Characteristics of local and system immunity, and features of cancer stem cells in patients with different stage, dynamics and prognosis of colorectal carcinoma

Clinical prognosis in malignant tumors` is among the most challenging problems of contemporary medicine. It is thought to depend on both biologic properties of tumor cells and patients` immune status. The features of tumor cells and immune reactions are closely interrelated and mutually conditioned. Therefore, possible application of their characteristics as prognostic markers is of great fundamental and clinical importance. The aim of our study is to find out the most significant immune factors for prognosis of colorectal cancer (CRC) based on estimation of local and system immune factors, and some characteristics of tumor cells in the patients at various stages of the disease and different clinical course. Cellular factors of immunity and cytokines were studied in blood and tumor tissue of 299 patients with colorectal cancer (stages I-IV). Malignant cells expressing stem cell markers CSC), MHC and PDL-1 molecules were also counted in the tumor tissue. Blood samples were drawn prior to operation, and tissue samples were taken during surgery being the 1st line of treatment. Flow cytometry techniques (FCM), immunohistochemistry (IHC), and ELISA approach were employed. We have compared data on the patients at different CRC stages (with or without local and distant metastases), as well as cases with different course of the disease (evolving distant metastases and fatal outcome during period of observation). Our results demonstrated increased amounts of NK-cells and IL-6 concentration, along with decreased percentage of blood CD4+ cells in the patients with local metastases, as well as higher CSC numbers in malignant tissue. The initially generalized CRC cases with distant metastases were characterized by high levels of blood IL-6, monocytes and granulocytes responding to fMLF, while in tumor tissue elevated amounts of NKT, CSC and decreased expression of MHC and PDL-1 were observed on tumor cells, like as lower PD-1/ PDL-1 expression on tumor-infiltrating lymhocytes. Unfavorable CRC dynamics, i.e., metastasizing during the observation period was preceded by increased levels of IL-10 in blood, NK cells with poor cytotoxicity, monocytes and granulocytes responding to fMLF. In tumor tissue, overexpression of CSC markers and hypo-expression of MHC on tumor cells were noted. Fatal outcome was preceded by elevation of blood IL-6levels, tissue levels of NKТ and CSC percentages, along with decreased NK cells subset (CD16dimCD56bright) in blood, and decline of MHC-expressing cells in the tumor. Thus, high blood levels of IL-6 and IL-10, fMLF-responding monocytes and granulocytes, as well as elevated amounts of NKT and CSC, hypo-expression of MHC in tumor tissue could be considered prognostic markers of unfavorable course in CRC patients. Decrease of PD-1/PDL-1 expression on tumor cells and lymphocytes from its microenvironment in advanced CRC is of special attention, because checkpoint inhibitors are prescribed in such cases

Expression level of androgen receptors in tumor tissue and its prognostic significance in primary operable luminal breast cancer without overexpression of Her2/neu in postmenopausal women

Aim. To evaluate the expression level and prognostic significance of androgen in primary operable luminal breast cancer without overexpression of Her2/neu in postmenopausal women. Methods. We analyzed treatment outcomes of 60 cases of primary operable (T1-2N0M0) luminal breast cancer without overexpression of Her2/neu in postmenopausal women. The follow-up period was 5 years. All cases were divided by immunohistochemical method into luminal A (20 females) and luminal B (40 patients) subtypes. Along with the standard panel of immunohistochemical markers, expression of nuclear androgen receptors was measured in tumor tissues of all patients. Depending on the expression levels, patients with luminal A and B subtypes were divided into three groups: (1) with high, (2) moderate and (3) low or negative expression. Results. Mean levels of androgen receptor expression in the nuclei of tumor cells in patients with luminal A subtype (57.3±5.9%) were higher than those of luminal B subtype (21.4±4.04%) by 62.7% (Mann-Whitney test, р=0.0026). In patients with luminal A subtype, the maximal accumulation of androgen receptors in the nuclei of tumor cells was 2.7 times higher (р=0.0023) than in patients with luminal B subtype. All cases diagnosed with the disease progression were characterized by low or negative level of nuclear androgen receptor expression. Conclusion. Negative and low levels of androgen receptor expression in tumor tissues of postmenopausal patients with luminal primary operable breast cancer without overexpression of Her2/neu might be an independent factor associated with poor prognosis

