543 detected by conventional means, whereas clinically well subjects showed no sustained significant increases. However, percentage changes in the level of a compound which enjoys such a large range of normal concentrations must be interpreted with caution. Both percentage changes and absolute values may be required to indicate variations. Our results continue to support the suggestion that variations in the concentration of P.A.G. correlate with the clinical status of patients with malignant disease-particularly breast
cancer-and we feel that the optimism expressed by The Lancee was well-founded. The question of whether the glycoprotein belongs to the loosely defined category of "acute-phase reactants" is a matter of conjecture. Dr Keyser and Dr Ward (Jan. 29, p. 258) believe that it does, but two previous studies3 ,found only a small change, if any, in the level of the oc-globulin after surgery. It would seem that the glycoprotein, although possibly subject to minor variations after trauma, does not belong to that group of proteins which are described as classical acute-phase reactants. However, any small short-term variations in concentration should in no way interfere with the use of this serum protein in monitoring cancer patients over a long period. Department of Biochemistry, University of Strathclyde,
Glasgow G4 0NR Surgical Division, Royal Infirmary, Glasgow Department of Biochemistry, University of Strathclyde
W. H. STIMSON
J. M. ANDERSON D. M.
FARQUHARSON
T AND B LYMPHOCYTES IN BREAST CANCER
SIR,-In a previous report of percentage T and B lymphocyte-counts in breast-cancer patients,’ as determined by E and EAC rosetting techniques, we demonstrated interesting results in relation to clinicopathological tumour stage. These were preliminary findings in a group of patients, most of whom had already received treatment. Subsequently we counted lymphocytes and both absolute and percentage E and EAC rosetting lymphocytes (as recommended by W.H.O./I.A.R.C. workshop2) in 100 breast-cancer patients before treatment. Two groups of controls were used-31 healthy women of similar age range and mean age to the cancer patients and 22 younger patients with benign breast disease. The 100 breastcancer patients were classified, as before, into stages t-tv according to the TNM classification.1 The total lymphocyte-counts were determined by a differential counting of 500 cells in a Romanovsky stained smear( The absolute T and B lymphocyte counts were determined as a product of the total lymphocyte-count and the percentage E and EAC rosetting cells, respectively. Mean values are given in the table and the results of percentage E-rosetting lymphocytecounts for individual patients are shown in the figure. It is interesting to compare the mean percentage counts with those obtained in the previous study. Although similar statistically significant comparisons between groups have been obtained for the percentage E-rosetting cells, the differences between groups have narrowed appreciably. The range of values seen in the groups makes it unlikely that these statistical differences between mean values carry any biological significance, except in stage-iv disease. Mean percentage EAC-rosetting lymphocyte counts were significantly higher in stageand n cancer patients than in controls in this study, which was not observed previously. 4. Lancet, 1975, ii, 1192. 5. Horne, C. H. W., Böhn, H., McLay, A. L. C., Wood, E. H., Thompson, W. D. Behring Inst. Mitt. 1975, 58, 50. 1 Whitehead, R. H., Thatcher, J., Teasdale, C., Roberts, G. P., Hughes, L. E. 2
Lancet, 1976, i, 330. Report of a W.H.O./I.A.R.C.-sponsored workshop m Human B and T cells. ScandJ. Immun. 1974, 3, 521.
Significant differences were observed between the groups in the mean total lymphocyte counts, a finding not noted in an earlier extensive study from our department.3 We can suggest two possible explanations for this discrepancy: the 500-cell differential count used might be more accurate than the routine laboratory 100-cell count used earlier, or the differences could be due merely to chance, since no patient was common to both studies. The differences between groups in absolute E and EAC rosetting lymphocyte-counts (which were also significant) largely reflect the changes seen in the total lymphocyte-counts. However, we feel that these are important differences and are more likely to be biologically relevant to the disease process than the percentage counts. The total lymphocyte-count has been reported to be related to prognosis in cancer patients,4 and one might therefore suspect that counts of one or more lymphocyte subpopulations will also prove to be similarly prognostically related. One particular striking feature, which substantiates the findings of each of our previous studies 13 was the normal values observed in patients with locally advanced disease (stage in) in contrast to the abnormal values found in those patients with other stages of breast cancer. In this group of patients, who have a very poor prognosis (only 30% clinically disease free 2 years after primary treatment), total lymphocyte-counts, 3.
4.
