It is suggested that cellular neoplastic transformations occur throughout life in all persons but that the vast majority are undetected because neoplastic cells are recognized and eliminated by an immunologic surveillance system. This is believed to be primarily a function of the cell mediated (thymus dependent) immune mechanism. Cell mediated immune responses were evaluated using DNCB contact sensitization in 25 patients with transitional carcinoma of the urinary tract and in 8 tumor free patients with a history of transitional cell tumor. Tumor bearing patients had a 56% incidence of impaired reactivity while tumor free patients had normal immune reactivity. Significant correlations were demonstrated between impaired host immunocompetence and tumor stage (impaired immunocompetence was observed in 25% of patients with non invasive lesions, 27% of those with T1 and T2 lesions and 100% of those with T3 and T4 lesions), tumor grade (impaired immunocompetence was observed in 40% of grade 1 and grade 2 lesions and 74% of grade 3 and grade 4 lesions) and the presence of vascular or lymphatic invasion (impaired immunocompetence was observed in 100% of patients with vascular or lymphatic permeation and 39% of those without it). Evaluation of host cell mediated immunocompetence in patients with transitional carcinomas provides an important means of gauging the biologic potential of the tumor.
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