Expression of some molecular and biological markers in esophageal tumors of various stages and grades

Objectives: immunohistochemical study of the expression of molecular and biological markers (p53, bcl-2 and ki-67) in esophageal tumors of various stages and grades, and evaluation of the markers in the disease prognosis. Material and methods: the study included 30 patients of a retrospective group with stage II-III squamous cell carcinoma of the esophagus. Immunohistochemical study of paraffi n sections was performed using primary mouse monoclonal antibodies against p53, bcl-2 and ki67, and Reveal Polyvalent HRP-DAB Detection System. Results: diff erences in the rates and expression of molecular and biological markers (p53, bcl-2 and ki-67), controlling apoptosis and proliferation, depended on the tumor stage and grade. Conclusions: fdvanced cancer of the esophagus demonstrated an increase in rates and expression of p53+ and ki-67, as well as in the proliferative activity of tumor cells. Bcl-2 expression was more frequent and intensive in stage II tumors, compared to stage III. Esophageal tumors of higher grades were characterized with higher rates and expression of p53 and ki-67, and conversely for the bcl-2 expression. Th e revealed diff erences can be used in the disease prognosis

Метаболизм триптофана при различном эффекте иммунотерапии немелкоклеточного рака легкого ингибиторами PD-1 / PD-L1

Introduction. In the structure of cancer incidence, lung cancer ranks first among men. In order to study the molecular mechanisms of the initiation and progression of lung cancer, it is necessary to study not only the tumor cells themselves, but also the features of the systemic tryptophan metabolism. Tryptophan catabolites, being to a large extent product of the metabolic activity of the intestinal microbiota, can affect the effectiveness of immunotherapy with checkpoint inhibitors. The kynurenine pathway of tryptophan metabolism is intensified in the body of cancer patients; its products have a pro-oncogenic and immunosuppressive effect, which may hinder the effectiveness of immunotherapy.Objective – to study the dynamics of changes in various metabolites of tryptophan metabolism in the blood serum and feces of patients with non-small cell lung cancer with various effects of immunotherapy with inhibitors of PD-1 (programmed cell death receptor 1) / PD-L1 (programmed cell death receptor 1 ligand).Materials and methods. The study included blood serum and stool samples obtained from 20 patients with non-small cell lung cancer treated with PD-1 / PD-L1 inhibitors. Using high-performance liquid chromatography with mass spectrometric analysis, the levels of 13 tryptophan metabolites were assessed in patients with various effects of immunotherapy. The significance of differences between the samples was assessed using a nonparametric method according to the Mann – Whitney test. They were considered statistically significant at p <0.05.Results. In fecal analyzes of patients in whom a positive effect of immunotherapy was observed, baseline levels of 5-hydroxyindole acetate and quinolinic acid were lower than in patients with tumor progression. Positive clinical dynamics was accompanied by a decrease in the content of indole-3-lactate, kynurenine and indole-3-carboxaldehyde in the feces of patients. In the serum of patients with a positive response, the initial content of 5-hydroxyindole acetate, indole-3-acetate, indole-3-butyrate and quinoline acid was lower than in patients with progression of non-small cell lung cancer. A positive response to immunotherapy was characterized by an increase in the levels of indole-3-butyrate and indole-3-propionate, and a negative response was not accompanied by statistically significant changes in the studied tryptophan metabolites.Conclusion. Profiling tryptophan metabolites in feces and serum of patients with non-small cell lung cancer can be used to predict the effectiveness of immunotherapy with PD-1 / PD-L1 inhibitors.Введение. В структуре онкологической заболеваемости рак легкого занимает 1-е место среди мужчин. С целью изучения молекулярных механизмов инициации и прогрессирования рака легких необходимо исследовать не только сами опухолевые клетки, но и особенности системного метаболизма триптофана. Катаболиты триптофана, будучи в большой степени продуктами метаболической активности микробиоты кишечника, могут влиять на эффективность проведения иммунотерапии ингибиторами контрольных точек. Кинурениновый путь метаболизма триптофана интенсифицируется в организме онкологических пациентов, его продукты имеют проонкогенное и иммуносупрессивное действие, что может препятствовать эффективности иммунотерапии.Цель исследования – изучение динамики изменений различных метаболитов триптофанового обмена в сыворотке крови и кале больных немелкоклеточным раком легкого при различных эффектах иммунотерапии ингибиторами PD-1 (рецептора программируемой клеточной гибели 1) / PD-L1 (лиганда рецептора программируемой клеточной гибели 1).Материалы и методы. В исследование были включены образцы сыворотки крови и кала, полученные от 20 больных немелкоклеточным раком легкого, получавших ингибиторы PD-1 / PD-L1. С помощью высокоэффективной жидкостной хроматографии с масс-спектрометрическим анализом проведена оценка уровней 13 метаболитов триптофана у больных с различными эффектами иммунотерапии. Достоверность различий между выборками оценивали с помощью непараметрического метода по критерию Манна–Уитни. Они считались статистически значимыми при р <0,05.Результаты. В анализах кала пациентов, у которых наблюдали положительный эффект от иммунотерапии, исходные уровни 5-гидроксииндолацетата и хинолиновой кислоты были ниже, чем у больных с прогрессированием опухоли. Положительная клиническая динамика сопровождалась снижением содержания индол-3-лактата, кинуренина и индол-3-карбоксальдегида в анализах кала больных. В сыворотке пациентов с положительным ответом исходное содержание 5-гидроксииндолацетата, индол-3-ацетата, индол-3-бутирата и хинолиновой кислоты оказалось ниже, чем у пациентов с прогрессированием немелкоклеточного рака легкого. Положительный ответ на иммунотерапию характеризовался повышением уровней индол-3-бутирата и индол-3-пропионата, а отрицательный – не сопровождался статистически значимыми изменениями исследованных триптофановых метаболитов.Заключение. Профилирование метаболитов триптофана в кале и сыворотке больных немелкоклеточным раком легкого может быть использовано для прогнозирования эффективности иммунотерапии ингибиторами PD-1 / PD-L1

