IMMUNE-RESPONSE IN BLADDER-CANCER PATIENTS

Patients with various stages of bladder cancer underwent skin testing with dinitrochlorobenzene, recall antigens and Croton oil. In vitro lymphocyte evaluation was performed with T and B cell quantitation, T cell cytotoxicity and non-T cell cytotoxicity. Increasing disease stage was reflected by a greater percentage of negative responses to all skin tests. No response to dinitrochlorobenzene was found in 52 percent of the patients with superficial tumor and 83 percent of the patients with metastatic disease failed to respond (p < 0.025). After surgical removal of the bladder cancer in patients with superficial disease there was a significant decrease in negative response (p < 0.05). Skin test response in patients with invasive disease who were tested before and after cystectomy demonstrated no significant differences in responses. Assessment of dinitrochlorobenzene skin test response indicates that dinitrochlorobenzene response is related to stage of disease, survival of patients with metastatic tumor was significantly better if the dinitrochlorobenzene test was positive and bladder cancer alters the non-immune host inflammatory system in addition to the delayed hypersensitivity immune system. Inflammatory (non-immune) function as measured by Croton oil response correlated with stage of disease (p < 0.001) but not with prognosis. None of the recall antigen responses correlated with prognosis. Streptokinase-streptodornase was the only recall antigen that related to tumor stage (p < 0.001). Lymphocyte evaluation indicated that bladder cancer patients, regardless of stage of disease, have significant variability, above and below the norm in T cell percentages and antibody-dependent cytotoxicity when compared to age-matched controls. Phytohemagglutinin-dependent cytotoxicity showed a significantly decreased variability after tumor removal (p < 0.001). Lymphocyte cytotoxicity in bladder cancer is greater than in the non-cancer population. This is particularly true in those with metastatic tumor. After removal of the tumor phytohemagglutinin-dependent cytotoxicity returned toward normal.