|HEAD AND NECK SYMPOSIUM - ORIGINAL ARTICLE
|Year : 2014 | Volume
| Issue : 3 | Page : 219-221
ABO blood groups and oral premalignancies: A clinical study in selected Indian population
S Bhateja1, G Arora2
1 Department of Oral Medicine Diagnosis and Radiology, Dr. DY Patil Dental College and Hospital, Pune, Maharashtra, India
2 Department of Public Health Dentistry, Vyas Dental College and Hospital, Jodhpur, Rajasthan, India
|Date of Web Publication||10-Dec-2014|
Department of Oral Medicine Diagnosis and Radiology, Dr. DY Patil Dental College and Hospital, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: The ABO blood group antigens are present on the surface of red blood cells and various epithelial cells. As the majority of human cancers are derived from epithelial cells, changes in blood group antigens constitute an important aspect of human cancers. The aim of the study was to establish clinical usefulness of ABO blood group as a predisposing factor in early diagnosis and management of patients with oral precancerous lesions/conditions. Materials and Methods: The study sample consisted of 50 control and 50 oral precancer (25 leukoplakia and 25 Oral Submucous Fibrosis) confirmed by histopathologic examination. All samples were subjected to blood group testing and their prevalence was compared by Z-test using STATA version 8. Results: The "A" blood group was prevalent among the precancerous group. Significant differences on prevalences of blood groups were found (P < 0.05) between control versus leukoplakia and OSMF. Interestingly, 24% gutka chewers who had higher number of grades of dysplasia were falling in "A" blood group. Conclusion: Blood group type should be considered along with other risk factors to understand the individual patient's risk and further studies in larger samples with inclusion of Rh factor is needed to elucidate the relationship with ABO blood group types.
Keywords: ABO blood group, oral cancer, oral precancer, oral premalignancies
|How to cite this article:|
Bhateja S, Arora G. ABO blood groups and oral premalignancies: A clinical study in selected Indian population. Indian J Cancer 2014;51:219-21
| » Introduction|| |
As the incidence and death rate due to cancer have shown a sharp acceleration since the last two decades, more intense efforts are required to fight against this-life threatening disease. Many investigators have been searching for a specific, reliable, and easily identifiable biomarker, which can differentiate cancer patients from healthy individuals and also to find out patients with precancerous lesions who have high risk of developing cancer. Since the discovery of an association between stomach cancer and blood group "A" by Arid and Bentall (1953), there have been several studies on possible relationship between blood groups and certain diseases. ,,
The ABO blood group system has been regarded as the most important determinant for transfusion reactions and organ transplantation. The ABO blood type system comprises 4 blood groups: O, A, B, and AB. Blood group antigens, which are the major alloantigens in humans, are present on the surface of red blood cells and various epithelial cells. As the majority of human cancers are derived from epithelial cells, changes in blood group antigens are an important aspect of human tumor. 
The ABO blood group distribution varies in different geographic and ethnic groups, and socioeconomic groups. In India, the ABO blood group frequency is variable, as blood group B ranges from 6% in negritos of Andamans to 48% in Birijas of Bihar, whereas A group is 20%-30% in Western and Eastern Himalayas and B > O > A > AB is the frequency of blood group in North India. 
The relationship with blood groups and incidence, clinicopathologic parameter, and prognosis had been studied in many cancers, such as gastric,  breast,  skin,  esophagus,  cardiac,  lung,  laryngeal,  hypopharyngeal,  salivary gland,  gynecologic,  colorectal,  pancreatic,  bone,  urinary bladder,  renal,  testicular,  uveal melanoma,  and prostate.  In some tumors, alteration of ABO antigens is associated with malignant transformation.  Apart from cancers ABO blood groups have also been associated with disease entities, such as pulmonary tuberculosis, leprosy, syphilis, malaria, coronary artery disease, diabetes mellitus,  vitiligo, infertility, schizophrenia, goiter, glucose-6-phosphate dehydrogenase deficiency, gout, and hepatic dysfunctions. 
