Immunosuppressive Acidic Protein Levels Research Articles

Predictive values of acute phase reactants, basic fetoprotein, and immunosuppressive acidic protein for staging and survival in renal cell carcinoma

Objectives. To determine the clinical significance and predictive value of three acute phase reactants (erythrocyte sedimentation rate, C-reactive protein, and ferritin), as well as basic fetoprotein (BFP) and immunosuppressive acidic protein, in patients with renal cell carcinoma. Methods. Erythrocyte sedimentation rate, C-reactive protein, ferritin, BFP, and immunosuppressive acidic protein levels were measured in 92 patients with renal cell carcinoma diagnosed in 1989 to 1999. The levels were compared with the clinical stage and nuclear grade, and their predictive values of survival were evaluated statistically. Results. All markers, with the exception of BFP, correlated with each other and with the clinical stage and nuclear grade. BFP did not correlate with the acute phase reactants. The log-rank test revealed that the levels of C-reactive protein, immunosuppressive acidic protein, and ferritin significantly influenced survival. Multivariate stepwise analysis identified ferritin as the only independent and significant prognostic marker (hazard ratio = 5.624, P = 0.001). However, when age, sex, clinical stage, and nuclear grade were entered into the same analysis, only clinical stage was an independent marker of prognosis. Conclusions. The results of our study demonstrated that serum ferritin is the most useful marker among five tested factors for staging and predicting survival, although the clinical stage is the best parameter that predicts the prognosis of patients with renal cell carcinoma accurately.

Serum immunosuppressive acidic protein as a potent prognostic factor for patients with metastatic renal cell carcinoma.

Estimation of survival probability of individual patients with metastatic renal cell carcinoma was difficult owing to diverse prognostic factors. We analyzed serum immunosuppressive acidic protein (IAP) levels and the cutoff value, then tested its validity for assessing patients' prognoses. Serum IAP was measured longitudinally in 84 patients with metastatic disease. Before therapy, cutoff levels of IAP were tested every 20 microg/ml between 600 and 1200 microg/ml. The prognostic importance of IAP and its cutoff level was estimated. The cutoff level of IAP was set at 800 microg/ml for 40 patients who had metastatic disease with the primary tumor in situ and for 44 patients with recurrent disease. IAP was found to be a significant prognostic factor for both patient groups. Serum IAP is an important prognostic factor for patients with metastatic renal cell carcinoma. Stratification of patients according to prognosis is feasible using the cutoff level.

Serum immunosuppressive acidic protein and natural killer cell activity in patients with metastatic renal cell carcinoma before and after nephrectomy.

To our knowledge the impact of nephrectomy on stage M1 renal cell carcinoma remains to be determined. We previously reported that nephrectomy is beneficial in patients with elevated serum C-reactive protein before treatment, and those in whom nadir C-reactive protein decreases postoperatively to within the normal range may expect longer survival when surgery is combined with postoperative immunotherapy. In this study we determine the effect of nephrectomy on the immune response in patients with metastatic renal cell carcinoma. We retrospectively reviewed the records of 40 patients with metastatic renal cell carcinoma diagnosed at our institution between 1986 and 1999. These patients underwent nephrectomy before cytokine therapy with interferon. Before and after nephrectomy we measured serum C-reactive protein, serum immunosuppressive acidic protein and peripheral blood natural killer cell activity. In 15 patients with pretreatment serum C-reactive protein within the normal range (less than 1 ng./ml.) there was no significant difference before and after nephrectomy in the serum immunosuppressive acidic protein level or natural killer cell activity (p = 0.4587 and 0.3892, respectively). On the other hand, in 25 patients with serum C-reactive protein elevated before treatment to 1 ng./ml. or greater serum immunosuppressive acidic protein decreased significantly and natural killer cell activity increased significantly after cytoreductive surgery (p = 0.0002 and 0.0286, respectively). Our study implies that nephrectomy may be beneficial in patients with elevated serum C-reactive protein before treatment. Further evaluation by a prospective study is needed to make a definitive conclusion.

