The systemic effect of cancers on human sera proton NMR relaxation times

In animal models of cancer, an elevation of T1 and T2 in uninvolved tissues and in the blood of tumor bearing animals has been termed "the systemic effect." This study reports T1 values in sera of human patients from Genoa, Italy, with several types of cancer and non-cancerous diseases. T1 values were significantly elevated over normal controls (1628 +/- 113 ms) in colorectal cancers (1725 +/- 149 ms) and stomach cancers (1817 +/- 219 ms). However a systemic effect was not demonstrated in acute myeloid leukemia, chronic lymphatic leukemia, chronic myeloid leukemia, or plasma cell myeloma, or in pancreatic and lung cancers. Noncancerous states of cirrhosis, chronic hepatitis, and monoclonal gammapathies did not show a T1 elevation. In general, T1 values of sera correlated with protein content of the sera; however, a disproportionate contribution of gamma-globulin protein on water proton relaxation times was observed in several cases.

Peanut lectin-binding sites in polyps of the colon and rectum. Adenomas, hyperplastic polyps, and adenomas with in situ carcinoma

Peanut lectin (PNA) has a specificity for the disaccharide beta-D-Gal-(1 leads to 3)-D-GalNac which is the purported antigenic determinant for the T blood group antigen (TAg). This TAg is considered the immediate precursor of the MN blood group substance. In normal colonic epithelium, PNA binds to the supranuclear (stalk) portion of epithelial cells. This corresponds to the detection of beta-DGal-(1 leads to 3)-D-GalNac in nascent oligosaccharide chains in the Golgi cisternae prior to addition of terminal sialic acid. Colonic carcinomas bind PNA in the "region" of the glycocalyx or in the apical portion of the cell, which represents incomplete glycoprotein synthesis. Eighty-two percent of tubular adenomas, 80% of villous adenomas, and 91% of adenomas with in situ cancer expressed PNA in a supranuclear distribution, reminiscent of normal colonic epithelium. This stalk distribution was seen in goblet cells. Twenty-five percent of tubular adenomas, 43% of villous adenomas and 60% of adenomas with in situ cancer (adenoma portion) expressed PNA in an apical cytoplasmic and/or glycocalyx pattern among nonmucinous columnar cells. In 80% of the cases, the in situ cancer itself expressed PNA in an apical cytoplasmic and/or glycocalyx pattern. Fetal and most colon cancer cells fail to produce mucin goblets and make incomplete glycoproteins. The cytologic localization of TAg by PNA corresponds to the cells' ability to produce mucin goblets. Most adenomas consist of goblet cells, localize TAg to the stalk, and probably make complete MN glycoprotein as does normal colonic epithelium. However, in adenomas, nonmucinous columnar cells localize TAg to the apical cytoplasm and/or glycocalyx region and represent incomplete blood group glycoprotein synthesis.

Antibody-dependent cellular cytotoxicity (ADCC) in colorectal carcinoma. II. Blood group association

Colorectal carcinoma patients' sera with ADCC antibody reacting with the HT-29 cell line (blood group A) generally (88%) cross-reacted with another group A cell line (COLO-394) but much less frequently (6-33%), with six tumor cell lines that did not express ABO blood group antigens. The findings suggested the possibility that the ADCC reactivity against the HT-29 cell line particularly by patients of blood group O is generally via "A" or "A-like" antigenicity of the target cells. This was supported by absorption studies that showed that the ADCC reactivity could be removed by blood group A but never by group B erythrocytes. Our results suggest that the prognostically favorable ADCC antibody in colorectal carcinoma patients' sera is of anti-blood group A specificity or cross reactivity.

[Diagnostic value of the assay of beta 2 microglobulin during the monitoring of surgically-treated colorectal cancers. Comparison with carcinoembryonic antigen]

This work presents an evaluation of the diagnostic value of seric beta 2-microglobulin in the follow-up of operated colorectal cancers. Ninety-one patients were operated on with a curative intent between 1976 and 1979. These patients were followed for at least 2 years and divided in 2 groups: a) group NR: 48 patients apparently free of loco-regional recurrence and of distant metastases, b) group R: 43 patients presenting a cancerous relapse. High levels of beta 2-microglobulin were found in 21 patients of group NR (specificity: 56 p. 100) and in 25 patients of group R (sensitivity: 58 p. 100). In the same population, the specificity and the sensitivity of carcinoembryonic antigen (CEA) for the diagnosis of a relapse were 92 p. 100 and 88 p. 100 respectively. No significant statistical correlation was observed between the levels of beta 2-microglobulin and CEA. The sensitivity of the association beta 2-microglobulin + CEA was not superior to the dosage of CEA alone despite its reduced specificity (54 p. 100). These results indicate that the diagnostic value of the dosage of beta 2-microglobulin is inferior to that of CEA and is without interest for the detection of tumoral recurrence in the postoperative follow-up of colorectal cancers.