Bolton, P. M., Teasdale, C., Mander, A. M., James, S. L., Davidson, J. M., Whitehead, R. H., Newcombe, R. G., Hughes, L. E. Cancer Immun. Immunother. 1976, 1, 251. Riesco, A. Cancer, 1970, 25, 135. TOTAL LYMPHOCYTE-COUNTS AND T AND B LYMPHOCYTE
PERCENTAGES IN PRE-TREATMENT BREAST-CANCER PATIENTS
Values are given as mean+ 1 S.D., and to nearest whole number. For comparison with female healthy controls *p
cancer-and we feel that the optimism expressed by The Lancee was well-founded. The question of whether the glycoprotein belongs to the loosely defined category of "acute-phase reactants" is a matter of conjecture. Dr Keyser and Dr Ward (Jan. 29, p. 258) believe that it does, but two previous studies3 ,found only a small change, if any, in the level of the oc-globulin after surgery. It would seem that the glycoprotein, although possibly subject to minor variations after trauma, does not belong to that group of proteins which are described as classical acute-phase reactants. However, any small short-term variations in concentration should in no way interfere with the use of this serum protein in monitoring cancer patients over a long period. Department of Biochemistry, University of Strathclyde,
Glasgow G4 0NR Surgical Division, Royal Infirmary, Glasgow Department of Biochemistry, University of Strathclyde
W. H. STIMSON
J. M. ANDERSON D. M.
FARQUHARSON
T AND B LYMPHOCYTES IN BREAST CANCER
SIR,-In a previous report of percentage T and B lymphocyte-counts in breast-cancer patients,’ as determined by E and EAC rosetting techniques, we demonstrated interesting results in relation to clinicopathological tumour stage. These were preliminary findings in a group of patients, most of whom had already received treatment. Subsequently we counted lymphocytes and both absolute and percentage E and EAC rosetting lymphocytes (as recommended by W.H.O./I.A.R.C. workshop2) in 100 breast-cancer patients before treatment. Two groups of controls were used-31 healthy women of similar age range and mean age to the cancer patients and 22 younger patients with benign breast disease. The 100 breastcancer patients were classified, as before, into stages t-tv according to the TNM classification.1 The total lymphocyte-counts were determined by a differential counting of 500 cells in a Romanovsky stained smear( The absolute T and B lymphocyte counts were determined as a product of the total lymphocyte-count and the percentage E and EAC rosetting cells, respectively. Mean values are given in the table and the results of percentage E-rosetting lymphocytecounts for individual patients are shown in the figure. It is interesting to compare the mean percentage counts with those obtained in the previous study. Although similar statistically significant comparisons between groups have been obtained for the percentage E-rosetting cells, the differences between groups have narrowed appreciably. The range of values seen in the groups makes it unlikely that these statistical differences between mean values carry any biological significance, except in stage-iv disease. Mean percentage EAC-rosetting lymphocyte counts were significantly higher in stageand n cancer patients than in controls in this study, which was not observed previously. 4. Lancet, 1975, ii, 1192. 5. Horne, C. H. W., Böhn, H., McLay, A. L. C., Wood, E. H., Thompson, W. D. Behring Inst. Mitt. 1975, 58, 50. 1 Whitehead, R. H., Thatcher, J., Teasdale, C., Roberts, G. P., Hughes, L. E. 2
Lancet, 1976, i, 330. Report of a W.H.O./I.A.R.C.-sponsored workshop m Human B and T cells. ScandJ. Immun. 1974, 3, 521.
Significant differences were observed between the groups in the mean total lymphocyte counts, a finding not noted in an earlier extensive study from our department.3 We can suggest two possible explanations for this discrepancy: the 500-cell differential count used might be more accurate than the routine laboratory 100-cell count used earlier, or the differences could be due merely to chance, since no patient was common to both studies. The differences between groups in absolute E and EAC rosetting lymphocyte-counts (which were also significant) largely reflect the changes seen in the total lymphocyte-counts. However, we feel that these are important differences and are more likely to be biologically relevant to the disease process than the percentage counts. The total lymphocyte-count has been reported to be related to prognosis in cancer patients,4 and one might therefore suspect that counts of one or more lymphocyte subpopulations will also prove to be similarly prognostically related. One particular striking feature, which substantiates the findings of each of our previous studies 13 was the normal values observed in patients with locally advanced disease (stage in) in contrast to the abnormal values found in those patients with other stages of breast cancer. In this group of patients, who have a very poor prognosis (only 30% clinically disease free 2 years after primary treatment), total lymphocyte-counts, 3.
4.
Bolton, P. M., Teasdale, C., Mander, A. M., James, S. L., Davidson, J. M., Whitehead, R. H., Newcombe, R. G., Hughes, L. E. Cancer Immun. Immunother. 1976, 1, 251. Riesco, A. Cancer, 1970, 25, 135. TOTAL LYMPHOCYTE-COUNTS AND T AND B LYMPHOCYTE
PERCENTAGES IN PRE-TREATMENT BREAST-CANCER PATIENTS
Values are given as mean+ 1 S.D., and to nearest whole number. For comparison with female healthy controls *p
