Abstract
Antitumor immunity assayed by tube leukocyte adherence inhibition (LAI) is suppressed during and for up to 1–3 weeks after surgery. The results of this study suggest that when cortisol is elevated above physiologic levels by the stress of surgery this has a marked suppressive effect on the LAI-reactive cell. Cortisol added to the in vitro tube LAI assay had a two-phase effect. Cortisol at concentrations about two-fold above physiologic levels inhibited the sensitization of the peripheral blood leukocytes with cytophilic IgG antitumor antibody; however, if the cell was already armed, the cortisol did not negate its LAI reactivity. Higher concentrations of cortisol had a direct inhibitory effect on the LAI-reactive cells' ability to react with tumor antigen whether or not the cells were armed. In addition, the in vivo elevation of cortisol by the administration of cortisone acetate to LAI-positive patients inhibited the LAI reactivity of their leukocytes. Stress-induced elevation of cortisol by surgery may have an adverse effect on resistance to tumor growth, and the extent of the immunodepression may be one of the variables in the difference in survival of patients with cancers with similar degrees of invasion.
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