Oਉਇਉਁ Aਔਉਃਅ Glioblastoma and ABO blood groups: further evidence of an association between the distribution of blood group antigens and brain tumours Mohammed Z. Allouh1, Mohammed M. Al Barbarawi2, Mohammad Y. Hiasat2, Mohammed A. Al-Qaralleh1, Emad I. Ababneh1 Department of Anatomy, 2Division of Neurosurgery, Department of Neuroscience, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan 1
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Background. Glioblastoma is a highly malignant brain tumour that usually leads to death. Several studies have reported a link between the distribution of ABO blood group antigens and a risk of developing specific types of cancer, although no consensus has been reached. This study aims to investigate the relationship between the distribution of ABO blood group antigens and the incidence of glioblastoma. Materials and methods. The study cohort consisted of 115 glioblastoma patients who were diagnosed at King Abdullah University Hospital, Jordan, between 2004 and 2015. Three different patient populations made up three control groups and these were selected from among patients at the same institution between 2014 and 2015 as follows: 3,847 healthy blood donors, 654 accidental trauma patients admitted to the Departments of Neurosurgery and Orthopaedics, and 230 age- and sexmatched control subjects recruited blindly from the Departments of Paediatrics and Internal Medicine. Results. There was a significant association between the distribution of ABO blood group antigens and the incidence of glioblastoma. Post hoc residual analysis revealed that individuals with group A had a higher than expected chance of developing glioblastoma, while individuals with group O had a lower than expected chance. Furthermore, individuals with group A were found to be at a 1.62- to 2.28-fold increased risk of developing glioblastoma compared to individuals with group O. Discussion. In the present study, we demonstrate that, in Jordan, individuals with group A have an increased risk of developing glioblastoma, while individuals with group O have a reduced risk. These findings suggest that the distribution of ABO blood group antigens is associated with a risk of brain tumours and may play an important role in their development. However, further clinical and experimental investigations are required to confirm this association. Keywords: ABO blood group system, brain tumours, cancer, glioblastoma.
Introduction
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Cancer represents one of the principal causes of death worldwide and disease management is a major cause for concern1. For decades, much research has been focused on determining risk factors that contribute to cancer aetiopathogenesis, including environmental factors such as smoking, alcohol consumption, diet, obesity, infections, environmental pollution, and radiation2. However, genetic factors such as gene mutations and ABO blood groups have also been associated with an increased cancer risk3-5. In addition to being expressed on red blood cells, the ABO blood group antigens are expressed by different cells in various human tissues, including epithelial cells, vascular endothelial cells, and neurons4. Many recent studies have focused on the role of ABO antigens in the pathogenesis of various systemic diseases, including cancer4. In fact, several reviews and meta-analyses have
confirmed a link between the distribution of ABO blood group antigens and a risk of developing specific types of cancer5-8. The most frequently reported associations have been in patients with gastric and pancreatic cancers7,8. For example, there is irrefutable evidence to suggest that individuals with group A harbour a greater risk of developing gastric cancer compared to individuals with group O6,7. However, there are conflicting data concerning associations between the distribution of ABO blood group antigens and other malignant neoplastic diseases, such as lung cancer9,10, nasopharyngeal carcinoma 11,12, and brain tumours (including glioblastoma)13,14, and further investigation is needed. Glioblastoma (GB), formerly known as glioblastoma multiforme, represents the highest grade glioma (World Health Organization, grade IV) and accounts for more than 50% of all gliomas15,16. It has been estimated that
Blood Transfus 2017; 15: 543-7 DOI 10.2450/2016.0041-16 © SIMTI Servizi Srl
All rights reserved - For personal use only No other use without premission
543
Allouh MZ et al
Statistical analyses The χ2 test for trend analysis was used to assess whether there was an association between the distribution of blood group antigens and GB. If a significant (p
SI M
TI
Se rv
iz i
Sr l
Background. Glioblastoma is a highly malignant brain tumour that usually leads to death. Several studies have reported a link between the distribution of ABO blood group antigens and a risk of developing specific types of cancer, although no consensus has been reached. This study aims to investigate the relationship between the distribution of ABO blood group antigens and the incidence of glioblastoma. Materials and methods. The study cohort consisted of 115 glioblastoma patients who were diagnosed at King Abdullah University Hospital, Jordan, between 2004 and 2015. Three different patient populations made up three control groups and these were selected from among patients at the same institution between 2014 and 2015 as follows: 3,847 healthy blood donors, 654 accidental trauma patients admitted to the Departments of Neurosurgery and Orthopaedics, and 230 age- and sexmatched control subjects recruited blindly from the Departments of Paediatrics and Internal Medicine. Results. There was a significant association between the distribution of ABO blood group antigens and the incidence of glioblastoma. Post hoc residual analysis revealed that individuals with group A had a higher than expected chance of developing glioblastoma, while individuals with group O had a lower than expected chance. Furthermore, individuals with group A were found to be at a 1.62- to 2.28-fold increased risk of developing glioblastoma compared to individuals with group O. Discussion. In the present study, we demonstrate that, in Jordan, individuals with group A have an increased risk of developing glioblastoma, while individuals with group O have a reduced risk. These findings suggest that the distribution of ABO blood group antigens is associated with a risk of brain tumours and may play an important role in their development. However, further clinical and experimental investigations are required to confirm this association. Keywords: ABO blood group system, brain tumours, cancer, glioblastoma.
Introduction
©
Cancer represents one of the principal causes of death worldwide and disease management is a major cause for concern1. For decades, much research has been focused on determining risk factors that contribute to cancer aetiopathogenesis, including environmental factors such as smoking, alcohol consumption, diet, obesity, infections, environmental pollution, and radiation2. However, genetic factors such as gene mutations and ABO blood groups have also been associated with an increased cancer risk3-5. In addition to being expressed on red blood cells, the ABO blood group antigens are expressed by different cells in various human tissues, including epithelial cells, vascular endothelial cells, and neurons4. Many recent studies have focused on the role of ABO antigens in the pathogenesis of various systemic diseases, including cancer4. In fact, several reviews and meta-analyses have
confirmed a link between the distribution of ABO blood group antigens and a risk of developing specific types of cancer5-8. The most frequently reported associations have been in patients with gastric and pancreatic cancers7,8. For example, there is irrefutable evidence to suggest that individuals with group A harbour a greater risk of developing gastric cancer compared to individuals with group O6,7. However, there are conflicting data concerning associations between the distribution of ABO blood group antigens and other malignant neoplastic diseases, such as lung cancer9,10, nasopharyngeal carcinoma 11,12, and brain tumours (including glioblastoma)13,14, and further investigation is needed. Glioblastoma (GB), formerly known as glioblastoma multiforme, represents the highest grade glioma (World Health Organization, grade IV) and accounts for more than 50% of all gliomas15,16. It has been estimated that
Blood Transfus 2017; 15: 543-7 DOI 10.2450/2016.0041-16 © SIMTI Servizi Srl
All rights reserved - For personal use only No other use without premission
543
Allouh MZ et al
Statistical analyses The χ2 test for trend analysis was used to assess whether there was an association between the distribution of blood group antigens and GB. If a significant (p
