STUDY ON TRANSCATHETER EMBOLIZATION FOR RENAL CARCINOMA

2nd Report—Host Immune Response After Transcatheter Embolization

Abstract

Host immune response after transcatheter embolization and subsequent nephrectomy for renal carcinoma was examined from laboratory findings such as albumin. to globulin ratio (A/G ratio), α₂-globulin, γ-globulin, WBC, neutrophils and lymphocytes in the peripheral blood and in vitro lymphocyte response to phytohemagglutinin mitogen (PHA) and poke weed mitogen (PWM). The following results were obtained.
1) Patients with renal carcinoma had A/G ratio: 1.10±0.28, (mean±standard deviation) globulin: 12.8±2.6%, γ-globulin: 20.0±6.1% and lymphocytes: 2, 128±705/mm³. Their A/G ratio was lower and α₂ globulin was higher than those in healthy volunteers. A/G ratio of patients with distant metastasis was 0.97±0.24, while the value of those without distant metastasis was 1.28±0.24. The former value was significantly lower than the latter.
After embolization, A-G ratio decreased, α₂-globulin and γ-globulin increased and lymphocytes decreased. These were significant changes compared with the values before embolization. These values tended to return gradually to the pre-embolization levels.
In patients nephrectomized within a few weeks after embolization, A/G ratio, α₂-globulin and γ-globulin returned to normal within 3months after operation, with a significant improvement rate.
2) In patients with renal carcinoma, lymphocyte response to PHA and PWM was 17, 790±7, 221 and 14, 972±11, 923cpm respectively. These values were lower than those in healthy volunteers. There were few differences in values between patients with and without distant metastasis of carcinoma.
After embolization, lymphocyte response to both PHA and PWM decreased slightly for a short period but not significantly as compared with the values before embolization. There were no significant differences even after long-term observation.
In patients nephrectomized within a few weeks after embolization, the values rose or tended to rise significantly from 2months after operation as compared with the values before embolization.
3) The inhibitory percent of lymphocyte response to PHA in patients with renal carcinoma was calculated from the difference between the response values at the time of addition of autologous plasma and pooled homologous plasma against host lymphocytes. The value thus obtained was 20.6±19.8%. There was a significant difference in inhibitory rate between patients with distant metastasis (30.1±19.6%) and those without distant metastasis (8.4±13.0%).
After embolization in patients both with and without distant metastasis, the inhibitory percent of lymphocyte response to PHA rose to 43.4±27.4% on the 2nd week and thereafter returned to the preembolization levels. The changes were not significant, as compared with the values before embolization.
In patients nephrectomized after embolization, the inhibitory percent of lymphocyte response to PHA decreased significantly from 2months after operation as compared with the levels before embolization.
4) One patient who underwent embolization was given an immuno-potentiator both locally and systemically and a favourable clinical course was obtained. It was observed that there was a correlation between changes of clinical course and immunological parameters.