A multifactorial analysis of melanoma: prognostic histopathological features comparing Clark's and Breslow's staging methods

A multifactorial analysis was used to identify the dominant prognostic variables affecting survival from a computerized data base of 339 melanoma patients treated at this institution during the past 17 years. Five of the 13 parameters examined simultaneously were found to independently influence five year survival rates: 1) pathological stage (I vs II, p = 0.0014), 2) lesion ulceration (present vs absent, p = 0.006), 3) surgical treatment (wide excision vs wide excision plus lymphadenectomy, p = 0.024), 4) melanoma thickness (p = 0.032), and 5) location (upper extremity vs lower extremity vs trunk vs head and neck, p = 0.038). Additional factors considered that had either indirect or no influence on survival rates were clinical stage of disease, age, sex, level of invasion, pigmentation, lymphocyte infiltration, growth pattern, and regression. Most of these latter variables derived their prognostic value from correlation with melanoma thickness, except sex which correlated with location (extremity lesions were more frequent on females, trunk lesions on males). This statistical analysis enabled us to derive a mathematical equation for predicting an individual patient's probability of five year survival. Three categories of risk were delineated by measuring tumor thickness (Breslow microstaging) in Stage I patients: 1) thin melanomas (<0.76 mm) were associated with localized disease and a 100% cure rate: 2) intermediate thickness melanomas (0.76-4.00 mm) had an increasing risk (up to 80%) of harboring regional and/or distant metastases and 3) thick melanomas (>/=4.00 mm) had a 80% risk of occult distant metastases at the time of initial presentation. The level of invasion (Clark's microstaging) correlated with survival, but was less predictive than measuring tumor thickness. Within each of Clark's Level II, III and IV groups, there were gradations of thickness with statistically different survival rates. Both microstaging methods (Breslow and Clark) were less predictive factors in patients with lymph node or distant metastases. Clinical trials evaluating alternative surgical treatments or adjunctive therapy modalities for melanoma patients should incorporate these parameters into their assessment, especially in Stage I (localized) disease where tumor thickness and the anatomical site of the primary melanoma are dominant prognostic factors.

A new B cell differentiation antigen (BDA) on normal and leukemic human B lymphocytes that is distinct from known DR (Ia-like) antigens

A newly defined human B cell differentiation antigen, designated as BDA, has been defined and partially characterized. BDA is expressed on normal human B cells and lymphocytic leukemia cells at all stages of known differentiation (pre-B cells to plasma cells). It is distinct from DR (Ia-like) determinants and other known B cell surface constituents.

A New B Cell Differentiation Antigen (BDA) on Normal and Leukemic Human B Lymphocytes That Is Distinct from Known DR (Ia-Like) Antigens

A newly defined human B cell differentiation antigen, designated as BDA, has been defined and partially characterized. BDA is expressed on normal human B cells and lymphocytic leukemia cells at all stages of known differentiation (pre-B cells to plasma cells). It is distinct from DR (Ia-like) determinants and other known B cell surface constituents.

Expression of two differentiation antigens on normal and cultured human T cells

An antiserum specific for human T lymphocytes (AMT) was used to examine patterns of T cell surface antigen expression and to isolate their reactive membrane antigens. By a quantitative adsorption assay, different plateaus of AMT reactivity with blood T cells were observed after serial adsorptions with individual T cell lines. MOLT-3 cells removed 95% of AMT activity to blood T cells whereas MOLT-4 removed 70% and HSB-2 removed only 30%. A cross-adsorption analysis demonstrated that each of the three cell lines differed in their adsorbing efficiency to remove AMT antibodies reactive with the reciprocal cell lines. Radiolabeled membrane proteins were solubilized with either sodium deoxycholate (DOC) or NP-40 detergents, precipitated with AMT, and Staphylococcus aureus Cowan strain I, and analyzed by sodium dodecyl sulfate-polyacrylamide disc gel electrophoresis (SDS-PAGE). Two distinct T lymphocyte antigens of approximately 25,000 daltons (p25) and 16,000 (p16) were identified on MOLT-3 cells. Similar relative quantities of p25 and p16 were detected on human peripheral T cells and thymocytes. MOLT-4 cells contained less of the p25 peak than did MOLT-3. HSB-2 cells gave a small peak in the same general location as the MOLT-3 p25 peak, and a relatively large p16 peak. Adsorption of AMT with HSB-2 removed the capacity of the antiserum to precipitate p16 from MOLT-3, but did not eliminate reactivity with p25.

