Lymphoid infiltration and prognosis in colorectal carcinoma.
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Biomedical subjects
Publications and source records attributed to O C Lunde.
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Inflammatory cells (lymphocytes, plasma cells, macrophages, mast cells and polymorphonucleated cells) forming infiltrates in the stroma of ten colon carcinomas were analysed in situ and compared with the cells of the normal colon wall. The cancer stroma contained a larger proportion of lymphocytes, while the number of IgA-containing plasma cells was markedly reduced compared to the normal colon mucosa from the resection edge. In both tissues the number of macrophages was much higher than the study of H & E stained routine preparations would suggest. The peritumoural cell infiltrates consisted of 47% lymphocytes, 19% plasma cells, 15% macrophages (including monocytes) and 5% granulated mast cells, while 15% of all inflammatory cells were polymorphonucleated (PMN). Necrotic areas of the tumours were dominated by a larger number of PMN and macrophages. Compared to the normal colon wall, the significant differences in cell composition and the accumulation of mononuclear cells (MC) at the cancer borders indicate that populations of cells are selectively attracted to the tumour site, although the factors responsible for the local cell reaction in cancer are still unknown.
Determination of carcinoembryonic antigen (CEA) in serum has been performed in 253 patients with proved adenocarcinoma in the colon and rectum. Preoperative CEA was normal in 58.3% of the patients. A correlation between CEA level and Dukes' grading was found. There was, however, no statistically significant difference in recurrence rate between patients with normal and patients with elevated pre-operative CEA. Transient CEA elevation was seen in the follow-up period after curative resection in 21.8%. 75% of the patients with recurrence had abnormal CEA, and CEA elevation was the first sign of recurrence in 59.1%. The majority of these patients, however, had advanced disease not available for surgical treatment. In cases with local resectable tumour CEA often was normal. Only a few patients had advantage of CEA determination for diagnosis of recurrence and its routine use is therefore questioned.
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