|Year : 2018 | Volume
| Issue : 3 | Page : 49-53
ABO blood group system and risk of brain tumors: A retrospective case–control study in Northeast of China
Liang Chang1, Shihong Zhao2, Zhou Dan3, Guofu Li1, Dongzhi Zhang1, Chunlei Tan1, Chuanlu Jiang2
1 Department of Neurosurgery, The Tumor Hospital of Harbin Medical University, Harbin, Heilongjiang, China
2 Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
3 Department of Biotherapy, The Tumor Hospital of Harbin Medical University, Harbin, Heilongjiang, China
|Date of Submission||25-Jan-2018|
|Date of Acceptance||23-Aug-2018|
|Date of Web Publication||28-Sep-2018|
Dr. Chuanlu Jiang
Department of Neurosurgery, The Second Affiliated Hospital, Harbin Medical University, 246 Xuefu Road, Harbin 150086, Heilongjiang
Source of Support: None, Conflict of Interest: None
Aim: The findings on ABO blood groups and risk of brain tumors are inconsistent and contradictory. The aim of this study was to investigate this association through a case–control study in the northeast of China. Methods: Between 2001 and 2016, a total of 2077 cases with glioma (n = 612), meningioma (n = 816), and pituitary adenoma (n = 649), and 2716 healthy controls were retrospectively included in this study. Data were statistically analyzed by comparing to the participants with blood type O; after adjusting for age, gender, smoking, and alcohol status. Results: A comparatively higher incidence of glioma was observed with blood type B and AB cases (adjusting odds ratio [OR] = 1.389 [1.087–1.777] and 95% confidence interval [CI] = 2.260 [1.572–3.250]). A comparatively lesser incidence of pituitary adenoma was observed with blood type B and AB cases (adjusting OR = 0.561 [0.445–0.706] and 95% CI = 0.358 [0.307–0.619]). Moreover, a comparatively lesser incidence of meningioma was observed with blood type B cases (adjusting OR and 95% CI of 0.577 [0.463–0.717]). Conclusion: Blood type B and AB could be associated with a higher incidence of glioma and lesser incidence of pituitary adenoma, with a decreased risk of meningioma in blood type B individuals. Future studies are needed to reconfirm our finding and explore the underlying mechanisms linking brain tumors to ABO blood types.
Keywords: ABO blood group, glioma, meningioma, pituitary adenoma
|How to cite this article:|
Chang L, Zhao S, Dan Z, Li G, Zhang D, Tan C, Jiang C. ABO blood group system and risk of brain tumors: A retrospective case–control study in Northeast of China. Transl Surg 2018;3:49-53
|How to cite this URL:|
Chang L, Zhao S, Dan Z, Li G, Zhang D, Tan C, Jiang C. ABO blood group system and risk of brain tumors: A retrospective case–control study in Northeast of China. Transl Surg [serial online] 2018 [cited 2019 Apr 26];3:49-53. Available from: http://www.translsurg.com/text.asp?2018/3/3/49/242491
| Introduction|| |
Glioma, meningioma, and pituitary adenoma, the three main types of primary brain tumor, represent the most common neoplasm of all brain tumors. Recently, the incidence of brain tumors is increasing worldwide; however, the cause remains largely unknown. The potential risk factors, such as smoking, alcohol abuse, and caffeine intake, play an important role in the incidence of brain tumors., However, these factors could explain the reason in only a small portion of exposed individuals and provide little opportunity for prevention. Therefore, it is a need to identify other risk factors.
ABO blood group system, being established by Landsteiner in 1900, is divided into A, B, AB, and O groups. This system is commonly followed in China and worldwide. Recently, more and more evidence revealed a possible relationship between ABO blood groups and risk of certain tumors including pancreatic cancer, hepatocellular carcinoma, and gastric cancer.,, Several plausible mechanisms, including intercellular adhesion, inflammation, and immune surveillance for malignant cells, have been proposed to explain such relationships.,, However, studies on the relationship between the ABO blood groups and brain tumors are sparse and inconsistent. Therefore, to investigate the relationship between ABO blood group and brain tumors risk in a Chinese population, we conducted a case–control study. To the best of our knowledge, this is the first study to examine the relationship between ABO blood group and brain tumors in a Chinese population.
| Methods|| |
The present retrospective study was approved by the Ethics Committee of The Second Affiliated Hospital of Harbin Medical University and The Tumor Hospital of Harbin Medical University. Written consent was given by the patients for their information to be stored in the hospital database and used for research.
