Delayed hypersensitivity reactions in patients with carcinoma of the colon and rectum.
Academic Article
Overview
abstract
Two hundred and thirty-seven patients with carcinoma of the colon and 16 patients with benign lesions of the colon and rectum underwent skin tests with 2-4, dinitrochlorobenzene and a battery of intradermal antigens. The incidence of 2-4, dinitrochlorobenzene reactors decreased with the increasing stage of the disease. Seventy-six per cent of the patients with Dukes' A cancer were 2-4, dinitrochlorobenzene positive compared with 56 per cent of those with Dukes' B cancer and 61 per cent of those with Dukes' C lesions. Of the patients with advanced primary operable cancer, those who have metastases beyond the intestine and its mesentery, only 46 per cent were 2-4, dinitrochlorobenzene positive. Only 42 per cent of the patients with inoperable advanced or recurrent disease reacted to 2-4, dinitrochlorobenzene. Neither age nor sex was a determinate factor in the capacity of the patient to respond to 2-4, dinitrochlorobenzene. Tumor burden appeared to correlate best with the ability of the patient to respond to 2-4, dinitrochlorobenzene. In patients with Dukes' A or B lesions, the clinical follow-up period was too short to gauge prognostic significance of skin tests. In patients with Dukes' C lesions who were observed at 12 months, six of 11 in the 2-4, dinitrochlorobenzene negative group had a recurrence or died of disease compared with only four of 17 in the 2-4, dinitrochlorobenzene positive group, p less than 0.10. In 38 patients with advanced primary operable cancer who were observed for nine months, 40 per cared iwth 28 per cent of 2-4, dinitrochlorobenzene positive group. A similar relationship was observed in a group of patients with advanced or recurrent disease who were observed for nine months in which 58 per cent of the patients in the 2-4, dinitrochlorobenzene negative group were dead of disease compared with 40 per cent of those in the 2-4, dinitrochlorobenzene positive group. Skin testing with 2-4, dinitrochlorobenzene and selected intradermal antigens adds prognostic information to that predicted from the clinicopathologic stage of the disease in instances of carcinoma of the colon and rectum. In general, patients with reactive skin tests have more favorable recurrence and survival rates with each stage of the disease.