Общая выживаемость больных раком ободочной кишки с различным уровнем циркулирующих опухолевых клеток и возможности повышения его прогностической значимости

Development of personalized approaches to diagnosis, treatment and prognosis of colon cancer (CC) still remains challenging. Levels of circulating tumor (CTC) and cancer stem cells (CSC) are promising non-invasive prognostic factors. Our aim was to assess the overall survival (OS) of patients with stage II–IV CC with different levels of CTCs as well as to enhance their prognostic value by additionally determining the level of CD44+ CSCs. Material and methods. The study included 299 patients with stage II–IV CC. All patients underwent surgery followed by adjuvant chemotherapy (FOLFOX). patients with stage IV CC with resectable liver metastases underwent simultaneous resection of the primary tumor and liver metastases, followed by FOLFOX chemotherapy. the proportion of CTCs was evaluated before surgery using Veridex CellSearch™, and the level of CD44+ CSCs was determined in the tissue of the removed tumor by the IHC method. OS was studied in patients with different CTC levels, cumulative OS was calculated by Kaplan–Meier`s method. prognostic algorithm was designed by logistic regression analysis and cox proportional hazards model. Results. OS was found to be lower in patients with higher CTC levels divided into ranges: 0, 1–3, 4–9, ≥10 (χ2=11.59, p=0.009); thus enabling us to use it for prognosis. its prognostic value is enhanced by estimation of CD44+ CSC in tumor. Statistically significant conjugation between CTC and CD44+ ranges was found. an increase in CTC level by 1 range resulted in the increase in the risk of fatal outcome by 1.58 times (р=0.002); the additive increase in CD44+ expression ≥10 % resulted in the increase in the risk of fatal outcome by 7.2 times (p<0.001). For individual risk assessment, a model for calculating the prognostic coefficient K with high diagnostic sensitivity and specificity was developed, and its mathematical expression was proposed. the value of K≥0.411 indicates a high risk of adverse outcome. Conclusion. The prognostic algorithm for the risk of unfavorable outcome of patients with CC, based on the assessment of CTC and CD44+ CSC levels, was developed.Разработка персонализированных подходов к диагностике, лечению и прогнозированию рака ободочной кишки является актуальной проблемой современной онкологии. Уровни циркулирующих опухолевых клеток (ЦОК) и опухолевых стволовых клеток (ОСК) рассматриваются как многообещающие неинвазивные прогностические факторы. Цель исследования – оценка общей выживаемости (ОВ) больных раком ободочной кишки II–IV стадий с различным уровнем ЦОК и изучение возможности повышения его прогностической значимости путем дополнительного определения уровня ОСК CD44+ в опухоли. Материал и методы. В исследование включено 299 больных раком ободочной кишки II–IV стадий. Выполнялось хирургическое лечение, после чего больные II–III стадий получали адъювантную химиотерапию (FOLFOX). Больным IV стадии с резектабельными метастазами в печень одновременно с удалением первичной опухоли выполнялась операция на печени, затем – химиотерапия (FOLFOX). До операции у больных определяли ЦОК методом Veridex CellSearch™, в удаленной опухоли – экспрессию маркера ОСК CD44+ иммуногистохимическим методом. Изучали ОВ больных с различным уровнем ЦОК, кумулятивную ОВ определяли методом Каплана–Мейера. Для построения прогностической модели использовали метод логистического регрессионного анализа, для оценки влияния изучаемых параметров на ОВ больных – регрессионный анализ Кокса. Результаты. Наблюдается более низкая ОВ при более высоких уровнях ЦОК, разделенных на ранги: 0, 1–3, 4–9, ≥10; (χ2=11,59, p=0,009), что позволяет использовать данный тест как фактор прогноза. Его прогностическую значимость можно повысить при определении в ткани опухоли процента cd44+ опухолевых клеток. Выявлено статистически значимое сопряжение рангов ЦОК и CD44+ с ОВ больных. Повышение концентрации ЦОК в крови на один ранг сопровождалось повышением риска развития летального исхода в 1,58 раза (р=0,002); при дополнительном увеличении экспрессии cd44+ ≥10 % – в 7,2 раза (p<0,001). Для индивидуальной оценки риска разработана модель расчета прогностического коэффициента К с высокой диагностической чувствительностью и специфичностью, предложено ее математическое выражение. Значение K≥0,411 говорит о высоком риске неблагоприятного исхода. Заключение. Разработан прогностический алгоритм для оценки риска неблагоприятного исхода рака ободочной кишки по уровню ЦОК в крови и CD44+ ОСК в ткани опухоли