Acute-phase reactant proteins and carcinoembryonic antigen in cancer of the colon and rectum

One hundred and twenty-eight patients bearing primary malignancies of the large bowel were studied to ascertain the value of acute-phase reactant proteins (serum protein hexose, ceruloplasmin, transferrin, alpha-1-antitrypsin, seromucoid and haptoglobin) either alone or in conjunction with carcinoembryonic antigen to accurately reflect the disease status of patients both before and after resection of their large bowel malignancy. The results indicate that acute-phase reactant proteins have a higher diagnostic rate for the presence of malignancy than does CEA. Estimation of the serum protein hexose alone is of greater diagnostic value than a combination of acute-phase reactant proteins. Furthermore, serum protein hexose and CEA are complementary and when combined will reflect the presence of malignancy in a greater number of patients than either one alone. Following resection of primary large bowel cancer, acute-phase reactant proteins are as accurate as CEA in evaluating the disease-free status of patients and furthermore when combined with CEA increased the predictive value for the detection of patients with recurrent disease.

Peripheral blood lymphocyte levels in large-bowel cancer

The relationship between peripheral blood lymphocyte levels and monitoring and assessment of prognosis of patients with large-bowel cancer has been assessed. There does not appear to be a correlation between the absolute lymphocyte count and the state of disease. Furthermore, the preresection and postresection lymphocyte levels do not accurately predict the likelihood of recurrent cancer subsequently developing, and the serial monitoring of patients with peripheral blood lymphocyte levels adds no important new information to clinical follow-up.

Prognostic factors in advanced colorectal carcinoma. Importance of lactic dehydrogenase level, performance status, and white blood cell count

In 220 patients with advanced colorectal carcinoma, objective tumor response to chemotherapy and survival were related to the following parameters: age, sex, performance status, time interval from diagnosis to metastases, initial site of metastases, and initial white blood cell count, lactic dehydrogenase, alkaline phosphatase, and carcinoembryonic antigen levels. Each variable was first evaluated separately. By conventional statistical methods, none of the variables significantly predicted response, although the following parameters significantly (p less than 0.01) predicted survival: Patients with an initially normal level of lactic dehydrogenase versus those with an abnormal level of lactic dehydrogenase had median survivals of 16 and 7.0 months, respectively; normal versus abnormal carcinoembryonic antigen levels, 23 and 9.2 months, respectively; white blood cell count of less than 10,000 versus greater than 10,000 cells/mm3, 11 and 7.0 months, respectively; performance status of greater than 70 versus less than 60, 11 and 6.6 months, respectively; and lung versus liver metastases, 12 and 8.0 months, respectively. By studying the variables together with multivariate analysis, we found that the most important variables in predicting response were the lactic dehydrogenase level and the white blood cell count. In predicting survival, the most important variables were the lactic dehydrogenase level, performance status, and lung involvement. We recommend that future randomized therapeutic trials for advanced colorectal carcinoma should delineate and perhaps stratify for the lactic dehydrogenase level, performance status, white blood cell count, and/or the presence of lung involvement.

[Case of rectal cancer with high level of serum alpha-fetoprotein]

A 61 year old male with a high serum alpha-fetoprotein level (2750 ng/ml) is reported. He had undergone curative surgery for early gastric cancer in June 1979, and palliative resection of a primary rectal lesion in December 1981. The postoperative alpha-fetoprotein level decreased to 1300 ng/ml but gradually increased despite the intraarterial infusion of 5-FU (9.25g) and Mitomycin-C (30 mg). He died of cachexia in February 1982. Histological examination revealed moderately differentiated adenocarcinoma; alpha-fetoprotein positive substances were found in the cytoplasm of rectal cancer cells by the enzyme labeled antibody method(peroxidase-antiperoxidase immune complex method). This rectal cancer patient had multiple primary cancers and gastric cancer.

