Application of the mixed cell agglutination test for cell surface antigens to renal cell carcinoma

The mixed cell agglutination test is used to demonstrate the presence or absence of the A, B and H(O) blood group antigens on the surface of superficial bladder tumors. Absence of these antigens has been shown to correlate well with invasive disease. Therefore, the test has an important prognostic value in bladder cancer. To determine its clinical value in patients with renal cell carcinoma the mixed cell agglutination test was done on unstained sections of tumor from 42 patients for whom followup was available. Red cell adherence was determined independently by each of us and without knowledge of the clinical status of the patients. Only 3 tumors were graded negative, while 14 were each 2 and 3 plus, and 11 were 4 plus. Tumor stage and patient blood type did not correlate with the degree of agglutination. Over-all survival did correlate significantly with 4 plus agglutination (p less than 0.041) as did 1 and 5-year survival (p less than 0.049 and 0.046, respectively). All 11 patients whose tumors had 4 plus reactions are alive, with a median followup of 5.0 years. Currently, there is little to offer the patient who has metastatic disease or is at high risk for its development after nephrectomy. Our preliminary report suggests some degree of accuracy in predicting the latter group by excluding those at low risk. Further studies would seem warranted so that the mixed cell agglutination test might be applied when better adjuvant therapy is discovered.