Telomerase activity in human renal cell carcinoma.

Telomerase activity has been detected in a wide variety of human tumors. The present study evaluated telomerase activity in association with the acquisition of renal cell carcinoma (RCC). Telomerase activity was examined in 30 RCC and the adjacent normal kidney tissue, obtained as surgical specimens. The activity was assayed by polymerase chain reaction-based telomeric repeat amplification protocol assay. Among the 30 RCC, 18 (60%) displayed telomerase activity, whereas none of the normal tissue samples exhibited it. Subdivision of the tumors according to telomerase activity did not reveal any obvious difference in distribution with regard to tumor size, stage, histocytological subtype, or DNA-ploidy. However, a statistically significant relationship was found between the frequency of telomerase-positive activity and both serum immunosuppressive acidic protein level in the patient and tumor grade (P<0.05). There was no significant difference in the recurrent-free survival and the disease-specific survival between patients with positive telomerase activity and patients with negative activity. The present results indicate that telomerase activity might be related to the progression of RCC and thus a marker of malignant potential.

Impact of splenectomy and immunochemotherapy on survival following gastrectomy for carcinoma: Covariate interaction with immunosuppressive acidic protein, a serum marker for the host immune system

The role of the spleen in tumor immunology is still controversial in that it can either enhance or suppress the antitumor immune response depending on the tumor-bearing host. To clarify this biphasic effect of the spleen, a clinical evaluation of splenectomy in conjunction with immunotherapy and the host immune status was performed in gastric cancer patients. The effect of splenectomy and immunotherapy in 253 gastric cancer patients enrolled in a prospective randomized trial (SIP) was analyzed using the Cox's proportional hazards model in terms of the covariate interaction of the preoperative immunosuppressive acidic protein (IAP) level. In patients with high IAP levels (>580 microg/ml) with predicted negative antitumor immune reactions, splenectomy improved the prognosis. In patients with lower IAP values, conversely, the preservation of the spleen and immunotherapy demonstrated a significant benefit to survival. The spleen was shown to have a biphasic activity in terms of its antitumor immune response depending on the IAP level of the patient. The effect of immunotherapy is significantly influenced by the activity of spleen cells. The preoperative IAP level is therefore considered to be a possible indicator for the effectiveness of splenectomy and immunotherapy in curatively resected gastric cancer patients.

Thymidine phosphorylase activity in tumor correlates with venous invasion.

Thymidine phosphorylase (dThdPase) is identical to platelet-derived endothelial cell growth factor (PD-ECGF), an angiogenesis factor. We investigated the correlation between dThdPase activity in gastric cancer tissue and clinicopathological factors. Thirty-three cancer tissue specimens and 23 adjacent normal gastric mucosal specimens were obtained from surgery. Measurement of dThdPase activity was based on the amount of 5-fluorouracil formed from 5'-deoxy-5-fluorouridine by dThdPase. Mean dThdPase activity in cancer tissue was approximately 3.2 times higher than that in normal tissue. Cancerous tissues with venous invasion had about twice the dThdPase activity as cancerous tissues without venous invasion. Other clinicopathological features were not related to dThdPase activity. A correlation between dThdPase activity and immunosuppressive acidic protein level was observed (r = 0.532, P = 0.005). dThdPase activity in gastric cancer cells was found to be correlated with venous invasion, supporting previous findings that it plays a role in tumor angiogenesis.

Indomethacin acts as an antitumor and anticachexic agent in colon 26-bearing CDF1 mice

Background This study uses Colon 26-bearing CDF1 mice to assess the pharmacologic actions of indomethacin on tumor growth and cancer cachexia. The effect on tumor growth was evaluated by tumor weight, and the effect on cachexia was screened by changes in body weight and food intake. Additional indices measured included serum levels of immunosuppressive acidic protein and interleukin-6, and prostaglandin E2 content in the tumor tissues.