Expression of Two Differentiation Antigens on Normal and Cultured Human T Cells

An antiserum specific for human T lymphocytes (AMT) was used to examine patterns of T cell surface antigen expression and to isolate their reactive membrane antigens. By a quantitative adsorption assay, different plateaus of AMT reactivity with blood T cells were observed after serial adsorptions with individual T cell lines. MOLT-3 cells removed 95% of AMT activity to blood T cells whereas MOLT-4 removed 70% and HSB-2 removed only 30%. A cross-adsorption analysis demonstrated that each of the three cell lines differed in their adsorbing efficiency to remove AMT antibodies reactive with the reciprocal cell lines.

Radiolabeled membrane proteins were solubilized with either sodium deoxycholate (DOC) or NP-40 detergents, precipitated with AMT and Staphylococcus aureus Cowan strain I, and analyzed by sodium dodecyl sulfate-polyacrylamide disc gel electrophoresis (SDS-PAGE). Two distinct T lymphocyte antigens of approximately 25,000 daltons (p25) and 16,000 (p16) were identified on MOLT-3 cells. Similar relative quantities of p25 and p16 were detected on human peripheral T cells and thymocytes. MOLT-4 cells contained less of the p25 peak than did MOLT-3. HSB-2 cells gave a small peak in the same general location as the MOLT-3 p25 peak, and a relatively large p16 peak. Adsorption of AMT with HSB-2 removed the capacity of the antiserum to precipitate p16 from MOLT-3, but did not eliminate reactivity with p25.

The logic of adjunctive therapy in surgical patients with resectable cancer

The principles and rationale of using multiple modalities (surgery, chemotherapy, radiotherapy, and immunotherapy) to treat solid malignancies is reviewed. Animal models of human tumors have clearly demonstrated the superiority of combining local treatment (eg, surgery) with systemic treatment (eg, chemotherapy). Although the results of many trials of adjunctive therapy in man are still preliminary, they warrant the caustious generalization that multiple modality therapy will increasingly become more effective than surgery alone for most types of solid tumors. Although the strategy of employing adjunctive therapy is rational, it must be emphasized that the therapeutic efficacy of specific drugs or agents for particular patients or tumor types has not always been satisfactory. Clinical trials now in progress may demonstrate more effective regimens. In the meantime, physicians should be cautious about using adjunctive therapy as standard treatment until long-term benefits and safety have been demonstrated. Participation in clinical trials is encouraged to verify the validity and application of this therapeutic approach.

Cross-reactive T-cell antigens among mammalian species

Fluoresceinated heteroantisera prepared against T cells of rats, monkeys, and humans were reacted withthymus and spleen cells from 11 selected species. These reagents recognized cross-reacting T cell antigen(s) among rodent species (mouse, rat, guinea pig, and hamster) and among primate species (monkey and humans). With one exception, the cross-reactivity was restricted to a phylogenetic order. All three antisera required relatively few absorptions to achieve T cell specificity for related species when compared to absorption requirements for the isologous species. Differentiation antigens within a phylogenetic order thus appear to be more homologous than other cell surface constituents on T cells.

Comprehensive evaluation of renal function in the transplanted kidney

By means of a comprehensive renal function test based on the analysis of orthoidohippurate kinetics carried out 223 times in 86 renal transplatn patients, we have been able to separate clearly five clinical entities: normally functioning transplanted kidneys, acute tubular necrosis, cell-mediated rejection, humoral (chromin) rejection, and postrenal obstruction. Accurate prediction of the fate of the rejecting kidney can be made while still subclinical as much as a week before manifestations by other techniques are evident. Data on 22 donors studied 44 times are also presented. The comprehensive test consists of measurements of effective renal plasma flow (ERPF), sequential scintigraphy, calculations of excretory index (EI) (percent dose actually found in bladder and voided urine as a fraction of the percent dose expected at a given time after injection at the patient's specific ERPF), and residual urine volume. Formulas and regression equations for the calculation of ERPF, EI, residual urine, etc., are presented.

