Retrospective analytical study of association between ABO blood group and malignancy.
The findings of Arid et al  in 1953 regarding association between carcinoma of stomach and B blood group and then again in 1954  regarding association between peptic ulcer and O blood group opened a new approach to find association of blood group with other commonly occurring diseases. The ABH histo-blood group antigens are a set of polymorphic and inherited glycoconjugate structures that are expressed on the cell surfaces of human erythrocytes.  The presence and lack of blood antigens in some blood groups induce blood membrane changes morphologically and functionally. The structure dependent functions of blood types can link the blood groups to health and diseases.  It is now well established that the blood group exhibits some relation with some diseases like nasopharyngeal carcinoma,  duodenal ulcer,  epitaxis,  anaemia  and even cardiovascular diseases like coronary artery diseases and cardiac ischaemia. [9,10]
In the same way, blood type antigen system maybe apparently involved in the pathophysiology of wide range of human malignancy by interaction between glycan structures on red blood cell surface and different agents. Therefore, the present study aims to find out to examine the association between ABO blood group and different forms of malignancy, so that a preventive measure can be applied to the risk blood group population.
MATERIALS AND METHODS
Selection of Subjects
This descriptive comparative study was conducted in Surgical Unit II at ESIC Medical College, Joka, Diamond Harbour Road, Kolkata--700104, between August 2015 to November 2016. This is the short study based on our observation with all malignant patients reported and hospitalised in our unit during the specified period are considered as study group, whereas the subjects for control group are selected from the non-malignant patients reported to our unit on the basis of simple random sampling as this sampling satisfies all the statistical analytic methods.
A total of 60 patients were included in the descriptive comparative study of which (30) patients were diagnosed with malignancy labelled as study group and (30) patients were with benign disease without any malignancy labelled as control group. The study group was considered from the malignant patients reported to the said surgical unit II at ESIC Medical College, Joka, as the number of such patients reported to this unit were low during the period of study. The sample size in study group is concomitantly low and the sample size in control group was kept accordingly same as that of study group. The study was approved by the institutional ethical committee and has no conflict of interest.
Determination of Blood Group
With all aseptic precaution, the whole blood of suspected anaemic patients was collected in fasting condition by venepuncture using disposable syringes. The ABO blood group and Rh factor of both the groups were determined using the tile or slide testing method  with the help of antisera-A, antisera-B and antisera-D and finally the frequency of occurrence of ABO and Rh blood group among diabetic and nondiabetic population was assessed.
The frequency distribution of ABO blood group and Rh factor was expressed as percentage of each blood group and to establish the relationship between the blood group and malignancy. The frequency distribution (observed frequency) of blood group among the entire malignant population, i.e. study group (N=30) was compared with that of general non-malignant population, i.e. control group (N=30) and also with the reference frequency distribution of blood group among the general population by Chi-square test  and a P value of 0.05 was considered significant for all the statistical test conducted.
Out of the total 60 patients (30) were diagnosed with malignant conditions of different type. It is found that the prevalence of B blood group is highest followed by O, Group A and then Group AB in non-malignant population (Table 1). Statistical analysis by Chi-square test reflects that there is no significant difference between the observed frequency distribution and reference frequency distribution  in West Bengal Zone. The Table 1 also shows that both the ABO blood group distribution and Rh distribution among the study group and control group is also insignificant (P<0.05). The apparent association between A blood group (33.33% in malignant population against 16.67% in non-malignant population) and O blood group (10% in malignant population against 33% in non-malignant population) in control and expected (study) value is also not significant by Fisher's test (two-tailed test) using GraphPad software.  The sex wise frequency distribution of both ABO group and Rh factors in study group also not significantly differs from control value or reference value as shown in Table No. 2.