[Carcinoembryonic antigen (CEA) in surgically treated cancer of the large intestine]

Preoperative CEA value. Dukes stage and recurrence rate have been evaluated in 112 patients with large bowel cancer. Recurrence rate within 24 months was significantly higher (33% vs. 10%, p = 0.01) for preoperative CEA values of more than 5 ng/ml. In patients with moderately or poorly differentiated adenocarcinoma the recurrence rate was nearly 40% if the preoperative CEA value was elevated. Among 13 CEA-detected early recurrences, 3 (23%) have been cured by resection.

[Glucagon-producing carcinoid of the rectum--report of a case]

A 22-year-old male who had been receiving insulin therapy to treat uncontrollable hyperglycemia, was diagnosed to have a carcinoid in the lower rectum. The excised tumor was 1.5 cm in diameter, and showed a yellowish-white cut surface. It did not invade into the proper muscle. Numerous glucagon immunoreactive cells were found. The tumor cells contained many rounded neurosecretory granules. After tumor excision, the patient's hyperglycemia did not return in the absence of insulin administration. We suggest that the tumor may have secreted glucagon which may have acted as an antagonist against insulin in the circulation.

Decreased blood histamine levels in patients with solid malignant tumours

In a one-year follow-up study, 444 blood histamine determinations were performed in 163 patients with solid malignant tumours. Compared with normal subjects, blood histamine levels were significantly lower in patients with unresected primary tumours (30.7 +/- 19.9 ng ml-1), metastases (34.1 +/- 17.1 ng ml-1), or both (24.5 +/- 12.8 ng ml-1). By contrast, after successful tumour resection, histamine blood levels were nearly normal (52.1 +/- 18.4 ng ml-1, versus 59.6 +/- 22.6 in control patients). Stability of the histamine blood levels was associated with stability of the disease. A progressive decrease in histamine blood levels preceded clinical relapse or detection of metastasis. In patients with consecutive histamine blood levels which were less than 15 ng ml-1, survival did not exceed 2 months. In patients with gastrointestinal tumours, blood histamine levels provided information additional to that derived from serum CEA determination. In patients with non-gastrointestinal tumours, the blood histamine level may be of more value than CEA as a marker of disease progression.

Clinical pharmacological studies of concurrent infusion of 5-fluorouracil and thymidine in treatment of colorectal carcinomas

The effects of thymidine (dThd) coadministration on the pharmacokinetics and metabolism of 5-fluorouracil (FUra) were investigated in 29 colorectal cancer patients. Five patients received 5-day i.v. infusion of FUra at 15 mg/kg/day and 24 patients received infusion of FUra (7.5 mg/kg/day, 5 days) and dThd (216 mg/kg/day, 6 days) preceded by a bolus dose of dThd (405 mg/kg). Plasma and urine concentrations of FUra, 5-fluorodeoxyuridine (FdUrd), thymine, and dThd were quantitated by a high-pressure liquid chromatographic assay. Concurrent dThd administration reduced the plasma clearance of FUra at steady state from 389.1 +/- 153.5 (S.D.) to 56.0 +/- 36.4 liters/kg/day. The mean steady-state plasma concentration of FUra in patients receiving FUra alone was 0.38 microM and was significantly lower than the 1.30 microM in patients receiving FUra-dThd. Plasma concentrations of FUra were linearly dependent on those of thymine. Furthermore, the metabolic and renal clearances of FUra decreased inversely with thymine concentrations indicating that the elimination of FUra was reduced by thymine. In contrast to the absence of FdUrd as a circulating metabolite in patients treated with FUra alone, microM concentrations of FdUrd were detected in plasma of most of the patients treated with FUra-dThd. This together with the linear correlation of FdUrd and dThd concentrations indicates that the interconversion of FUra to FdUrd was enhanced by dThd. The incidence of dose-limiting leukopenia in the FUra-dThd combination therapy was 40%. There is an inverse correlation between the plasma clearance of FUra at steady state and hematological toxicity. The plasma clearance of FUra in the toxic population was 32.0 +/- 16.8 liters/kg/day and was significantly lower than the clearance of 72.0 +/- 37.3 liters/kg/day in the nontoxic population (p less than 0.001). The corresponding critical toxic steady-state FUra plasma concentration was 1.5 microM. The biochemical effects of dThd on the incorporation of FUra and FdUrd into RNA and into acid-soluble 5-fluorodeoxyuridine monophosphate (FdUMP) in human colon tumor cells were studied in vitro. At 100 microM, dThd increased the incorporation of FUra into RNA up to 4-fold but diminished the acid-soluble FdUMP pool. Similarly, the incorporation of FdUrd into acid-soluble FdUMP was inhibited by dThd. The response rate of colorectal carcinoma to FUra was not improved by coadministration of dThd; only one of the 11 patients who had no prior FUra therapy achieved partial remission. The lack of clinical response in these patients may be partly due to the inhibition of anabolism of FUra and FdUrd to FdUMP by dThd.

