ABO blood groups as a prognostic factor for recurrence in ovarian and vulvar cancer

Abstract

The relationship between ABO blood groups (BG) and risk of incidence in cancers including gynecological cancers has been widely studied, showing increased incidence risk for BG A patients. As available data are inconsistent we investigated whether BG and their anti-glycan antibodies (anti-A and anti-B) have prognostic values in gynecological cancers. We retrospectively evaluated 974 patients with gynecological cancers in three cancer centers (Switzerland and Australia) between 1974 and 2014 regarding the relationships between clinico-pathological findings and the BG. Time to disease recurrence was significantly influenced by BG in patients with ovarian (n = 282) and vulvar (n = 67) cancer. BG O or B patients showed a significantly increased risk for ovarian cancer relapse compared to A, 59% and 82%, respectively (p = 0.045; HR O vs A = 1.59 (CI 1.01-2.51) and (p = 0.036; HR A vs B = 0.55 (CI 0.32-0.96). Median time to relapse for advanced stage (n = 126) ovarian cancer patients was 18.2 months for BG O and 32.2 for A (p = 0.031; HR O vs A = 2.07 (CI 1.07-4.02)). BG also significantly influenced relapse-free survival in patients with vulvar cancer (p = 0.002), with BG O tending to have increased relapse risk compared to A (p = 0.089). Blood groups hence associate with recurrence in ovarian and vulvar cancer: women with BG O seem to have a lower ovarian cancer incidence, however are more likely to relapse earlier. The significance of the BG status as a prognostic value is evident and may be helpful to oncologists in prognosticating disease outcome and selecting the appropriate therapy.

Fig 1

Time to relapse (A), Kaplan-Meier curve for RFS (B), and HR for disease recurrence (C) in ovarian cancer patients (n = 252). BG O and B patients showed a significantly increased risk for relapse compared to A patients (59%, p = 0.045 and 82%, p = 0.036, respectively; Cox regression). Hence, BG A patients have better prognosis with a significant longer RFS than those with O and B. Time to relapse presented as median (months) and 95%CI and compared by overall logrank test and disease recurrence risk presented as HR and 95%CI. Statistical significance marked by asterisks (*) or highlighted. NE, not estimable. RFS given as probability of freedom from relapse as a function of time (months).

Fig 2

Time to relapse (A), Kaplan-Meier curve for RFS (B), and HR for disease recurrence (C) in vulvar cancer patients (n = 57). BG O patients tend to have increased risk for relapse compared to A patients A (HR O vs A = 4.03, 95%CI: 0.81–20.14, p = 0.089), i.e. A patients have better prognosis with a trend to longer RFS than patients with BG O. Time to relapse presented as median (months) and 95%CI and compared by overall Logrank Test. Disease recurrence risk presented as HR and 95%CI by Cox regression (only possible for O vs A owing the small sample size for AB and B). Statistical significance marked by asterisks (*) or highlighted. NE, not estimable. RFS given as probability of freedom from relapse as a function of time (months).

Fig 3

Time to relapse (A), Kaplan-Meier curve for RFS (B), and HR for disease recurrence (C) in the FIGO III adenocarcinoma patient subgroup (n = 108). BG O patients have two time increased risk for relapse compared to A patients A, i.e. BG A patients have better prognosis with a significant longer RFS than patients with O. Time to relapse presented as median (months) and 95%CI and compared by overall Logrank test. Disease recurrence risk presented as HR and 95%CI by Cox regression. Statistical significance marked by asterisks (*) or highlighted. NE, not estimable. RFS given as probability of freedom from relapse as a function of time (months).