Immune reactivity in patients with colorectal cancer: assessment of biologic risk by immunoparameters.

The concept whether immune reactivity was intrinsically related to risk of recurrence was examined in 307 patients with rectal colon cancer, including 181 patients with primary resectable cancer, 48 patients with advanced primary operable cancer, and 78 patients with recurrence. Immune reactivity was measured by 2,4-dinitrochlorobenzene (DNCB) skin tests (219 patients) and by in vitro immunoparameters (1 10 patients) including lymphocyte levels and lymphocyte stimulation tests with mitogens and antigens. There was a linear depression of immune reactivity as measured by DNCB, phytohemagglutinin (PHA) response, and lymphocyte count with increasing stage of disease (P < -05). Immunity was depressed even in patients with Dukes' A cancer (24% were DNCB negative, 33% had low PHA) and was more depressed in patients with Dukes' Band C lesions (40% were DNCB negative, 30% had low PHA), but was profoundly depressed in patients with advanced primary cancer or recurrence (60% had depression of DNCB, PHA, and lymphocyte counts). Short-term prognosis was examined according to DNCB, lymphocyte count, and mitogen responses in patients with resected Dukes' A, B, and C cancers. There was no correlation of recurrence rates in Dukes' C patients with DNCB, lymphocyte count, or the mitogens PHA, Con A o r pokeweed mitogen (PWM). In contrast, tests with CEA have shown a significant correlation of elevated levels with increased recurrence rates in patients with Dukes' C. There were no correlations of any of the immune tests with recurrence rates in Dukes' A or B, although the follow-up is still short (median 48 months), and the median diseasefree survival has not yet been reached. Only patients with advanced disease (liver metastases) showed correlation of immune responses (PHA and lymphocyte count but not DNCB) with survival, P < .05. Although tests of non-specific immune reactivity generally correlated well with extent of disease in colorectal cancer, selected tests correlated with prognosis only in patients with advanced disease. Combining these tests with preoperative CEA levels may provide additional prognostic information. Cancer 45~12541263, 1980.