Biological markers and breast cancer. A multiparametric study. II. Depressed immune competence.

Immune functions were evaluated in 207 carefully staged breast cancer patients, 54 patients with benign breast diseases and 152 normal controls. All patients were followed for at least five years and the prognostic significance of immune competence determined at diagnosis was established. The parameters employed were dermal hypersensitivity to four skin test antigens and to 2,4-dinitrochlorobenzene (DNCB), blastogenic responses to PHA (phytohemagglutinin), ConA (Concanavalin A), and PW (Pokeweed mitogen) mitogens and percentage of T- and B-lymphocytes. A significant degree of impairment of immune functions was found in breast cancer patients when compared to controls; this was illustrated by depressed T-cell counts and low responses to PHA, ConA and PW mitogens and by depressed responses to recall antigens. However, only lymphocyte stimulation with PHA, percentage of T-cells and dermal hypersensitivity tests showed a continued decrease with advancing stages of the disease. Moreover, among cancer patients with low responses to recall antigens, 61% died before five years, 16% showed progressive disease and only 22% were disease-free after five years of follow-up; compared to 30, 18 and 52%, respectively, in patients with normal responses to recall Ags (overall P value less than or equal to 0.005). A similar relation could be illustrated in patents with low PHA responses as 42% of these patients died before five years, 19% showed progressive disease and 39% were disease-free compared to 26, 19, and 54%, respectively. In patients with normal PHA responses (overall P value less than or equal to .05). It is concluded that initial immunocompetence, determined by parameters of cell-mediated immunity, could be significantly depressed in patients with localized or even premalignant breast disease as well as in advanced cancer. Depressed responses to PHA and dermal hypersensitivity to recall antigens seem to indicate a poorer prognosis. There is no single ideal biological marker as yet. Combined with our previous results on serum proteins, this current study may help us, at the time of initial treatment, in the identification of a subset of Stage I breast cancer patients likely to do poorly.