Microalbuminuria is a good predictor which evaluates the responses of treatment in patients with inflammatory bowel disease

It has been shown that microalbuminuria correlated with laboratory inflammatory parameters such as C reactive protein (CRP) and erythrocyte sedimentation rate in patients with inflammatory bowel disease (IBD). However, these laboratory parameters are likely to be changed by anemia and treatments such as corticosteroids or immunosuppressive agents. Endoscopic examination is invasive and its use is limited in patients with severe disease. Thus, there is a need for a simple and objective predictor, which represents the severity of the disease and evaluates the responces of treatment in patients with IBD. Aim: The levels of microalbuminuria, endoscopic severity indices, clinical activity indices, and laboratory parameters before treatment were compared with those after treatment in patients with IBD. Methods: Urine was collected for 24 hours and the microalbuminuria was measured by chromatoimmuno-assay method. Clinical disease activity was assessed using Crohn's disease activity index (CDAI) for patients with Crohn's disease (CD), and International Organization for the study of IBD (IOIBD) for patients with ulcerative colitis (UC). Endoscopic severity was assessed using endoscopic index of the severity for CD (CDEIS), and Matts grading system for patients with UC. Laboratory inflammatory parameters were assessed using immunosuppressive acidic protein (IAP) and CRP. Results: 11 patients with IBD (7 patients with CD and 4 patients with UC) were studied. All patients after treatment had lower concentrations of microalbuminuria compared with those patients before treatment. Similarly, both endoscopic severity indacies and clinical activity indacies were also lower in all patients after treatment compared with patients before treatment. The levels of IAP were not reduced by treatment in 2 patients, while CRP did not change in 3 patients. Conclusion: These results show a possibility that microalbuminuria is a simple, objective and non-invasive predictor which represents endoscopic and clinical feature and evaluates the responces of treatment in patients with IBD.

Effect of Surgical Stress on Immune Function in Patients With Urologic Cancer

Background: To determine the immunosuppressive effect of surgery for urologic cancers, multiple variables of immune function were measured serially before and after operation in patients with urologic cancer. Methods: Peripheral blood was obtained before operation and at postoperative day 7 and 14 from 20 patients with bladder cancer, renal pelvic, or ureteral cancer, or renal cell carcinoma. Results: In patients with bladder cancer who were undergoing radical cystectomy with use of intestine for urinary diversion, the serum level of immunosuppressive acidic protein (IAP) increased, and serum levels of immunoglobulin (Ig)A, IgG, and IgM decreased after operation. In contrast, the number of CD25+ lymphocytes significantly increased. Transurethral resection of bladder cancer also resulted in an increase in serum IAP level, however, the number of CD4+ and human leukocyte-associated HLA-DR+ lymphocytes increased. In patients with renal pelvic or ureteral cancer undergoing nephroureterectomy with cuff, the level of serum IAP increased and serum IgG level decreased after operation. By contrast, the number of CD3+ lymphocytes increased. In patients with renal cell carcinoma, radical nephrectomy led to a significant increase in the number of CD8+ lymphocytes. Conclusions: These findings suggest that surgical stress in patients with urologic cancer may result in both suppression and stimulation of host immunity.

Antitumor effect of a peptide-glucan preparation extracted from Agaricus blazei in a double-grafted tumor system in mice.

