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ORIGINAL ARTICLE
Year : 2018  |  Volume : 14  |  Issue : 4  |  Page : 785-788

Lack of association between the distribution of ABO blood groups and nasopharyngeal carcinoma in a population of Southern China


1 The Maternal and Child Health Hospital of Huadu District, Guangzhou 510800, P.R. China
2 The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, P.R. China
3 Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China

Date of Web Publication27-Jun-2018

Correspondence Address:
Hao Chen
Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong
China
Songguo Peng
Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrt.JCRT_567_17

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 > Abstract 


Objectives: Nasopharyngeal carcinoma (NPC) is endemic in Southern China and Southeast Asia. The ABO blood group antigens are chemical constituents on the surface of red blood cells and various epithelial cells. Several studies have described the association of ABO blood types with multiple types of human cancer. In this study, we aimed to investigate the relationship between the incidence of NPC and ABO blood groups.
Materials and Methods: We retrospectively analyzed the files of 1136 pathologically confirmed patients with NPC and 1024 cancer-free healthy controls, including the information of serologically determined blood group. The distribution of blood groups between patients with NPC and the control group was determined. The Chi-square test was applied to assess the distribution of age, gender, smoking, family history, and ABO blood groups between the NPC and the controls. Pearson's correlation was performed to evaluate the correlation between ABO blood groups and clinical stages.
Results: There was no significant difference in age, smoking, family history, and ABO blood group between patients with NPC and the control group (P > 0.05). ABO blood groups were also not associated with NPC stages (P = 0.506). However, the proportion of males with NPC was higher than that of control group (P < 0.01).
Conclusion: The blood group types were not associated with increased risk of NPC and NPC stages in a population of Southern China.

Keywords: ABO blood groups, molecular epidemiology, nasopharyngeal carcinoma


How to cite this article:
Lin K, Qiu F, Chen S, He X, Peng S, Chen H. Lack of association between the distribution of ABO blood groups and nasopharyngeal carcinoma in a population of Southern China. J Can Res Ther 2018;14:785-8

How to cite this URL:
Lin K, Qiu F, Chen S, He X, Peng S, Chen H. Lack of association between the distribution of ABO blood groups and nasopharyngeal carcinoma in a population of Southern China. J Can Res Ther [serial online] 2018 [cited 2019 Nov 20];14:785-8. Available from: http://www.cancerjournal.net/text.asp?2018/14/4/785/235089

Keng Lin and Feng Qiu contributed equally to this work.





 > Introduction Top


Nasopharyngeal carcinoma (NPC) is a nonlymphomatous, squamous cell carcinoma that arises from the lateral epithelial lining of the nasopharynx.[1] In 1921, Regaud and Schmincke initially described NPC as a distinct entity.[2] NPC has been a highly prevalent cancer in China, particularly in Southern China.[3] It is identified to be constantly associated with the Epstein–Barr virus (EBV), which was characterized by noticeable geographic variation in incidence. Besides, smoking,[4] lifestyle,[5] and family history of cancer [6] also significantly contributed to the development of this disease. Therefore, host genetic susceptibility, ethnicity, and environmental factors are all recognized to be significant risk factors in the pathogenesis of NPC, contributing to the variation in individual susceptibility to cancer.

The antigens of the ABO blood group system have been principally the first human genetic markers discovered in 1900.[7] The association between the ABO blood groups and benign or malignant diseases has been recognized for a long time.[8] In early 1953, a study for the first time reported a significant association between blood group A and an increased risk of gastric cancer, while blood group O was less frequent in patients with gastric cancer as compared to the normal healthy population in England. Moreover,[9] the risk of developing pancreatic cancer was increased with the non-O blood type, while the highest risk was reported among individuals with blood group B.[10] However, the relationship between the ABO blood groups and NPC remained controversial, as some studies have reported no association between the ABO blood groups and NPC.[11] Nevertheless, there were also studies indicated that the ABO blood group was associated with increased susceptibility to NPC. Blood group A increased the risk, whereas blood group O exhibited a protective effect.[12] Moreover, whether the results will exhibit variations among the population from different regions was still unknown. Thus, the present study is aimed to investigate the association between the distribution of ABO blood groups and the risk of NPC in endemic area of China.


