DELAYED-HYPERSENSITIVITY REACTIONS IN PATIENTS WITH CARCINOMA OF COLON AND RECTUM

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 increasing stage of the disease. Seventy-six percent of patients with Dukes'' A cancer were 2,4-dinitrochlorobenzene positive compared with 56% of those with Dukes'' B cancer and 61% of those with Dukes'' C lesions. Of the patients with advanced primary operable cancer, those with metastases beyond the intestine and its mesentery, only 46% were 2,4-dinitrochlorobenzene positive. Only 42% of the patients with inoperable advanced or recurrent disease reacted to 2,4-dinitrochlorobenzene. Neither age nor sex with 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 mo., 6 of 11 in the 2,4-dinitrochlorobenzene negative group had a recurrence or died of disease compared with only 4 of 17 in the 2,4-dinitrochlorobenzene positive group, P < 0.10. In 38 patients with advanced primary operable cancer who were observed for 9 mo., 40% of the 2,4-dinitrochlorobenzene negative group were dead of disease, compared with 28% 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 9 mo., in which 58% of the patients in the 2,4-dinitrochlorobenzene negative group were dead of disease compared with 40% 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 clinico-pathologic stage of the disease in carcinoma of the colon and rectum. Patients with reactive skin tests had more favorable recurrence and survival rates with each stage of the disease.