Local chemotherapeutic effects in bladder cancer demonstrated by selective sampling and flow cytometry.

A method is described by which the effect of intravesical chemotherapy can be monitored. Cytological samples obtained selectively during treatment were used for morphological and flow cytometric studies, and isoantigen (A, B and H) assessment in 2 patients with urothelial cancer. With flow cytometry even small aneuploid populations in the urothelium could be identified. From the histograms the urothelium was seen to contain 2 different cell populations: 1) diploid and 2) aneuploid. The ratio between aneuploid and diploid cells decreased significantly during treatment. Treatment was continued until no evidence of aneuploid cells could be identified in the histograms. Thus, it is demonstrated that intravesical chemotherapy for certain types of bladder cancer can eradicate the aneuploid cell population. A good correlation was found between cytological studies and flow cytometric measurements. Isoantigen assessment was done in the cell suspension used for morphological and flow cytometric studies. Isoantigen assessment also showed loss of antigens after completion of treatment, indicating that the diploid population was not normal biologically. Thus, 3 parameters can be correlated and related also to topography.

A, B and O(H) isoantigens in tumor of the urinary bladder. Preliminary results, relating the specific red cell adherence test to pathological grade and stage.

In a prospective study we have included the specific red cell adherence (SRCA) test for the identification of blood group isoantigens in the investigation of patients with bladder tumor. The preliminary results, relating the SRCA test to grade and stage in 50 patients are presented. None of the SRCA-positive tumors were of high-grade malignancy (WHO III), and only SRCA-negative tumors had invasive properties at the time of investigation. 8 of 9 patients with carcinoma in situ were SRCA-negative.

Response of T lymphocytes to phytohaemagglutinin (PHA) and to cancer-tissue-associated antigens, measured by the intracellular fluorescence polarization technique (SCM test).

Human peripheral-blood mononuclear cells, separated by Isopaque-Ficoll flotation and E-rosette formation, were tested by the fluorescein fluorescence polarization method of Cercek & Cercek (the SCM test). The response to stimulation with PHA or cancer tissue leads to a decreased polarization value TP). The responding cells were present in the T-cell fraction (E-rosette-forming cells), which contained less than 10% macrophages and less than 1% cells with surface-bound Ig. Control experiments with the non-T-cell fraction gave different response patterns. The response of T cells from apparently healthy donors and patients with and without cancer were compared. All of the group of 16 healthy persons had a polarization value (P) which decreased (mean +/- s.e. = 23% +/- 2) after PHA stimulation, compared with no or little decrease after stimulation with cancer tissue, giving cancer indices (P cancer/PPHA) of 1.15--1.56. In 13 patients with carcinoma of the colon, stimulation with PHA produced little decrease of polarization, while stimulation with colonic cancer tissue decreased the polarization in all cases (mean +/- s.e. = 25% +/- 2). The corresponding cancer indices were 0.61--0.86. Seven of 10 colonic-cancer patients tested against ovarian cancer tissue did not respond, whilst 3 patients in this group responded and had a cancer index less than 1.0. Three patients with non-malignant diseases had response patterns similar to those of healthy persons, except for the lack of PHA response in the patient with ulcerative colitis. This method seems to open up new possibilities for evaluation of cancer patients, although further studies including many more patients are needed before any conclusion can be drawn as to the validity of the test.