 > Materials and Methods Top


This retrospective observational study analyzed the records of 1136 patients with pathologically confirmed NPC, including the information of serologically determined blood groups at the Sun Yat-Sen University Cancer Centre between January and December 2013. Patients were classified according to blood groups (A, B, AB, and O). The distribution of blood groups among the NPC patients was compared with that of among outpatients, who were randomly selected from a pool of normal healthy individuals from the Guangdong General Hospital. The study was approved by the Ethics Committee of Sun Yat-Sen University Cancer Center and Guangdong General Hospital. Informed consent was observed from all NPC patients and healthy control before their inclusion in the study. Qualitative variables were expressed as the percent and the correlation between categorical variables was determined with the Chi-square test. Data analysis was performed with SPSS 19.0 software (IBM, Chicago, IL, USA). A P< 0.05 was considered statistically significant.


 > Results Top


Demographic characteristics of patients

A total of 1136 cases of NPC and 1024 cancer-free controls were included in this study. Demographic characteristics (age, gender, smoking, and family history of cancer) among NPC patients and controls were summarized [Table 1]. Of the NPC patients, 1092 (96.1%) were <65 years old; 309 (27.2%) were females and 827 (72.8%) were males; 352 (31.0%) were smokers and 784 (69.0%) were nonsmokers; majority of the patients (77.9%) had no family history of cancer and 22.1% of the patients had positive family history. There was no statistically significant difference in age, smoking, and family history of cancer between the cases and controls. However, statistically significant difference was observed in gender of the controls, including 522 (51.0%) female and 502 (49.2%) male cases. The proportion of male in NPC group was higher than that of in control group.
Table 1: Characteristics of nasopharyngeal carcinoma patients and cancer-free controls

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Comparison of distribution of ABO blood groups between nasopharyngeal carcinoma and control groups

The percentages of NPC patients with A, B, AB, and O blood groups were 25.09%, 27.99%, 5.37%, and 41.55%, respectively, whereas were 26.37%, 27.05%, 5.66%, and 40.92% in the control group. The comparison of the distribution of ABO blood groups between NPC and control group was provided [Table 2]. There was no significant difference in the distribution of ABO blood groups between the two groups (P = 0.884).
Table 2: Comparison of ABO blood groups between Nasopharyngeal carcinoma and control groups

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Comparison of the distribution of ABO blood groups between different stages

The comparison of the distribution of ABO blood groups between different tumor stages was presented [Table 3]. There was no significant difference in the distribution of ABO blood groups between different tumor stages (P = 0.506). The percentages of A, B, AB, and O blood groups in patients with Stage I was 12.50%, 18.75%, 0%, and 68.75%, respectively. The percentages of A, B, AB, and O blood groups in patients with Stage II were 29.13%, 26.77%, 3.94%, and 40.16%, respectively. The percentages of A, B, AB, and O blood groups in patients with Stage III were 23.91%, 27.78%, 6.06%, and 42.25%, whereas the percentages in patients with Stage IV were 26.07%, 29.07%, 5.01%, and 39.85%, respectively. The percentage of blood type O group was found to be higher in patients with different stages, and the type AB was least recorded. However, no significant difference was observed in the distribution of ABO blood groups between different stages (P = 0.506).
Table 3: Comparison of the distribution of ABO blood groups between different stages

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Comparison of the constitution of ABO blood groups between genders and ABO blood group in nasopharyngeal carcinoma patients and controls

The constitution of ABO blood groups between genders and ABO blood groups was further compared. [Table 4] shows a significant difference between genders and constitution of ABO blood groups, except for type AB (P = 0.246). The proportion of males was significantly higher than that of females in NPC group. The percentages of A, B, AB, and O blood groups in male patients were 70.18%, 76.42%, 68.85%, and 72.46%, respectively, whereas the percentages in control were 45.19%, 45.85%, 58.62%, and 52.27%. The percentages of A, B, AB, and O blood groups in female patients were 29.82%, 23.58%, 31.15%, and 27.54%, respectively, while the percentages in control were 54.81%, 54.15%, 41.38%, and 47.73%, respectively. The proportion of males in NPC was significantly higher than that of in the control group.
Table 4: Comparison of the constitution of ABO blood groups between patients and controls in gender

