Beitsch P, Lotzová E, Hortobagyi G, Pollock R
University of Texas, M.D. Anderson Cancer Center, Houston 77030.
Surg Oncol. 1994 Aug;3(4):211-9. doi: 10.1016/0960-7404(94)90036-1.
Breast cancer is the most common cancer in women. Surgery, and more recently neoadjuvant chemotherapy, are being utilized as the initial treatment for breast cancer; however little is known about their effects on the natural immune system. The natural immune system (natural killer [NK] cells) is thought to be important in immune surveillance, including protection from metastasis during the intravascular tumour seeding that occurs during surgery. To investigate the effects of surgery on the natural immune system, we studied the pre-operative and post-operative peripheral blood lymphocytes (PBL) of 10 patients with stage I or II breast cancer: there was a 71.6 +/- 25.3% post-operative reduction in NK cell function (P < 0.005, Student's paired t-test). To investigate the effects of neoadjuvant chemotherapy and surgery, we examined PBL from five patients with stage III breast cancer: NK cell function dropped 95.7 +/- 1.9% after neoadjuvant chemotherapy, and there was a further 51.0 +/- 23.4% decrease after surgery (P < 0.05, Student's paired t-test). Neither group of patients had decreased numbers of NK cells, changes in the percentage of T helper or suppressor cells, or alterations in the production of cytotoxic factor by NK cells. These findings suggest that the impairment in NK cell function reflects a defect in the ability of NK cells to recognize and/or bind to tumour target cells. We conclude that the initial treatment of breast cancer patients, whether it involves surgery alone or with neoadjuvant chemotherapy, profoundly impairs their natural immune system and could increase the risk of metastasis. Further studies are needed to delineate the mechanism of this derangement in natural immunity and possibly alter its course.
乳腺癌是女性中最常见的癌症。手术以及最近的新辅助化疗正被用作乳腺癌的初始治疗方法；然而，关于它们对天然免疫系统的影响却知之甚少。天然免疫系统（自然杀伤[NK]细胞）被认为在免疫监视中很重要，包括在手术期间发生的血管内肿瘤播种过程中防止转移。为了研究手术对天然免疫系统的影响，我们研究了10例I期或II期乳腺癌患者术前和术后的外周血淋巴细胞（PBL）：术后NK细胞功能下降了71.6±25.3%（P<0.005，学生配对t检验）。为了研究新辅助化疗和手术的影响，我们检查了5例III期乳腺癌患者的PBL：新辅助化疗后NK细胞功能下降了95.7±1.9%，手术后进一步下降了51.0±23.4%（P<0.05，学生配对t检验）。两组患者的NK细胞数量均未减少，辅助性T细胞或抑制性T细胞百分比无变化，NK细胞产生细胞毒性因子的能力也无改变。这些发现表明，NK细胞功能的损害反映了NK细胞识别和/或结合肿瘤靶细胞能力的缺陷。我们得出结论，乳腺癌患者的初始治疗，无论是单独手术还是联合新辅助化疗，都会严重损害其天然免疫系统，并可能增加转移风险。需要进一步研究来阐明这种天然免疫紊乱的机制，并可能改变其进程。