Human cadaver kidney preservation using hypothermic hyperosmolar, intracellular washout solution

The utilization of a hypothermic, hyperosmolar, intracellular washout solution for human kidney preservation was shown to be successful in 18 kidneys obtained from 9 heart beating cadavers. The ischemic interval ranged from 2 hrs and 57 mins to 39 hrs and 48 mins. All 18 kidneys functioned within 3 hrs of revascularization. Acute tubular necrosis with oliguria was noted in 4 of 6 patients with ischemic intervals longer than 20 hrs but not in the 12 patients obtaining kidneys preserved for 19 hrs or less. All patients with acute tubular necrosis required hemodialysis for one to 16 days post-transplantation with eventual recovery.

Kidney transplantation in patients with end stage congenital renal disease. Report of eighteen cases and review of the Organ Transplant Registry

Eighteen patients with end stage congenital renal disease requiring kidney transplantation constituted 12 per cent of the transplantation recipients at this institution over the past six years. The post-transplantation course in this group was remarkably satisfactory, with a 94 per cent graft survival at three years. In addition, we analyzed survival data from over 9,900 patients in the Organ Transplant Registry and demonstrated that transplant recipients with end stage congenital renal disease have equal or better five year patient survival compared with those with acquired end stage renal disease. Only those patients with adult polycystic disease had a less satisfactory prognosis, probably because of age-related factors. In contrast, there were few statistical correlations between renal allograft survival, age, and original disease.

Blood group compatibility and aortic valve allotransplantation in man

Immunologic injury is an important contributing factor in failure of aortic valve allografts. The etiology of this immune reaction is unknown, but blood group antibodies have been postulated. In 46 patients, ABO and rhesus blood group compatibility bore no relationship between the success or failure or aortic valve allotransplantation. Therefore, circulating blood group antibodies do not contribute to valve failure, and recipients do not have to receive aortic valve allografts matched for ABO or rhesus compatibility.

Thymus-Dependent (T) Lymphocytes in the Rat

Thymus-dependent (T) lymphocytes in the rat may be recognized by their reactions with fluorescein-labeled heteroantibodies and by their functional activities. The Ig fractions of horse and rabbit antisera to rat thymocytes, when labeled with fluorescein, stained more than 95% thymocytes, less than 2% bone marrow cells, and 30 to 60% of the lymphocytes in peripheral blood, lymph nodes and spleen, and did not stain IgG-bearing lymphocytes. Cell-mediated cytotoxicity and stimulation by PHA and Con A were eliminated by these heteroantisera and C in vitro; survival of skin allografts was prolonged in vivo. T lymphocytes in the rat resembled, by analogy, T lymphocytes in the mouse.

Origin and Development of Rat Thymus-Dependent (T) Lymphocytes

Bone marrow (BM) cells of LBNF1 donor rats, from which detectable thymus-dependent (T) lymphocytes were removed by anti-T lymphocyte antisera and C, were infused into lethally irradiated (IrBM) and into thymectomized lethally irradiated (TxIrBM) BN recipients. The lymphoid tissues of these animals were examined from 6 to 24 days after reconstitution for donor cells (AgB+), donor T cells (AgB+T+), and T cells (host and donor). Donor cells and donor T cells progressively increased in number in all lymphoid tissues of IrBM rats. In TxIrBM rats donor cells increased to a lesser extent and donor T cells decreased 24 days after reconstitution. Spleen and lymph node cells of IrBM and TxIrBM responded little or not at all to PHA and Con A, in vitro. The response was less than expected of the number of T cells present in culture. T lymphocytes can differentiate from bone marrow precursor elements and thymus seems to be a necessary organ for maintenance of T cell levels. The newly differentiated T cells differ from normal T cells in their response to mitogens.

Thymus-dependent lymphocytes in tissue sections of rejecting rat renal allografts

Lewis kidneys were grafted into BN recipients and examined at daily intervals up to 6 days after grafting with immunofluorescent reagents. A horse antiserum specific for T lymphocytes revealed an increasing number of T lymphocytes in the cellular infiltrates of rejecting allografts. These were detectable 1 day after grafting, reached a maximum 3 days later, and were relatively diminished at 6 days. In control isografts and nonimmunological inflammations of kidney, a small number of dispersed T lymphocytes was seen. A rabbit antirat thymocyte antiserum, given to allografted BN rats, prolonged survival of the grafts and decreased the cellular infiltrate and the number of T lymphocytes in the infiltrates. We conclude that in graft rejection there is a flow of T lymphocytes into areas of tissue damage and these T lymphocytes are immunologically reactive to graft antigens.