Study population and data collection
A total of 2077 cases with glioma (n = 612), meningioma (n = 816), or pituitary adenoma (n = 649), treated between 2001 and 2016 at The Second Affiliated Hospital of Harbin Medical University and The Tumor Hospital of Harbin Medical University, were enrolled in the study. We excluded the participants with other tumor. The inclusion criteria for cases were as follows: all patients had definitive histopathologic confirmation; laboratory data on ABO blood types were available; detailed information, such as sex, age, alcohol consumption, and smoking status, could be obtained through medical records; and the patients lived in northeast of China more than 10 years. In addition, a total of 2716 noncancer patients, who were admitted during the same period to the same hospital for conditions unrelated to any type of cancer, were randomly selected as controls. The inclusion criteria for controls were the same as those for cases, except for the tumor diagnosis. Detailed information (age, sex, alcohol consumption, and histopathological subtypes as well as smoking status) was obtained from the medical record of the participants. We classified smoking status as “No” (<100 cigarettes during his lifetime) and “Yes” (>100 cigarettes during his lifetime). Alcohol consumption divided into two groups based on whether or not the person consumes more than 30 g/day. Glioma subtypes were divided into “low-grade glioma (Grade I–II)” and “high-grade glioma (Grade III–IV)” and pituitary adenoma subtypes into “functioning pituitary adenoma” as well as “nonfunctioning pituitary adenoma.”
Statistical analysis was performed using SPSS 19.0 statistical software program (IBM Corp, Armonk, NY, USA). Pearson's Chi-square test was used to compare proportions regarding subtypes of glioma and pituitary adenoma among cases with various blood groups. The relationship between ABO blood types and the incidence of glioma, meningioma as well as pituitary adenoma, as well as crude and adjusted odds ratios (ORs) for each variable were evaluated by unconditional logistic regression analysis. With 95% confidence interval (CI), P < 0.05 was considered statistically significant.
| Results|| |
ABO blood groups and incidence of glioma
The relationship between the incidence of glioma and ABO blood groups was analyzed using unconditional logistic regression analysis [Table 1]. Compared with blood type O, the OR and 95% CI in univariate analysis were determined as 1.205 (0.932–1.558; P = 0.154) for blood type A, 1.277 (1.008–1.618; P = 0.043) for type B, and 2.184 (1.546–3.083; P = 0.001) for type AB. The OR and 95% CI in multivariate analysis were determined as 1.290 (0.993–1.677; P = 0.057) for blood type A, 1.389 (1.087–1.777; P = 0.009) for type B, and 2.260 (1.572–3.250; P = 0.001) for type AB, compared with blood type O, after adjusting for alcohol consumption, smoking status, and gender as well as age [Table 1]. The results showed that blood type B and AB were significantly related to the risk of glioma. Glioma subtypes in the present study grouped by blood type are shown in [Table 2]. No significant differences in the proportion of glioma subtypes among patients with various blood groups were evident (P = 0.701).
|Table 1: The relationship between ABO blood type and glioma: Univariate and multivariate logistic regression analyses|
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ABO blood groups and incidence of meningioma
The relationship between the incidence of meningioma and ABO blood groups was analyzed using unconditional logistic regression analysis [Table 3]. Compared with blood type O, the OR and 95% CI in univariate analysis were determined as 1.144 (0.935–1.399; P = 0.192) for blood type A, 0.589 (0.479–0.725; P = 0.000) for type B, and 1.119 (0.809–1.549; P = 0.497) for type AB. The OR and 95% CI in multivariate analysis were determined as 1.121 (0.909–1.383; P = 0.286) for blood type A, 0.577 (0.463–0.717; P = 0.000) for type B, and 1.414 (0.855–1.273; P = 0.674) for type AB, compared with blood type O, after adjusting for alcohol consumption, smoking status, and gender as well as age [Table 3]. The results showed that blood type B was significantly related to the lower incidence of meningioma.
