Immunotherapy of ovarian cancer with cell wall skeleton of Mycobacterium bovis Bacillus Calmette-Guérin: effect of lymphadenectomy.
The significance of lymphadenectomy in surgery for various kinds of cancer has been widely debated, particularly in the gynecological field. The cell wall skeleton of Mycobacterium bovis Bacillus Calmette-Guérin (BCG-CWS) has been used as an effective adjuvant for immunotherapy of a variety of cancer patients. Here we tested the immunological importance of lymph nodes in treatment of ovarian cancer patients with BCG-CWS. After surgical removal of tumors, 73 ovarian cancer patients were intracutaneously inoculated with BCG-CWS in the antigen-unloaded state in the upper arm at 4-week intervals at a dosage of 2-200 microg. Significant correlation of lymphadenectomy and reduced survival of patients was observed (stages I, II, III, IV; hazard ratio 2.38, 95% confidence interval 1.02-5.12, Cox regression model). Lymphadenectomy also compromised with induction of interferon-gamma. In view of the importance of the role of lymph nodes in stimulation of Toll-like receptors by BCG-CWS, it is suggested that lymph nodes should be kept as much as possible to preserve the patient's immunity against cancer. Application of these results to surgery for other cancers should be considered.
Hayashi
Akira
A
CI Hayashi Immunotherapy Clinic and Research Institute, Osaka, Japan. ci-hayashi@sutv.zaq.ne.jp
Nishida
Yuichi
Y
Yoshii
Saiji
S
Kim
Seo Young
SY
Uda
Hirotsugu
H
Hamasaki
Toshimitsu
T
D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000368:Aged; D017358:Cell Wall Skeleton / Q000276:immunology*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D007371:Interferon-gamma / Q000096:biosynthesis; D008197:Lymph Node Excision / Q000009:adverse effects*; D008875:Middle Aged; D009163:Mycobacterium bovis / Q000276:immunology; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis
D000276:Adjuvants, Immunologic; D017358:Cell Wall Skeleton; D007371:Interferon-gamma