Immunologic reactivity and prognosis in breast cancer.

Abstract

The relationship of immune reactivity to the stage of disease and to prognosis within stages was studied in 202 women with breast cancer. Patients were staged according to the following system: those with primary operable breast cancer were classified according to the presence or absence of regional lymph node metastases; those with advanced breast cancer were classified according to the predominant site of metastases: (1) those with skin, soft tissue, or nodal metastases, (2) those with bone metastases, and (3) those with visceral organ metastases. A significant linear trend of decreasing DNCB reactivity was seen with increasing extent of disease (P < 0.01). The results of other tests of immune reactivity, including intradermal skin tests with microbial antigens, and, in patients with advanced breast cancer only, absolute lymphocyte counts, lymphocyte proliferative responses to mitogens and microbial antigens, serum immunoglobulin levels, and T and B-cell counts, did not change significantly with increasing extent of disease. No significant difference in recurrence distributions was seen when all primary operable breast cancer patients with positive and negative DNCB responses were compared. However, when the presence or absence of lymph node involvement was taken into account, a trend to earlier recurrence for DNCB-positive patients was seen (P = 0.03). When the survival distributions for all DNCB-positive and-negative patients were compared, the DNCB-positive patients showed a significantly longer survival (P < 0.01). However, when the survival distributions for DNCB-positive and-negative patients with either primary operable or advanced breast cancer were compared separately, significant differences were not seen. Other tests of immune function, including intradermal skin tests with microbial antigens, absolute lymphocyte counts, and lymphocyte responses to mitogens in vitro, were not useful in distinguishing prognostically favorable groups among patients with advanced disease. Advanced breast cancer patients who were given an adequate trial of combination chemotherapy showed no difference in response rate or survival when DNCB-positive and-negative patients were compared. We conclude that, although DNCB reactivity is progressively impaired in patients with increasing tumor burden and correlates with survival in breast cancer patients in general, in our experience such tests do not provide prognostically important information above that given by careful clinical and pathologic staging.