細胞性免疫能よりみた膀胱癌の浸潤度について

Abstract

The relationships between host immunocompetence in 63 patients with bladder carcinoma (Me=64 years old) and tumor stage, tumor grade, as well as three years survival have been studied. The host immunocompetence was investigated by the following methods: the first was a delayed cutaneous hypersensitivity test using 2-4-dinitrochlorobenzene (DNCB) test, the second one was a tuberculin (PPD) test, the third was degree of blastogenesis of lymphocytes in vitro using phytohemagglutinin (PHA-P), and the forth was peripheral lymphocyte counts. The 63 carcinoma cases consisted of 47 cases of transitional cell carcinoma, 4 of squamous cell carcinoma, 7 of undifferentiated carcinoma, 1 of adenocarcinoma, and 4 unknown cases. According to Jewett and Marshall's staging and AFIP's grading, the 63 carcinoma cases were divided into: 26 cases of stage A, 14 of stage B, 11 of stage C, and 12 of stage D; 7 cases of grade I, 25 of grade II, 16 of grade III, 8 of grade IV, and 7 unknown cases. In the control groups with benign diseases, the DNCB tests were positive in all 22 cases (Me=60), the degree of blastogenesis of lymphocytes had a mean value of 60% in 10 cases (Me=35), and peripheral lymphocyte counts had a mean value of 2, 100(mm in 23 cases (Me=48). The correlations of tumor stage with the DNCB test, the PPD test, and the degree of blastogenesis of lymphocytes were highly significant (P<0.01) when calculated by chi-square test. But the correlation of tumor stage with peripheral lymphocytes was not significant. Concerning tumor grade, the correlations of tumor grade with the PPD test, and the degree of blastogenesis of lymphocytes were highly significant (P<0.01). The correlation of tumor grade with DNCB test was significant (p<0.02), but the correlation of tumor grade with peripheral lymphocytes was not significant. The correlations of peripheral lymphocyte counts with DNCB test and PPD test showed P<0.02 and P<0.01, respectively, by t-test. The correlation of the degree of blastogenesis oflymphocytes with the DNCB test showed P<0.01 as calculated by t-test, but the relationships between degree of blastogenesis of lymphocytes and PPD test was not significant. There were 20 deaths and 9 recurrences of bladder carcinoma during the follow-up period of 36 months. Sixteen patients survived the period without evidence of recurrence. Impaired immunocompetence was outstanding in the 20 dead patients. The DNCB test was negative in 84% of them (P<0.01), the PPD test was negative in 89% of them (p<0.05), the value of degree of blastogenesis of lymphocytes was less than 50% in all (P<0.05), and the value of peripheral lymphocyte counts was less than 1, 000(mm in 30% of them (not significant). The relative number of impaired host immunocompetence cases among the recurrence group and the group without evidence of recurrence was not significantly different.