J Cancer Res Clin Oncol DOI 10.1007/s00432-015-1908-3
ORIGINAL ARTICLE – CLINICAL ONCOLOGY
Prognostic value of ABO blood group in patients with renal cell carcinoma: single‑institution results from a large cohort Chunwoo Lee · Dalsan You · Mooyoung Sohn · In Gab Jeong · Cheryn Song · Taekmin Kwon · Bumsik Hong · Jun Hyuk Hong · Hanjong Ahn · Choung‑Soo Kim
Received: 16 September 2014 / Accepted: 4 January 2015 © Springer-Verlag Berlin Heidelberg 2015
Abstract Objectives To evaluate the association between ABO blood group and prognosis in patients with renal cell carcinoma (RCC) undergoing surgery. Materials and methods A review of the nephrectomy database of the Asan Medical Center identified 3,172 consecutive patients who underwent nephrectomy for RCC between 1997 and 2012. Patients were followed up for a median 60.2 months (interquartile range 33–102 months). Recurrence-free (RFS), cancer-specific (CSS), and overall survival (OS) were calculated by the Kaplan–Meier method and compared using the log-rank test. A Cox proportional hazards regression model was used to estimate the prognostic significance of each variable. Results Of these 3,172 patients, 915 (28.8 %), 1,057 (33.7 %), 860 (26.7 %) and 340 (10.8 %) were blood types O, A, B, and AB, respectively. ABO blood group was not associated with age, sex, operation method, American Society of Anesthesiologists physical status classification, histologic subtype, or pathological TNM stage. The 5-year OS rates in patients with blood types O, A, B, and AB were 86.0, 86.8, 86.6, and 88.6 %, respectively, and the 10-year OS rates were 78.7, 78.6, 79.1, and 76.9 %, respectively (P = 0.990). ABO blood group was not significantly associated with RFS (P = 0.921) or CSS (P = 0.808). Univariable and multivariable analyses showed that ABO blood group was not a significant prognostic factor of RFS, CSS, or OS.
C. Lee · D. You · M. Sohn · I. G. Jeong · C. Song · T. Kwon · B. Hong · J. H. Hong · H. Ahn · C.‑S. Kim (*) Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic‑ro 43‑Gil, Songpa‑gu, Seoul 138‑736, Korea e-mail: [email protected]
Conclusions Our study found that ABO blood group is not associated with survival outcomes and is not a prognostic factor in patients who underwent surgery for RCC. Keywords ABO blood group system · Renal cell carcinoma · Prognosis
Introduction Blood group antigens are expressed most abundantly in endodermal epithelial cells, including oral, esophageal, gastric, intestinal, colorectal, bronchopulmonary, and urogenital cells (Hakomori 1999). The blood antigens may modify cell adhesion, membrane signaling, and immune surveillance, which may in turn affect cancer development and progression (Hakomori 1999). The ABO blood type has been associated with the cancer risk of several types (Aird et al. 1953; Graziano et al. 1997; Zmijewski 1978), including pancreatic cancer (Amundadottir et al. 2009; Wolpin et al. 2010a, b). The ABO allele subtypes corresponding to increased glycosyltransferase activity were associated with an increased risk of pancreatic cancer (Wolpin et al. 2009). ABO blood group may be an inherited marker of cancer susceptibility and tumor progression. Despite the close link between ABO blood group and pancreatic cancer, little is known about the influence of ABO blood group on the prognosis of patients undergoing surgery for renal cell carcinoma. Several studies have assessed the relationship between ABO blood group and prognosis in patients with renal cell carcinoma (de Martino et al. 2014; Kaffenberger et al. 2012), but these studies yielded conflicting results. Similar to pancreatic cancer, we hypothesized that O blood type would be associated with improved survival in
13
patients with renal cell carcinoma. Therefore, we retrospectively evaluated the association between ABO blood group and prognosis in a large cohort of patients who underwent surgery for renal cell carcinoma.