The antitumor effect of extracts obtained from the fruit body of Agaricus blazei Murill was examined in a double-grafted tumor system, in which BALB/c mice received simultaneous intradermal injections of Meth-A tumor cells in both the right (10(6) cells) and left flank (2 x 10(5) cells), and were then injected with 5 mg of extracts of A. blazei in the right tumor on days 3, 4 and 5. Intratumoral administration of ethanol-soluble (Fraction 1), water-ethanol-soluble (Fraction 2), ammonium oxalate-soluble (Fraction 3) and ammonium oxalate-insoluble (Fraction 4) fractions resulted in inhibition of tumor growth, with Fraction 3 showing the most tumoricidal activity, producing regression of the right tumor and inhibition of growth of the left, non-injected tumor. The maximum effect was obtained using 0.5 mg of Fraction 3 and this amount was used in subsequent experiments. The antitumor effect of intratumorally administered Fraction 3 was enhanced by oral ad lib administration of feed containing 0.083% of Fraction 3. When immunized spleen cells from mice that had been cured by intratumoral administration of 0.5 mg of Fraction 3 were directly injected (2 x 10(7) cells/mouse) into the Meth-A tumor, tumor growth was inhibited. The tumor cells on day 7 from the Fraction 3-treated right tumor and from the left tumor were cultured for 24 h and their culture supernatants were assayed for neutrophil or macrophage chemotactic activity. Significant macrophage chemotactic factor activity was detected in the culture media from the left tumor tissue. Serum levels of immunosuppressive acidic protein (IAP), produced by activated macrophages and neutrophils, increased transiently soon after intradermal injection of 0.5 mg of Fraction 3. These results suggest that regression of the left non-injected tumor was due to an immune reaction, involving induction of cytotoxic cells in the spleen, and the release of chemotactic factors in the distant tumor.

Continuous infusion of 5‐fluorouracil and low dose cisplatin infusion for the treatment of advanced and recurrent gastric adenocarcinoma

Several chemotherapy studies have suggested that continuous infusion of 5-fluorouracil (5-FU) is more effective than bolus 5-FU. In addition, 5-FU and cis-Diamminedichloroplatinum-II (cisplatin) in combination have been shown to have synergistic cytotoxicity against several human neoplasms. In this study, the authors evaluated the efficacy and toxicity of continuous infusion of 5-FU and low dose cisplatin infusion (FP therapy) in the treatment of advanced and recurrent gastric adenocarcinoma. The relationship between the response to FP therapy and several factors was also examined. A total of 26 patients fulfilling standard eligibility criteria were enrolled in the trial. FP therapy consisted of 5-FU (350 mg/m2/day every day by continuous infusion) and cisplatin (7.5 mg/m2/day in 100 mL of normal saline infused over 1 hour on Days 1-5 every week) for 4 weeks. A complete response was observed in 2 cases and a partial response in 11 cases, for an overall response rate of 50%. Patients with good performance status (PS) (0-1) and differentiated histologic type showed higher response rates (50.0% and 63.6%, respectively) than patients with poor PS (2 or 3) and undifferentiated histologic type (28.6% and 35.3%, respectively), although there were no significant differences. Patients with low serum levels of immunosuppressive acidic protein (IAP) showed a significantly higher response rate (71.4%) than those with high IAP levels (0%). Toxic effects included leukopenia, thrombocytopenia, nausea, and vomiting; these were not life-threatening and did not require treatment interruption. FP therapy is a promising regimen for patients with advanced and recurrent gastric adenocarcinoma. Serum levels of IAP may predict chemosensitivity.

Continuous infusion of 5‐fluorouracil and low dose cisplatin infusion for the treatment of advanced and recurrent gastric adenocarcinoma

BACKGROUND Several chemotherapy studies have suggested that continuous infusion of 5-fluorouracil (5-FU) is more effective than bolus 5-FU. In addition, 5-FU and cis-Diamminedichloroplatinum-II (cisplatin) in combination have been shown to have synergistic cytotoxicity against several human neoplasms. In this study, the authors evaluated the efficacy and toxicity of continuous infusion of 5-FU and low dose cisplatin infusion (FP therapy) in the treatment of advanced and recurrent gastric adenocarcinoma. The relationship between the response to FP therapy and several factors was also examined. METHODS A total of 26 patients fulfilling standard eligibility criteria were enrolled in the trial. FP therapy consisted of 5-FU (350 mg/m2/day every day by continuous infusion) and cisplatin (7.5 mg/m2/day in 100 mL of normal saline infused over 1 hour on Days 1-5 every week) for 4 weeks. RESULTS A complete response was observed in 2 cases and a partial response in 11 cases, for an overall response rate of 50%. Patients with good performance status (PS) (0-1) and differentiated histologic type showed higher response rates (50.0% and 63.6%, respectively) than patients with poor PS (2 or 3) and undifferentiated histologic type (28.6% and 35.3%, respectively), although there were no significant differences. Patients with low serum levels of immunosuppressive acidic protein (IAP) showed a significantly higher response rate (71.4%) than those with high IAP levels (0%). Toxic effects included leukopenia, thrombocytopenia, nausea, and vomiting; these were not life-threatening and did not require treatment interruption. CONCLUSIONS FP therapy is a promising regimen for patients with advanced and recurrent gastric adenocarcinoma. Serum levels of IAP may predict chemosensitivity. Cancer 1997; 80:1-7. © 1997 American Cancer Society.