Increased incorporation of an infused labelled amino acid into plasma proteins as a means of assessing the severity of injury or activity of disease in surgical patients

Following injury there is increased synthesis of several plasma proteins. During a constant rate infusion of 1-(1-14C) leucine some of the labeled amino acid became incorporated into plasma proteins, the amount being readily determined after precipitation with perchloric acid. This value was correlated with the clinical state of the patient to see if an index of severity of injury could be derived. Before operation 6.7 +/- 0.5% (mean +/- SD, n = 16) of the infused labeled amino acid was incorporated in asymptomatic patients, irrespective of their dietary intakes, while in the presence of symptomatology this value rose, correlating with tumor staging in patients with colorectal neoplasia (r = 0.988, p = 0.001). It returned to normal following tumor resection, but was elevated in the presence of recurrence or residual disease. After operation it also rose, being maximal in the early postoperative period and following the more major surgical procedures, the increase correlating with the change in cortisol level in patients following cholecystectomy (r = 0.84, p less than 0.01; n = 8). The pattern of distribution of the label among the plasma proteins did not change with increased incorporation. The increase in incorporation of 1-(1-14C) leucine into plasma proteins would appear to offer a good index for severity of injury of activity of a disease state.

Clinical significance of carcinoembryonic antigen (CEA) in patients with adenocarcinoma in colon and rectum

Determination of carcinoembryonic antigen (CEA) in serum has been performed in 253 patients with proved adenocarcinoma in the colon and rectum. Preoperative CEA was normal in 58.3% of the patients. A correlation between CEA level and Dukes' grading was found. There was, however, no statistically significant difference in recurrence rate between patients with normal and patients with elevated pre-operative CEA. Transient CEA elevation was seen in the follow-up period after curative resection in 21.8%. 75% of the patients with recurrence had abnormal CEA, and CEA elevation was the first sign of recurrence in 59.1%. The majority of these patients, however, had advanced disease not available for surgical treatment. In cases with local resectable tumour CEA often was normal. Only a few patients had advantage of CEA determination for diagnosis of recurrence and its routine use is therefore questioned.

Predictive value of plasma CEA levels: preoperative prognosis and postoperative monitoring of patients with colorectal carcinoma

Plasma CEA levels were determined in 280 patients with histologically proven colorectal carcinoma: in 180 once or twice preoperatively and repeatedly postoperatively, and in 100 postoperatively only. Preoperative levels correlated directly with surgical-pathologic state and inversely with the time of recurrence; i.e., groups of patients with more advanced stage showed higher proportion of elevated CEA levels, and patients with higher levels had recurrences earlier. Levels above 20 ng/ml were strongly suggestive of liver metastases or disseminated disease. Postoperative plasma CEA levels displayed three patterns of variation. 1) Levels fluctuating within normal range, below 3.2 ng/ml, strongly evidenced that surgery was effective, and 2) those fluctuating below 7.5 ng/ml indicated usually nonmalignant concomitant disease; in either group no more than 10 per cent of the patients had recurrences. 3) Levels rising persistently from a postoperative nadir indicated recurrence or, when the rise was dramatic, liver metastases or disseminated cancer in at least 97 per cent of the patients.