J Cancer Res Clin Oncol
stage was classified according to the 2009 TNM classifications (Greene et al. 2009). Fuhrman classification was used for grading (Fuhrman et al. 1982). Data analysis
Materials and methods Population and design The study was performed with the approval and oversight of the Institutional Review Board of the Asan Medical Center. A review of the nephrectomy database of the Asan Medical Center identified 3,172 consecutive patients who underwent radical or partial nephrectomy for locoregional or distant metastatic renal cell carcinoma between 1997 and 2012. Our study excluded the patients with bilateral renal cell carcinoma and von Hippel–Lindau disease. Before surgery, the staging workup included a chest X-ray, computed tomography of the abdomen and pelvis (APCT), and a bone scan. Based on their symptoms, some patients underwent computed tomography of the chest or brain imaging. Radical or partial nephrectomy was performed using the standard techniques. Following surgery, all patients were recommended to undergo radiologic evaluation, including a chest X-ray, APCT, and a bone scan, every 6 months for 2 years and yearly thereafter. The diagnosis of disease recurrence was based on radiologic findings and was confirmed, if required, by a biopsy. The median follow-up was 60.2 months (interquartile range 33–102 months). We evaluated clinical and pathological variables including ABO blood type, age, sex, American Society of Anesthesiologists (ASA) physical status classification, hypercalcemia (corrected serum calcium >10 mg/dL), thrombocytosis (platelet >450 × 109/L), elevated alkaline phosphatase (ALP > 120 IU/L), tumor size, histologic subtype, or pathological TNM stage and grade. We identified the patients through serology of the blood group ABO system. The ABO blood type test was performed in all patients before surgery so as to be prepared for possible bleeding and transfusion. All clinical and pathological data were missing less than 2 % of patients in our study. All renal cell carcinoma histologic subtypes were included. Renal cell carcinoma not fitting any of the known histologic subtypes or containing more than one type of cell was categorized as “unclassified.” We simply divided the classification of histologic subtypes into clear cell, papillary, chromophobe, and other subtypes. The other subtypes were included multilocular cystic, sarcomatoid, and the unclassified subtype. Patients with locoregional advanced disease, including those with direct adrenal invasion, regional lymph node metastases, and tumor thrombi, were included. Pathologic
13
The relationship between the ABO blood group and the clinicopathological variables was assessed using Pearson’s Chi-square test or Fisher’s test for categorical variables and Student’s t test for continuous variables. Quantitative data were expressed as mean ± standard deviation (SD) or median and interquartile range (IQR). Patients were followed up from the time of surgery to the date of death or last clinic visit. Recurrence-free survival (RFS) was defined as the time from radical or partial nephrectomy to the first documented clinical recurrence. Cancer-specific survival (CSS) was calculated from the date of surgery to the date of death from renal cell carcinoma, and overall survival (OS) was calculated from the date of surgery to the date of death from any cause. The primary outcome measures were CSS and OS. Kaplan–Meier survival curves for RFS, CSS, and OS were generated according to individual potential prognostic variables and compared using the log-rank test. A Cox proportional hazards regression model was used to estimate the prognostic significance of each variable. Correlations between outcomes and variables were expressed as hazard ratios (HR) with 95 % confidence intervals (CI). All statistical tests were two-tailed, with P
ORIGINAL ARTICLE – CLINICAL ONCOLOGY
Prognostic value of ABO blood group in patients with renal cell carcinoma: single‑institution results from a large cohort Chunwoo Lee · Dalsan You · Mooyoung Sohn · In Gab Jeong · Cheryn Song · Taekmin Kwon · Bumsik Hong · Jun Hyuk Hong · Hanjong Ahn · Choung‑Soo Kim
Received: 16 September 2014 / Accepted: 4 January 2015 © Springer-Verlag Berlin Heidelberg 2015
Abstract Objectives To evaluate the association between ABO blood group and prognosis in patients with renal cell carcinoma (RCC) undergoing surgery. Materials and methods A review of the nephrectomy database of the Asan Medical Center identified 3,172 consecutive patients who underwent nephrectomy for RCC between 1997 and 2012. Patients were followed up for a median 60.2 months (interquartile range 33–102 months). Recurrence-free (RFS), cancer-specific (CSS), and overall survival (OS) were calculated by the Kaplan–Meier method and compared using the log-rank test. A Cox proportional hazards regression model was used to estimate the prognostic significance of each variable. Results Of these 3,172 patients, 915 (28.8 %), 1,057 (33.7 %), 860 (26.7 %) and 340 (10.8 %) were blood types O, A, B, and AB, respectively. ABO blood group was not associated with age, sex, operation method, American Society of Anesthesiologists physical status classification, histologic subtype, or pathological TNM stage. The 5-year OS rates in patients with blood types O, A, B, and AB were 86.0, 86.8, 86.6, and 88.6 %, respectively, and the 10-year OS rates were 78.7, 78.6, 79.1, and 76.9 %, respectively (P = 0.990). ABO blood group was not significantly associated with RFS (P = 0.921) or CSS (P = 0.808). Univariable and multivariable analyses showed that ABO blood group was not a significant prognostic factor of RFS, CSS, or OS.