A Case of Subacute Thyroiditis Accompanied by Thyroid Stimulating Antibodies and Thyroid Stimulation-Blocking Antibodies

After one month of suffering from cervical pain, subfever, palpitation and tachycardia, a 78-year-old woman came to our hospital. Tenderness was noted when we palpated her diffuse goiter. Thyroid stimulating hormone (TSH) level was less than 0.1μU/ml with high serum levels of free T3 (9.8pg/ml) and free T4 (4.4ng/dl), showing hyperthyroid state. Microsome test and thyroid test were both negative, with C-reactive protein (CRP) at 3.1mg/dl, erythrocyte sedimentation rate (ESR) at 139mm/hr and immunosuppressive acidic protein (IAP) at 881μg/ml. She was diagnosed as having subacute thyroiditis. However, thyroid scanning with 123I revealed normal uptake. TSH binding inhibitor Immunoglobulin (TBII) activity was 71.8%. Thyroid stimulating antibody (TSAb) was positive (869%). Thyroid stimulation-blocking antibody (TSBAb) was 22%. The histological examination by needle biopsy showed thyroid follicular cell destruction and appearance of giant cells, compatible with subacute thyroiditis. After administration of anti-inflam-matory drug alone, the cervical pain disappeared and CRP, ESR and IAP levels were normalized. Three months later, serum TSH level was 45.2μU/ml, free T3 was 2.4pg/ml and free T4 was 0.4ng/dl, showing hypothyroid state. TBII was 75.9%, TSAb was negative (122%) and TSBAb was positive (86%). Six months later, TBII, TSAb and TSBAb became negative and the thyroid function returned to normal. The occurrence of subacute thyroiditis may induce transitional multifunctional TSH-receptor antibody appearance.

Prognostic role of immunosuppressive acidic protein in advanced ovarian cancer

OBJECTIVE: Our purpose was to investigate immunosuppressive acidic protein in the prognostic characterization of advanced ovarian cancer. STUDY DESIGN: Serum levels of immunosuppressive protein were prospectively measured in 80 patients with untreated ovarian carcinoma. To evaluate the prognostic significance of immunosuppressive acidic protein levels, cutoff points were studied every 50 μg/ml between 450 and 1350 μg/ml. RESULTS: Pretreatment immunosuppressive acidic protein levels were not significantly associated with stage, histotype, grade of differentiation, postoperative residual tumor, and response to chemotherapy. The most significant association with survival was observed at a cutoff value of 1100 μg/ml ( p = 0.0089). In the univariate analysis for overall survival, International Federation of Gynecology and Obstetrics stage and immunosuppressive acidic protein status were found to have a role in predicting ovarian cancer prognosis. In the multivariate analysis only immunosuppressive acidic protein status was significantly associated with survival. A statistical correlation was found between serum levels and overall survival ( p = 0.0104, χ 2 6.56), including immunosuppressive acidic protein as a continuous variable. CONCLUSION: Our data suggest that immunosuppressive acidic protein assay is a potentially useful tool in the prognostic characterization of advanced ovarian cancer. (Am J Obstet Gynecol 1996;175:1606-10.)

Effect of surgical stress on immune function in patients with urologic cancer.