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 > Discussion Top


Over the past five decades, many studies have investigated the association between ABO blood group types and cancer,[13],[14] which found its clinical relevance and showed disease prevention value. ABO antigens are expressed on the surface of many cells other than erythrocytes, including normal epithelial and endothelial cells. The variations of ABO blood antigens on the cell surface can lead to varied interactions between cells or cells and extracellular matrix. These changes have suggested to be critical for tumor development.[15] Many previous studies have reported the association of ABO blood group and increased susceptibility to multiple malignancies, including gastric and pancreatic cancers. Wang et al.[16] reported the association between the ABO blood group and the risk of gastric cancer in China. They reported that gastric cancer risk in the blood group A was significantly higher than that of non-A groups, of which individuals with blood type O consistently exhibited reduced gastric cancer risk. Furthermore, Li et al.[17] retrospectively reviewed the association between ABO blood group and various cancers, including lung cancer, esophageal cancer, gastric cancer, colon cancer, and rectal cancers in Western China population. An increased risk of 24.5% was observed in gastric cancer cases with blood type A as compared to those with blood type O; however, no association was detected in other cancers. Wolpin et al.[18] have examined the relationship between blood groups and the risk of pancreatic cancer in two prospective cohort studies. They found that the risk of developing pancreatic cancer was significantly differed among blood group types. Those with blood group A, AB, or B were more likely to develop pancreatic cancer compared to group O, and the highest risk was associated with blood group B. For other cancers, no association was detected. Moreover, Oguz et al.[19] investigated the relationship between lung cancer histological subtypes and ABO-Rh blood groups. However, there was no significant difference in the distribution of ABO blood groups and Rh factor between patients with lung cancer of either type and the control group (P = 0.073). No significant correlation was reported between blood group antigen in patients with gastrointestinal stromal tumor and normal population.[20]

Previous studies on the association between ABO blood groups and NPC have been rare with conflicting findings. Seow et al. reported the earliest data on relationship between NPC and ABO blood groups,[11] which demonstrated no association between ABO blood group and NPC. However, Turkoz et al.[12] indicated that the ABO blood group was significantly related to NPC susceptibility. Blood type A group was related to increased risk in the Turkish population, whereas blood type O showed a protective effect. In 2013, Sheng et al.[21] analyzed the association between ABO blood type and NPC risk in 1538 patients and 1260 cancer-free controls in a population of Southeast China. The result indicated that blood type A or AB was significantly associated with an increased risk of NPC. However, the mechanism of the association between ABO blood group and NPC was unclear. There were reports indicated that ABO antigens might mediate Helicobacter pylori infection,[22] so they hypothesized that ABO status might interact with EBV, thereby influencing NPC. Our findings were consistent with previous studies on NPC;[11],[20] however, the results were contrary to the study from Turkoz. Thus, for the area-specific population and the different outcomes in ABO blood groups, the follow-up multicenter research and mechanisms would be needed in detail. Furthermore, Bei et al. conducted genome-wide association study to identify genetic susceptibility loci for NPC, which has not revealed the association of ABO with cancer risk.[23] The significant risk factors for NPC included genetic factors, viral infection, and environmental exposures. Notably, the genetic alterations and EBV infection were critical in the early development of this cancer.[24] However, there was still no conclusive evidence on the association between ABO blood groups and NPC. Moreover, NPC exhibited remarkable geographic variations worldwide, the highest incidence rate of NPC was reported in the Guangdong Province and Hong Kong of Southern China.[25] Moreover, the incidence of each subtype of NPC was different. The reasons could explain these different results. Therefore, the relationship between ABO blood groups and NPC remained controversial, and high-power genomic sequencing approaches would be needed for providing more solid evidence.

There were several limitations of this study. First, this study was based on prospective studies; there was a strong selection bias due to retrospective data collection. Second, the EBV infection was observed to be closely associated with NPC [26] because the determination of EBV-DNA was not common in the pool of cancer-free institutions; therefore, the interaction between ABO blood antigens and EBV infection has not been analyzed. In the future, more attention should be paid to the immunological evidence of past or present EBV infection. Third, this investigation was based on a single-center study; thus, large-scale, multicenter studies are required to validate our results.

Taken together, we found no significant relationship between the ABO blood groups and NPC stages, ABO blood groups, and the incidence of NPC in the high incidence region of Southern China. Nevertheless, we found that there were significant differences between the constitution of ABO blood groups in genders between NPC and the controls. The incidence in males was higher than that of in females in ABO blood group because of smoking, an important factor in tumor development. In our cases, the proportion of smoking in males with NPC was markedly higher than that of in females with NPC (data not presented).


 > Conclusion Top


The blood group types were not associated with increased risk of NPC and NPC stages in a population of Southern China.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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