ОСОБЕННОСТИ ЭКСПРЕССИИ CD133 И CD44 МАРКЕРОВ ОПУХОЛЕВЫХ СТВОЛОВЫХ КЛЕТОК ПРИ МЕТАСТАТИЧЕСКОМ И НЕМЕТАСТАТИЧЕСКОМ РАКЕ ЖЕЛУДКА

Background. Gastric cancer is the second leading cause of cancer-related death due to advanced disease. A special role in the pathogenesis and metastasis of the tumor is assigned to tumor stem cells (TSC ),  responsible for resistance to chemotherapy and radiotherapy and causing tumor progression.Objective: to determine the CD 44 and CD 133 markers of TSC in tumor tissues of non-metastatic and metastatic gastric cancer using the immunohistochemical method.Material and Methods. A prospective study of tumors in patients with gastric cancer was conducted: Group 1 – 20 people with T3–4aN0–3M0G2 tumor, average age 58.9 ± 9.7; Group 2 – 20 people with T3–4aN0–3M1G2 tumor, with metastases in the peritoneum, average age 53.4 ± 11.9. The expression of CD 44 and CD 133 in the tumor tissue was determined by immunohistochemistry.Results. Differences were found in the number of tumor cells expressing the CD 44 marker in the presence and absence of metastases in patients with gastric cancer – their number was 10.0 ± 3.08 and 6.0 ± 2.3, respectively. The CD 133 molecule was detected in 100 % of cases having metastases, while in cases having no metastases, the marker was detected only in 80 % of cases. The average percentage of CD 133 + cells was 21.3 ± 11.6 % in patients with metastatic gastric cancer and 10.0 ± 2.4 % in patients having no metastases.Conclusion. The degree of expression of the CD 44 and CD 133 markers had characteristic differences in patients with gastric cancer, which can be used further to explain the results of the treatment and the prognosis of the disease.Введение. В структуре смертности рак желудка (РЖ) занимает второе место, что обусловлено поздней диагностикой в сочетании с агрессивным течением заболевания. Особую роль в патогенезе и метастазировании опухоли отводят опухолевым стволовым клеткам, ответственным за устойчивость к химио- и радиотерапии и обусловливающим прогрессию опухоли. Цель исследования – определение cd44 и cd133 маркеров опухолевых стволовых клеток в ткани опухоли при неметастатическом и метастатическом раке желудка с  использованием иммуногистохимического метода. Материал и методы. Проведено проспективное исследование опухолевой ткани у больных раком желудка: 1-я группа – 20 больных РЖ t3–4аN0–3m0, степень дифференцировки опухоли – g2, средний возраст – 58,9 ± 9,7 года; 2-я группа – 20 больных РЖ t3–4аN0–3m1 с метастатическим поражением брюшины, степень  дифференцировки опухоли – g2, средний возраст – 53,4 ± 11,9 года. Экспрессию cd44 и cd133 в ткани опухолей осуществляли иммуногистохимическим методом. Результаты. Выявлены отличия в количестве опухолевых клеток, экспрессирующих cd44 маркер при наличии и отсутствии метастазов у больных раком желудка – их количество составило 10,0 ± 3,08 % и 6,0 ± 2,3 % соответственно. При этом cd133 молекула при наличии метастазов выявлялась в 95 %, при их отсутствии – в 80 % случаев. Средний уровень cd133+-клеток при метастатическом раке желудка составил 21,3 ± 11,6 %, при локализованном – 10,0 ± 2,4 %. Заключение. Степень экспрессии выбранных молекул имела характерные отличия у больных различными формами рака желудка, что может быть использовано в дальнейшем для понимания результатов лечения и прогноза течения заболевания