To determine the immunosuppressive effect of surgery for urologic cancers, multiple variables of immune function were measured serially before and after operation in patients with urologic cancer. Peripheral blood was obtained before operation and at postoperative day 7 and 14 from 20 patients with bladder cancer, renal pelvic, or ureteral cancer, or renal cell carcinoma. In patients with bladder cancer who were undergoing radical cystectomy with use of intestine for urinary diversion, the serum level of immunosuppressive acidic protein (IAP) increased, and serum levels of immunoglobulin (Ig)A, IgG, and IgM decreased after operation. In contrast, the number of CD25+ lymphocytes significantly increased. Transurethral resection of bladder cancer also resulted in an increase in serum IAP level, however, the number of CD4+ and human leukocyte-associated HLA-DR+ lymphocytes increased. In patients with renal pelvic or ureteral cancer undergoing nephroureterectomy with cuff, the level of serum IAP increased and serum IgG level decreased after operation. By contrast, the number of CD3+ lymphocytes increased. In patients with renal cell carcinoma, radical nephrectomy led to a significant increase in the number of CD8+ lymphocytes. These findings suggest that surgical stress in patients with urologic cancer may result in both suppression and stimulation of host immunity.

Prognostic value of preoperative immunosuppressive acidic protein in patients with gastric carcinoma: Findings from three independent clinical trials

Immunosuppressive acidic protein (IAP) has been reported to have close correlation with the impairment of host immune response. To evaluate the significance of IAP in clinical studies, the prognostic value of preoperative IAP was investigated in clinical trials of patients with gastric carcinoma after curative resection. An appropriate IAP threshold value of 580 micrograms/mL was determined using Cox's proportional hazards model. Five-year survival rates were estimated for high and low IAP groups in three different clinical studies. Meta-analysis was performed based on individual patient data, and summarized hazard ratios were estimated using a stratified proportional hazards model. Meta-analysis of the three clinical trials demonstrated that patients with preoperative IAP levels above the threshold had significantly poorer cancer related survival (P = 0.0039) and absolute survival (P = 0.0023), even after adjustment for the major prognostic factors. Gastric carcinoma patients with an IAP value above the threshold level of 580 micrograms/mL have a higher risk of cancer death and absolute death than patients with an IAP value below the threshold value.

Surgical treatment strategy for patients with stage IV hepatocellular carcinoma

This study was conducted to identify the prognostic indicators for patients with stage IV hepatocellular carcinoma (HCC), as well as to clarify the strategy of surgical treatment for those patients. Forty-six patients with stage IV HCC were included in this study. Prognostic factors were univariately and multivariately analyzed. Furthermore, the significance of intraoperative treatment for residual tumors was investigated in patients with an absolute noncurative operation. The poor prognostic factors were as follows: host factors, Child's classification of B and C and immunosuppressive acidic protein level of greater than 400 micrograms/ml; tumor factors, tumor diameter of greater than 5 cm, poorly differentiated histologic features, positive portal vein invasion, and intrahepatic metastases involving more than three segments; others, an absolute noncurative operation and no preoperative treatment. Tumor diameter of more than 5 cm was then suggested to be an independent prognostic indicator. Survival of patients with stage IV-A HCC who underwent a curative operation was similar to that of those with stages III HCC: Furthermore, the survival of patients with Stage IV-A who had an absolute noncurative operation but underwent either intraoperative microwave coagulation or ethanol injection to the residual HCCs was not statistically different from that of those with a curative operation. Therefore for stage IV-A HCC surgical treatment is considered to be both useful and the first choice of treatment when all the tumors in the liver can be removed or when the residual tumors can be treated during operation by either microwave coagulation or ethanol injection as a result of an incomplete removal of the tumors.

Acute-phase plasma proteins in gastric cancer: association with metastatic potential and prognosis.

