Mantoux in children and adults.…”

Antibody production in cultured blood lymphocytes from breast cancer patients

“…Other authors have reported similar findings. Adler et al (1980) found that small tumours with nodal involvement inhibited immune responsiveness more than those with no palpable homolateral axillary lymph nodes (NO).…”

“…Axillary nodes provide the first setting where antigen(s) released by the tumour stimulate the immunocompetent cells. Data from previous investigations suggest that locally-generated effector cells and their secretory products bring about a specific depression of the lymphocyte reactivity against non-tumour-related agents (recall antigens skin testing, PHA stimulation, mixed leukocyte reactions) (Whitthaker & Clark, 1971;Ellis et al, 1975;Whitehead et al, 1976;Nathanson, 1977;Adler et al, 1980;Cannon et al, 1981).…”

Wertigkeit des Leukozyten-Migrations-Inhibitionstests (LMI-Test) bei der Verlaufsbeobachtung von Patientinnen mit Mammakarzinom

“…Während eine prognostische Relevanz der peritumorösen mononukleären Infiltrate sowie der reaktiven Veränderungen regionaler drainierender Lymphknoten als morphologische Zeichen einer immunologischen Auseinandersetzung zwischen Tumor und Tumorträger nahegelegt wird (4), sind die Ergebnisse zur prognostischen Bedeutung von Parametern der zellvermittelten Immunität sehr widersprüchlich. Während in einigen Arbeiten eine klinische Relevanz dieser Parameter nahegelegt wird (1,2,4,7,8,9,12,19,20,24,28), wird diese von anderen Autoren abgelehnt (9,14,26,27). Es wurde daher im Rahmen einer prospektiven Studie der Nachweis einer zellvermittelten Reaktion im LMI-Test mit der Ausbreitung des Tumors korreliert und durch engmaschige Nachsorgeuntersuchungen bezüglich seiner prognostischen Bedeutung analysiert.…”