Elsevier

Surgery

Volume 141, Issue 2, February 2007, Pages 212-221
Surgery

Original communication
Activation of human peritoneal immune cells in early stages of gastric and colon cancer

https://doi.org/10.1016/j.surg.2006.06.031Get rights and content

Background

The immune reaction of the peritoneum to growing gastrointestinal neoplasms remains unclear. We investigated mobilization of immune cells in peritoneal fluid of gastric and colon cancer, phenotypes and level of activation of recruited cells, and concentration of cellular and peritoneal fluid cytokines.

Methods

Peritoneal cells (PCs) were obtained intraoperatively by peritoneal lavage from 18 patients with adenocarcinoma of the stomach and 32 patients with adenocarcinoma of the colon (all were stage T2N0M0) and 52 patients who underwent elective cholecystectomy as control subjects.

Results

The number of PCs harvested from cancer patients was 25 times greater than from control patients (P < .001). In the patients with colon cancer, the percentage of CD68+ macrophages was 1.2 times, of CD14+ monocytes was 2.3 times, and of CD15+ granulocytes was 3 times greater than in control patients (all P < .05). The percentage of HLA DR+ cells exceeded the control values by a factor of 2; and within this population, the percentage of CD3+ HLA DR+ cells exceeded control patients by a factor of 3 (P < .05). The percentage of cytokine-producing cells was greater than in control patients, with values 2 times higher for interleukin (IL)-1, 2.5-times for IL-6, and 6-times for IL-8 (P < .05). The concentration of IL-1 in peritoneal fluid exceeded control values by a factor of 2.2, of IL-6 by a factor of 5.0, of IL-8 by a factor of 3, and of monocyte chemotactic protein–1 by a factor of 2.0 (P < .05). In the patients with gastric cancer, the values for mobilized PC granulocytes were 1.5 times greater than in control patients (P < .05). The frequency rate of cytokine-producing cells remained close to control values. The concentration of peritoneal cytokines did not exceed normal values for IL-1 but was 4 times higher for IL-6 and 2 times higher for IL-8 and monocyte chemotactic protein–1 (all P < .05). When the cancer groups were compared, there was evidently more activated myeloid- and cytokine-producing PC in the patients with colon cancer than in patients with gastric cancer. There was no correlation between the blood and PC phenotype frequency.

Conclusion

Patients with T2N0M0 colon cancer and to lesser extent gastric cancer evoke a slight but measurable mobilization and activation of PCs.

Section snippets

Patients

Fifty patients of both sexes with gastric and colon cancer stage T2N0M0 were included in the study. Group I was comprised of 18 patients aged 37 to 76 years (median, 64 years) with adenocarcinoma of the stomach, and group II was comprised of 32 patients aged 47 to 78 years (median, 63 years) with adenocarcinoma of the colon. Staging was based on the preoperative search for metastases and intraoperative evaluation of tumor size and regional lymph nodes. There were no lymph node or peritoneal

PC yield and viability

The retrieved peritoneal lavage fluid volume, which was similar in all groups, ranged from 100 to 540 mL (mean, 320 mL). The differences in retrieval were purely technical and depended on the difficulties that were caused by large intestinal and mesenterial fat volume. Peritoneal fluid contained in the control group ranged from 0.10 to 9.88 × 106 (mean, 1.00 × 106), in the colon cancer group (group I) from 0.45 to 138 × 107 cells (mean, 2.74 × 107) and in the gastric cancer group (group II)

Discussion

We demonstrated that neoplastic growth in the stomach and colon, but not visually penetrating serose membrane, evoked evident changes in the cellular composition of PCs when compared with patients with chronic cholecystitis who underwent elective cholecystectomy. These changes included a 25-times higher number of PCs in cancer patients than in control patients and significant differences in cell subpopulations among the studied colon and gastric cancer groups. The most pronounced changes were

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    Supported by Komitet Badan Naukowych (Committee of Scientific Research) grant no. 4S402 128 07.

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