Preterm birth and small for gestational age in relation to alcohol consumption during pregnancy: stronger associations among vulnerable women? Results from two large Western-European studies

Pfinder M, Kunst AE, Feldmann R, van Eijsden M, Vrijkotte TGM. Preterm birth and small for gestational age in relation to alcohol consumption during pregnancy: stronger associations among vulnerable women? Results from two large Western-European studies. BMC Pregnancy and Childbirth. 2013;13(1): 49.BACKGROUND: Inconsistent data on the association between prenatal alcohol exposure and a range of pregnancy outcomes, such as preterm birth (PTB) and small for gestational age (SGA) raise new questions. This study aimed to assess whether the association between low-moderate prenatal alcohol exposure and PTB and SGA differs according to maternal education, maternal mental distress or maternal smoking. METHODS: The Amsterdam Born Children and their Development (ABCD) Study (N=5,238) and the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) (N=16,301) are both large studies. Women provide information on alcohol intake in early pregnancy, 3 months postpartum and up to 17 years retrospectively. Multivariate logistic regression analyses and stratified regression analyses were performed to examine the association between prenatal alcohol exposure and PTB and SGA, respectively. RESULTS: No association was found between any level of prenatal alcohol exposure (non-daily, daily, non-abstaining) and SGA. The offspring of daily drinkers and non-abstainers had a lower risk of PTB [ABCD: odds ratio (OR) 0.31, 95% confidence interval (CI) 0.13, 0.77; KiGGS: OR 0.75, 95% CI 0.57, 0.99]. Interactions with maternal education, maternal distress or maternal smoking were not significant. CONCLUSIONS: Although these results should be interpreted with caution, both studies showed no adverse effects of low-moderate prenatal alcohol exposure on PTB and SGA, not even in the offspring of women who were disadvantaged in terms of low education, high levels of distress, or smoking during pregnancy

THE POSSIBILITY OF USING TUMOR NECROSIS FACTOR-THYMOSIN-α1 IN NEOADJUVANT CHEMOTHERAPY OF BREAST CANCER

The article covers the results of clinical application of a domestic drug based on recombinant tumor necrosis factor-alphathymosin-alpha1 (TNF-T) combined with chemotherapy FAC and РА during neoadjuvant treatment of patients with breast cancer IIB-IIIB stage. In contrast to the standard subcutaneous application method, the authors proposed peritumoral administration of TNF-T to maximize the drug’s action directly on the tumor, peritumoral tissue. TNF-T 200000 IU peritumorally on days 1–5 of each treatment course during chemotherapy showed significant increase in objective effect rate, including increase in frequency of complete regressions, and decrease in frequency and intensity of chemotherapy complications. Morphological examination revealed an increase rate of medical pathomorphosis grade III-IV, decreased number of microvessels in tumor in comparison with primary tumors. Study of immune status of patients in dynamics shows that the proposed method of peritumoral application of recombinant hybrid protein of tumor necrosis factor-alpha- thymosin-alpha1 has an immunocorrective effect because of its effect on T- and B-cell component of the immune system