We evaluated the possibility that acute-phase plasma proteins such as alpha 1-antichymotrypsin (ACT) and immunosuppressive acidic protein (IAP) might be useful predictors of lymph node metastasis and prognosis in patients with gastric cancer. Both ACT and IAP levels generally increased according to the pTNM stage. Patients with both abnormal IAP and ACT levels showed a high risk of lymphatic and hepatic metastasis as well as peritoneal dissemination, with a resultant poor prognosis. Patients who had abnormal IAP levels with or without abnormal ACT levels had a significantly higher risk of lymph node metastasis, as well as more invasive tumors and a worse prognosis than those who had normal IAP levels with or without abnormal ACT levels. In combination group 4 [IAP(+) ACT(-) vs. IAP(-) ACT(+)] lymphatic metastasis was seen more often with isolated IAP(+) (76.4%) than with ACT(+) (52.9%) (p < 0.0045), especially in the subgroup of poorly differentiated adenocarcinoma (POR; p < 0.0177). However, this does not demonstrate that ACT(+) is a protective factor against lymphatic invasion, because the results of combination group 6 [IAP(-) ACT(+) vs. IAP(-) ACT(-)] show that isolated ACT(+) is also significantly related to lymphatic metastasis (p < 0.001). The same is true for the subgroup of signet ring cell carcinomas (p = 0.038), but it has not been tested versus the POR subgroup.

Changes of white blood cells, immunosuppressive acidic protein, and interleukin-2 receptor after open heart surgery.

There are a lot of immunological changes after major surgery, especially in open heart surgery when blood flows through a cardiopulmonary bypass system. We monitored leukocyte count, lymphocyte subpopulation count, soluble IL- 2 receptor (sIL-2r) and serum IL-2 levels, and an immunosuppressive acidic protein (IAP) level before and on the 1st, 7th, and 14th day after open heart surgery. It was noted that there were significant increases of total leukocyte and granulocyte counts for more than two weeks. But total lymphocyte, T-lymphocyte, b-lymphocyte, natural killer cell, suppressor T-cell, and helper T-cell all showed significant decreases in absolute numbers for more than one week as compared to the preoperative values. Serum IAP level was elevated for more than two weeks after operation. Serum IL-2 decreased but serum sIL-2R increased in the postoperative period. It is concluded that there is a period of immunosuppression after open heart surgery which lasts for at least one week and perhaps more than two weeks.

口腔扁平上皮癌における腫瘍マーカーの combination assay に関する臨床的研究

Tumor markers are tumor-mediated substances, but are not specific substances directly produced by the tumor tissue. The use of tumor markers has been accepted as a valuable tool for the diagnosis, prognosis, and treatment monitoring. The tumor markers that have been used in patients with oral squamous cell carcinoma (O-SCC) include carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC), immunosuppressive acidic protein (IAP), and cytokeratin 19 fragment (Cyfra). All of these markers have very low sensitivity in O-SCC and are not useful for clinical purposes. Most authors have measured single tumor markers, and there are very few reports concerning the use of combination assays in which two or more markers were measured simultaneously. Since the most predominant histological type of cancer in the oral and maxillofacial region is squamous cell carcinoma, various tumor markers were determined singly and in combination in patients suffering from O-SCC. Forty-two consecutive patients with O-SCC treated in our department between 1988 and 1992 were entered in the study. Blood specimens were collected after informed consent was received from the patients with O-SCC and oral benign diseases. Four tumor markers were simultaneously measured, including CEA, SCC, IAP, and Cyfra. The results were as follows : 1. The positive rates were 31.0% for CEA, 38.1% for SCC, 52.4% for IAP and 38.1% for Cyfra in patients with O-SCC. Therefore, CEA, SCC, IAP, and Cyfra levels, of which the positive rates were significantly different (p<0.01) from those of control patients with oral benign diseases, were considered to be of diagnostic value. 2. The CEA, SCC, IAP, and Cyfra levels in these cancer patients were found to differ significantly from the levels in patients with a oral benign disease. 3. The sensitivity (81.0%) and accuracy (77.8%) of the combination assay with these four tumor markers proved to be higher than those obtained with individual markers. 4. In these investigations, the determination of CEA, SCC, IAP, and Cyfra serum levels in patients with O-SCC leads to a more accurate diagnosis. This combination assay may prove to be useful for screening of patients with oral cancer and in the early diagnosis of metastases to other organs.