C. Lee · D. You · M. Sohn · I. G. Jeong · C. Song · T. Kwon · B. Hong · J. H. Hong · H. Ahn · C.‑S. Kim (*) Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic‑ro 43‑Gil, Songpa‑gu, Seoul 138‑736, Korea e-mail: [email protected]
Conclusions Our study found that ABO blood group is not associated with survival outcomes and is not a prognostic factor in patients who underwent surgery for RCC. Keywords ABO blood group system · Renal cell carcinoma · Prognosis
Introduction Blood group antigens are expressed most abundantly in endodermal epithelial cells, including oral, esophageal, gastric, intestinal, colorectal, bronchopulmonary, and urogenital cells (Hakomori 1999). The blood antigens may modify cell adhesion, membrane signaling, and immune surveillance, which may in turn affect cancer development and progression (Hakomori 1999). The ABO blood type has been associated with the cancer risk of several types (Aird et al. 1953; Graziano et al. 1997; Zmijewski 1978), including pancreatic cancer (Amundadottir et al. 2009; Wolpin et al. 2010a, b). The ABO allele subtypes corresponding to increased glycosyltransferase activity were associated with an increased risk of pancreatic cancer (Wolpin et al. 2009). ABO blood group may be an inherited marker of cancer susceptibility and tumor progression. Despite the close link between ABO blood group and pancreatic cancer, little is known about the influence of ABO blood group on the prognosis of patients undergoing surgery for renal cell carcinoma. Several studies have assessed the relationship between ABO blood group and prognosis in patients with renal cell carcinoma (de Martino et al. 2014; Kaffenberger et al. 2012), but these studies yielded conflicting results. Similar to pancreatic cancer, we hypothesized that O blood type would be associated with improved survival in
13
patients with renal cell carcinoma. Therefore, we retrospectively evaluated the association between ABO blood group and prognosis in a large cohort of patients who underwent surgery for renal cell carcinoma.
J Cancer Res Clin Oncol
stage was classified according to the 2009 TNM classifications (Greene et al. 2009). Fuhrman classification was used for grading (Fuhrman et al. 1982). Data analysis
Materials and methods Population and design The study was performed with the approval and oversight of the Institutional Review Board of the Asan Medical Center. A review of the nephrectomy database of the Asan Medical Center identified 3,172 consecutive patients who underwent radical or partial nephrectomy for locoregional or distant metastatic renal cell carcinoma between 1997 and 2012. Our study excluded the patients with bilateral renal cell carcinoma and von Hippel–Lindau disease. Before surgery, the staging workup included a chest X-ray, computed tomography of the abdomen and pelvis (APCT), and a bone scan. Based on their symptoms, some patients underwent computed tomography of the chest or brain imaging. Radical or partial nephrectomy was performed using the standard techniques. Following surgery, all patients were recommended to undergo radiologic evaluation, including a chest X-ray, APCT, and a bone scan, every 6 months for 2 years and yearly thereafter. The diagnosis of disease recurrence was based on radiologic findings and was confirmed, if required, by a biopsy. The median follow-up was 60.2 months (interquartile range 33–102 months). We evaluated clinical and pathological variables including ABO blood type, age, sex, American Society of Anesthesiologists (ASA) physical status classification, hypercalcemia (corrected serum calcium >10 mg/dL), thrombocytosis (platelet >450 × 109/L), elevated alkaline phosphatase (ALP > 120 IU/L), tumor size, histologic subtype, or pathological TNM stage and grade. We identified the patients through serology of the blood group ABO system. The ABO blood type test was performed in all patients before surgery so as to be prepared for possible bleeding and transfusion. All clinical and pathological data were missing less than 2 % of patients in our study. All renal cell carcinoma histologic subtypes were included. Renal cell carcinoma not fitting any of the known histologic subtypes or containing more than one type of cell was categorized as “unclassified.” We simply divided the classification of histologic subtypes into clear cell, papillary, chromophobe, and other subtypes. The other subtypes were included multilocular cystic, sarcomatoid, and the unclassified subtype. Patients with locoregional advanced disease, including those with direct adrenal invasion, regional lymph node metastases, and tumor thrombi, were included. Pathologic
13
The relationship between the ABO blood group and the clinicopathological variables was assessed using Pearson’s Chi-square test or Fisher’s test for categorical variables and Student’s t test for continuous variables. Quantitative data were expressed as mean ± standard deviation (SD) or median and interquartile range (IQR). Patients were followed up from the time of surgery to the date of death or last clinic visit. Recurrence-free survival (RFS) was defined as the time from radical or partial nephrectomy to the first documented clinical recurrence. Cancer-specific survival (CSS) was calculated from the date of surgery to the date of death from renal cell carcinoma, and overall survival (OS) was calculated from the date of surgery to the date of death from any cause. The primary outcome measures were CSS and OS. Kaplan–Meier survival curves for RFS, CSS, and OS were generated according to individual potential prognostic variables and compared using the log-rank test. A Cox proportional hazards regression model was used to estimate the prognostic significance of each variable. Correlations between outcomes and variables were expressed as hazard ratios (HR) with 95 % confidence intervals (CI). All statistical tests were two-tailed, with P