|Table 3: The relationship between ABO blood type and meningioma: Univariate and multivariate logistic regression analyses|
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ABO blood groups and incidence of pituitary adenoma
The relationship between the incidence of pituitary adenoma and ABO blood groups was analyzed using unconditional logistic regression analysis [Table 4]. Compared with blood type O, the OR and 95% CI in univariate analysis were determined as 1.132 (0.911–1.407; P = 0.263) for blood type A, 0.637 (0.510–0.794; P = 0.000) for type B, and 0.361 (0.214–0.610; P = 0.000) for type AB. The OR and 95% CI in multivariate analysis were determined as 1.063 (0.849–1.332; P = 0.595) for blood type A, 0.561 (0.445–0.706; P = 0.000) for type B, and 0.358 (0.307–0.619; P = 0.000) for type AB, compared with blood type O, after adjusting for alcohol consumption, smoking status, and gender as well as age [Table 4]. The results showed that blood type B and AB were significantly related to the lower incidence of pituitary adenoma. Pituitary adenoma subtypes, in the present study, grouped by blood type are shown in [Table 5]. No significant differences in the proportion of pituitary adenoma subtypes among patients with various blood groups were evident (P = 0.443).
|Table 4: The relationship between ABO blood type and pituitary adenoma: Univariate and multivariate logistic regression analyses|
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|Table 5: Tumor subtype of pituitary adenoma cases according to ABO blood type|
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| Discussion|| |
ABO blood group has been associated with risk for various tumors. For instance, blood type A was related to a higher incidence of pancreatic cancer; there is a relationship between non-O blood group and a higher risk of colon adenocarcinoma; a positive relationship could be found between blood type B and risk of ovarian cancer. In this case–control study, we found that blood type B and AB may be associated with higher incidence of glioma and lesser incidence of pituitary adenoma. Furthermore, a decreased risk of meningioma was identified in blood type B individuals. In addition, we did not observe a significant relationship between ABO blood group and the proportion of histological subtypes of glioma as well as pituitary adenoma (Data not shown).
The mechanisms of the impact of ABO blood group system on tumor development are elusive. However, some hypotheses may explain such observed association. To begin with, blood group antigens are expressed not only on the surface of red blood cells but also on the surface of other tissues throughout the body. Research has shown that these antigens could participate in cell-extracellular matrix and cell-cell interactions, which are important for tumor development. Moreover, it has been observed that ABO blood group may alter blood levels of soluble E-selectin, tumor necrosis factor alpha, and soluble ICAM-1 which influence cell adhesion and apoptosis.,, Finally, it is possible that ABO gene is in linkage disequilibrium with other gene influencing cancer risk.
At present, few studies have assessed and reported no association between blood type and risk of developing brain tumors., However, few other studies have noted a significant association between blood groups and glioma or other primary intracranial tumors.,
Diamond et al. reported that meningioma was more frequent in blood Group B individuals. In contrast, they also found a striking deficiency of pituitary adenoma in Group B in the study population, and there was a considerable excess in Group A. However, Choi et al. found no significant difference in blood group distribution in a study of pituitary adenoma. As to glioma, Zampieri et al. noted that patients with blood type A exhibited a higher incidence of glioma. Compared to the general population, Campbell et al. reported significantly higher incidence of glioma in blood Group O individuals. Till date, the evidence on the relationship between ABO blood group and brain tumors is inconsistent. The possible reason for this discrepancy may be difference in populations and ethnicities studied. In this study, the participants living in the northeast of China were chosen as participants being investigated, and the results were inconsistent with some prior studies. We found that blood type B and AB may influence the development of glioma; however, they were considered as protective factors against pituitary adenoma. Further, blood Group B was associated with a lower incidence of meningioma.
Our study also has several limitations. Due to the nature of the retrospective study, it is subjected to the variety of bias including referral and selection bias. In addition, our study population was mainly composed of Chinese Han participants, which may limit the generalization of the results. Further investigations are necessary to include other ethnic groups. Finally, owing to technical difficulties, the data on histopathological subtypes of meningioma were not obtained, and thus could not compare the ABO blood groups with the subtypes of meningioma.
| Conclusion|| |
Our finding lends further support to the hypothesis that ABO blood group can be a marker of brain tumors susceptibility. Future studies are warranted to examine the mechanisms linking the brain tumors risk to ABO blood types.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]