The expression of blood group antigen alters during the process of cell differentiation and malignancy. Lack of A and B antigens resulted in promotion of cell motility, proliferation, invasion and metastatic tumour formation. [14,15] Cancer is abnormal proliferation of different kinds of cells in the body and is categorised into three groups--carcinomas, sarcomas and leukaemia or lymphomas based on the primary types of cells where cancer cells originate. The most prevalent form of human cancer is carcinomas that are the malignancy of the epithelial cells.  Most of the epithelial and endothelial cells can express ABO blood antigens, which are normally present on the red blood cells.  ABO blood group antigens are carbohydrate structures relating to the cell surface glycolipids and glycoproteins, which are responsible for tumour development and progression. The expressions of blood group antigens are different in human normal tissue and carcinomas, while the type of differentiation of the epithelium determines ABO antigens, which are decreased in carcinoma as in oral carcinoma. Possible mechanism by which blood antigens relate to cancers includes hypermethylation of ABO gene promoter. [18,19]
Loss of Heterozygosity (LOH) at ABO locus and chromosome 9q43  variant ABO alleles SNP (i.e. SNP correlated with TNF) [21-23] and presence of H blood group antigens on CD44 adhesion molecule.  It was proved that ABO gene variability can effect glycosyltransferase expression and activity and result in cancer development. These mechanisms decrease the activity of glycosyltransferase and increase tumour progression, metastasis and migration. But, in the present study, no such role of ABO antigens or Rh antigens were found in the occurrence of malignancy. This study thus collaborates the fact that not always the blood group antigens has role in occurrence of some diseases, which is in accordance with the findings of some other researchers. [25,26] However, for definite conclusion, multifaceted and multicentered retrospective study with large sample size is desirable.
The blood group is a genetic factor that has recognised association with multiple cancers. But, in this present study, no such correlation was found in between ABO blood group and malignancy. Though in this study, blood group (B) was found to be maximum amongst the study population in malignant cases followed by the group (A), (AB) and (O), but it is insignificant in terms of frequency distribution of ABO blood group among non-malignant population. Chi-square test also failed to suggest any significant difference in between control and study group maybe because of very small sample size under each blood group. Hence, a multifaceted retrospective study with large sample size and multicentered study is desirable to come to an authentic conclusion.
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Siladri Sengupta (1), Subhadip Sarkar (2), Adnan Rehan Khan (3)
(1) Associate Professor, Department of Surgery, ES1-PG1MSR, ES1C Medical College, Joka.
(2) Assistant Professor, Department of Surgery, ESI-PGIMSR, ESIC Medical College, Joka.
(3) Junior Resident, Department of Surgery, ES1-PG1MSR, ES1C Medical College, Joka.
Financial or Other, Competing Interest: None.
Submission 26-01 -2017, Peer Review 28-06-2017, Acceptance 05-07-2017, Published 10-07-2017.
Dr. Siladri Sengupta,
Flat-13CI, Bay Tower, Hiland Park, 1925 Chak Garia, P. O. Chak Garia, Kolkata-700094, West Bengal.
Table 1. Blood Group Distribution between Study Group and Controls Blood Observed Frequency Observed Frequency Group Distribution of Study Distribution of Control Group, i.e. Malignant Group, i.e. Non- Group (N=30) Malignant Group (N=30) A 10 (33.33%) 5 (16.67%) B 13 (43.33%) 12 (40%) AB 4 (4%) 3 (3%) O 3 (10%) 10 (33%) Rh+ 29 (96.66%) 28 (93.33%) Rh- 1 (3.44%) 2 (6.67%) Blood Frequency Distribution of Group Reference Population A 22% B 38% AB 8% O 32% Rh+ 96% Rh- 6% Table 2. Sex Wise Distribution of Blood Group in Study Group and Control Group Blood Absolute Values in Study Group Group (Frequency Female (20) Distribution in % Age) Male (N=10) A 3 (10) 7 (23.33) B 4 (13.33) 9 (30) AB 1 (3.33) 3 (10) O 2 (6.67) 1 (3.33) Rh+ 10 (100) 19 (95) Rh- 0 (0) 1 (5) Blood Absolute Values in Group Control Group (Frequency Female (N=13) Distribution in % Age) Male (N=17) A 4 (13.33) 1 (3.33) B 6 (20) 6 (20) AB 1 (3.33) 2 (6.67) O 6 (20) 4 (13.33) Rh+ 16 (94.11) 12 (92.30) Rh- 1 (5.89) 1 (7.70)
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|Title Annotation:||Original Research Article|
|Author:||Sengupta, Siladri; Sarkar, Subhadip; Khan, Adnan Rehan|
|Publication:||Journal of Evolution of Medical and Dental Sciences|
|Date:||Jul 10, 2017|
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