EXPERIENCE WITH INTRAOPERATIVE CHEMOIMMUNOTHERAPY AFTER RADICAL OPERATIONS IN PATIENTS WITH NON-SMALL CELL LUNG CANCER

The purpose of this study  was to evaluate the  tolerability  and effects on the  immune status of  patients with  radically resection of  non-small cell lung  cancer  new  method of intraoperative chemoimmunotherapy. Pilot results  treatment of  twenty patients indicate a satisfactory tolerability  and  positive impact  on the  immune  status. Further  study  of the effectiveness of this method as a component of the complex treatment of early-stage nonsmall cell lung cancer seems  to be promising

FEATURES OF LOCAL IMMUNITY IN PATIENTS WITH OROPHARYNGEAL CANCER

Background. Oropharyngeal cancer is the second most frequent cancer among patients with head and neck tumors in the Russian Federation. Patients usually seek medical assistance in the late stages of the disease (stages III–IV). The mortality rate in such patients during the first year after treatment varies from 30 % to 40 %. This makes it necessary to improve the methods of its diagnosis and treatment. Modern laboratory techniques allow predicting patient’s condition before and during the course of treatment; they were implemented into clinical practice for successful treatment correction. An important role is given to assessing the practical experience of related medical institutions.Objective: to develop an algorithm for the diagnosis and treatment of patients with oropharyngeal cancer using the experience of medical institutions dealing with these patients. We explored the experience of the Rostov Research Institute of Oncology and the Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology of the Ministry of Health of the Republic of Uzbekistan.Materials and methods. The study included 40 patients with oropharyngeal cancer who received treatment in the departments of head and neck tumors of the Rostov and Uzbek Oncology Institutes between 2007 and 2014. Twenty-five patients had stage III (T1–3N0–1) oropharyngeal cancer, seven patients were diagnosed with stage IV (T4N0–1) cancer, and eight patients had a widespread relapse. Before admission to the hospital for surgery, all patients received neoadjuvant radiation therapy (40 Gy). The surgeries included radical removal of the primary tumor; patients with cervical metastases underwent simultaneous cervical lymph node dissection (levels IB, IIA–B, III, and VA). Samples of tumor tissues and pertumoral tissues were collected during the surgery. They were homogenized and used for the assessment of the levels of pro- and antiinflammatory cytokines: interleukins (IL) 1β, 6, 8, 10; IL-1 receptor antagonist; interferons (IF) α, and γ; tumor necrosis factor (TNF) α, and secretory immunoglobulin А. Results. Among newly diagnosed patients without regional metastases, the level of proinflammatory cytokines was significantly higher in the tumor tissue compared the peritumoral tissue. Patients with regional metastases had similar differences. In patients with relapses, such difference was observed only for interleukin-6. It should be mentioned that patients with relapses (unlike the participants from the two remaining groups) usually have no difference in the levels of IL-1β, IL-6, and IL-8 between tumor and peritumoral tissues. This may indicate the transformation of visually non-malignant tissue into the malignant one in terms of its immunological characteristics, which is likely to reflect the loss of ability to limit the proliferative potential. In the peritumoral tissue, the levels of tumor necrosis factor α and interleukin 1β were higher in patients with relapses than in newly diagnosed patients without regional metastases. No difference in the level of secretory immoglobulin A between the tumor and peritumoral tissue was observed among patients with or without metastases, whereas patients with relapses were found to have higher levels of secretory immoglobulin A in the tumor tissue compared to the peritumoral tissue. In these patients, the level of secretory immoglobulin A in the tumor tissue was significantly higher than that in patients with metastases who demonstrated its minimal concentrations, which probably indicates the inhibition of its local synthesis. In the peritumoral tissue, this parameter did not vary across the groups. Conclusions. 1. Both clinical data and immunological parameters should be evaluated to supplement the objective assessment of the status of patients with oropharyngeal cancer. 2. The increasing level of pro-inflammatory cytokines in the tumor tissue promotes its progression and dissemination, which may be caused either by their production by tumor cells or by the local inflammatory process; the levels of cytokines in the tumor tissue exceed their levels in the peritumoral tissue. 3. The level of secretory immoglobulin A is minimal in the tissue of the metastatic tumor and maximal in the tissue of the recurrent tumor. However, the differences failed to reach statistical significance