Value of plasma alpha-1-acid glycoprotein assay in the detection of human colorectal cancer: comparison with carcinoembryonic antigen

Plasma specimens assessed by caracinoembryonic antigen (CEA) in the clinical laboratory for the detection of colorectal cancer were simultaneously assayed in our laboratory for alpha-1-acid glycoprotein (alpha 1AG), by means of a solid-phase enzyme-linked immunosorbent assay we developed. In 28 patients with colorectal cancer of Dukes A, B, and C classes, elevated levels of alpha 1AG were seen in 12 and of CEA in 8. In 44 patients with distant metastasis (Dukes D lesions), elevated plasma levels of alpha 1AG were seen in 29 and of CEA in 34. No statistical differences in the detection rate were found among these markers in these 2 groups of patients. In 33 cases of non-neoplastic disease involving the large bowel, elevated plasma levels of alpha 1AG were seen in 6, and elevated CEA levels were seen in 7. There was no statistical difference of false positive rates among ;these two markers. Elevated plasma levels of either CEA or alpha 1AG were found in 57 cases of colorectal cancer. This preliminary study suggests that the sensitivity of the plasma alpha 1AG assay is similar to that of the CEA assay in the detection of colorectal cancer. The combination of these two assays increases the detection rate of colorectal cancer significantly.

Prognostic value of preoperative serum CEA level compared to clinical staging. I. Colorectal carcinoma

In a clinical investigation of observed postoperative survival, 563 patients have been registered for primary surgical treatment of colorectal cancer since 1974. The potential prognostic factors examined within the first days of hospitalization for primary resection included age of the patients, operability, location of the tumour, tumour extension and the preoperative serum CEA level. Statistical treatment of the data revealed that each of the clinical parameters except tumour location covers ranges associated with highly significant differences in survival of the patients. The preoperative serum CEA level gave prognostic information in addition to operability or tumour extension. The prognostic significance of the preoperative CEA level was still evident when selected subgroups of patients with distinct resectability and tumour extension were examined. The results indicate that the preoperative serum CEA level is an independent prognostic parameter.

Significance of pregnancy-associated alpha 2-glycoprotein (alpha 2-PAG) in patients with breast, gastric and colorectal cancer

Pregnancy-associated alpha 2-glycoprotein (alpha 2-PAG) levels were measured in human sera by a modification of Laurell's electroimmunoassay using rabbit anti-alpha 2-PAG serum. Sera were obtained from healthy controls (32 males and 46 females), patients with benign breast diseases (55 cases), and patients with breast (82 cases), gastric (89 cases), or colorectal (22 cases) cancers. In healthy controls, the mean alpha 2-PAG value for females was higher than that for males (p less than 0.05), so alpha 2-PAG values for males and females were considered separately in this study. Serum alpha 2-PAG levels in patients with benign breast tumors were almost the same as those of controls. In patients with primary breast and gastric cancer, alpha 2-PAG levels were higher than those of controls (p less than 0.005) and tended to increase with progress of the disease. Raised alpha 2-PAG levels decreased in these patients after curative surgery. These results show that serum alpha 2-PAG is useful as a marker in both the initial diagnosis and follow-up of breast and gastric cancer. The reliability of alpha 2-PAG as a tumor-associated marker was reinforced by comparison of the positive rates of the three parameters alpha 2-PAG, carcinoembryonic antigen (CEA), and immunosuppressive acidic protein (IAP) in patients with breast and gastric cancer.

Peculiarities of hyperlipidaemia in tumour patients

The study group included 684 cases: 258 patients with breast carcinoma, 113 males with lung cancer, 42 patients with rectal tumours, 42 patients with stomach tumours, 59 patients with fibroadenomatosis, and 170 healthy subjects of varying age (male and female). A relatively high blood triglyceride level was found in patients with breast, lung, rectal (females), and stomach (female) tumours. The blood concentration of high-density lipoprotein-cholesterol in patients with breast, lung, and stomach (female) tumours was relatively low. The elimination of tumour (breast carcinoma) did not lead to significant changes in lipid metabolism. There was no correlation between degree of lipidaemia and stage of tumour progression except in the cases of rectal cancer. Preliminary results are presented on the tentative classification of hyperlipoproteinaemia in tumour patients, using the lipid concentration threshold values advocated by Carlson et al. (1977); an increased frequency of Type IV hyperlipoproteinaemia proved to be the most characteristic feature of tumour patients. The results are discussed in terms of the concept of the importance of lipid metabolic disturbances, primarily those due to ageing, in the genesis of the syndrome of "cancerophilia" (predisposition to cancer).