Reizenstein P, Ogier C, Blomgren H, Petrini B, Wasserman J
Adv Immun Cancer Ther. 1985;1:1-28. doi: 10.1007/978-1-4612-5068-5_1.
Currently, the most probable theory of tumor surveillance is neither the existence of any tumor-specific, antigen-dependent, T-cell-mediated cytotoxic effect that could eliminate spontaneous tumors in man and that could be used for some kind of vaccination against tumors, nor the complete absence of any surveillance or defense systems against tumors. What is probable is the cooperation of a number of antigen-independent, relatively weakly cytotoxic or possibly only cytostatic humoral and cellular effects, including nutritional immunity, tumor necrosis factor, certain cytokines, and the cytotoxic effects mediated by macrophages, NK cells, NK-like cells, and certain stimulated T-cells. One question remaining to be solved is why these antigen-independent effects do not attack normal cells. A number of plausible hypotheses are discussed. The hypothetical surveillance system is modulated both by traditional cancer treatment and by attempts at immunomodulation. Radiotherapy reduced the T-helper cell function for almost a decade, but not those of macrophages or NK cells. T-cell changes have no prognostic implication, supporting, perhaps, the suggestion of a major role for macrophages and NK cells. Cyclic adjuvant chemotherapy reduces the peripheral lymphocyte population and several lymphocyte functions but not NK activity. Most of the parameters were normalized some years following treatment, but NK activity remained elevated and Th/Ts cell ratio was still decreased. This might possibly be taken to support the surveillance role of NK cells. Bestatin increases the frequency of lymphocytes forming rosettes with sheep red blood cells (but not their mitogenic responses), enhances NK activity, and augments the phagocytic capacity of granulocytes and monocytes (but not their cytotoxic activity). Improved survival with Bestatin treatment following chemotherapy has been observed in patients with melanoma Stages 1b and II and in patients with acute nonlymphatic leukemia, where BCG also seems active, although possibly only in patient groups with less than 49% complete remissions.
目前，关于肿瘤监测最有可能的理论既不是存在任何肿瘤特异性、抗原依赖性、T细胞介导的细胞毒性作用，这种作用能够消除人类的自发性肿瘤并可用于某种肿瘤疫苗接种；也不是完全不存在任何针对肿瘤的监测或防御系统。可能的情况是多种抗原非依赖性、细胞毒性相对较弱或可能仅是抑制细胞生长的体液和细胞作用相互协作，包括营养性免疫、肿瘤坏死因子、某些细胞因子，以及由巨噬细胞、自然杀伤（NK）细胞、NK样细胞和某些活化T细胞介导的细胞毒性作用。一个有待解决的问题是，为什么这些抗原非依赖性作用不会攻击正常细胞。文中讨论了一些看似合理的假说。这种假设的监测系统受到传统癌症治疗和免疫调节尝试的双重调节。放射治疗会使T辅助细胞功能降低近十年，但不会影响巨噬细胞或NK细胞的功能。T细胞变化没有预后意义，这或许支持了巨噬细胞和NK细胞起主要作用的观点。周期性辅助化疗会减少外周淋巴细胞数量和多种淋巴细胞功能，但不会影响NK活性。治疗后的几年里，大多数参数都恢复了正常，但NK活性仍然升高，Th/Ts细胞比值仍然降低。这可能支持了NK细胞的监测作用。贝司他汀增加了与绵羊红细胞形成玫瑰花结的淋巴细胞频率（但不影响其促有丝分裂反应），增强了NK活性，并提高了粒细胞和单核细胞的吞噬能力（但不影响其细胞毒性活性）。在Ⅰb期和Ⅱ期黑色素瘤患者以及急性非淋巴细胞白血病患者中，化疗后使用贝司他汀治疗可提高生存率，在这些患者中卡介苗似乎也有作用，尽管可能仅在完全缓解率低于49%的患者组中有效。