Therefore, the need for a study was felt for the analysis of blood group and related antigens on oral precancers that would provide useful information on the risk factors. The habits and grades of dysplasia were also analyzed to check the prevalence of blood groups. To date, no published report has evaluated the relationship between the ABO blood groups and the oral precancers. The current study was an attempt to correlate ABO blood group frequency with preponderance of oral precancer in Mathura (India) to assess the utility of ABO blood group as a preclinical marker.
| » Materials and Methods|| |
The study samples were selected from our hospital and prior consent has been taken from all the participants. The present study was conducted on 100 subjects after approval by local ethics committee, of which 50 had oral precancers among whom 25 leukoplakia (Group 1) and 25 Oral Submucous Fibrosis (Group 2) patients were confirmed by histopathologic examination and 50 were controls. All the study participants were subjected to blood group testing at Clinical Pathology Laboratory
| » Statistical analysis|| |
The statistical analyses were carried out to obtain the prevalence and comparison of blood groups among the precancer and control group by Z-test using STATA software version 8.0. The comparison between habits, grades of dysplasia, and blood group was established using Chi-square test by SPSS version 11.5.
| » Results|| |
The frequencies of blood groups among control and study groups were analyzed [Table 1] and [Table 2]. In the control group, the highest number of subjects of 24 (48%) belonged to "B" blood group than A, O, and AB blood group in a frequency of 13 (26%), 12 (24%), and 1 (2%), respectively. But 24 (48%) precancerous patients of whom 12 (48%) patients each in leukoplakia and OSMF group belonged to "A" blood group, then B, O, and AB blood group in the order of frequency."A" blood group represented maximum number of precancerous patients with dysplastic changes than other blood groups [Graph 1]. Gutka chewers had a higher risk of precancerous lesions among blood group A. On comparison between control versus study groups, a statistically significant difference existed between blood groups A and B (P < 0.05). However, no difference existed between the study groups. On correlating habits and grades of dysplasia with blood groups, statistically insignificant results were obtained within each blood groups, although in blood group A (P > 0.05), the number of subjects with tobacco and gutka chewing habits were more as compared with other blood groups.
| » Discussion|| |
More than 20 genetically determined blood group systems are known today but ABO blood groups are sensitive than other blood grouping system in detecting antigen responsible for cancers as ABO blood group genes are mapped at 9q34.2 region in which genetic alteration is common in many cancers. Thus, blood group antigen expression may be affected by genetic change of tumor, the loss or presence of blood group antigens can increase cellular motility or facilitate the interaction between tumor cells and endothelial cells of distant organs. , In many cancers, the deficiency of A or B epitope has been reported, which is associated with the accumulation of their precursor, which causes enhanced malignancy, although the molecular genetic mechanism leading to such phenotypic changes is not known. The expression of certain blood group carbohydrate antigens on the surface of cancer cells thus can be regarded as an end product of tumor progression that can be used as useful prognostic and diagnostic markers. 
In the literature blood group "A" has shown to be significantly more frequent in patients with gastric, laryngeal, hypopharynx, pancreatic, breast, testicular, and bone cancers.  Documents suggest that association between blood group "A" and gastric carcinoma was that, the carcinoma cells produce an antigen immunologically related to blood group "A" antigen but blood group "O" antigens may have a protective effect by preventing the growth and spread of the tumor. Because of this similarity, antibodies to "A" blood group probably also attack precancerous and cancerous cells expressing this antigen. The homotypic and heterotypic cell adhesion mediated by interactions of certain blood group carbohydrates with corresponding lectins is a critically important event at the extravasation step of the metastatic cascade when metastatic cancer cells escape from circulation into distant sites of secondary tumor growth.  In our study the frequency of blood group "A" was predominant in both leukoplakia and OSMF group.
Blood group "A" individuals appear to be at a moderately increased risk for many cancers. There is a small association between blood group "A" and cancer development.  Deletion or reduction of blood group A or B antigen in tumors of A or B individuals is correlated with the degree of malignancy and metastatic potential in many types of human cancers. The individuals with blood groups A and AB lack antibodies to A and so are more prone to develop carcinomas.  In our study blood group "A" also represented maximum number of precancerous patients with severe dysplasia than other blood groups.
In the present study, we also attempted at correlating habit type in oral precancer patients with the blood group and found that gutka chewing habit was predominantly seen in association with blood group "A." Such an association could be because of gutka chewing and arecanut placement being most prevalent habits in India.  In previous literature, comparison of blood group frequencies with smoking habits found a deficiency of blood group "B" among heavy smokers and suggested that the development of habit may be genetically determined by some metabolic peculiarity, which is less likely to be present if mechanisms concerned in production of blood group "B" polysaccharide are active. 
Studies of the relative incidence of the ABO blood group in different disease entities have failed to provide a unifying and testable hypothesis as to the basis for the associations observed. It could be merely the result of population history, environment, diet, and customs. The relative frequencies of the ABO blood groups in oral precancers have the strongest association with blood group "A." But the racial and ethnic distribution of blood groups and size of sample is an important factor for predicting the cancer risk. The present study draws some clues regarding the trends in oral precancer occurrence. Thus we emphasize that blood group type needs to be considered together with other risk factors in oral precancerous patients.
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[Table 1], [Table 2]