The Correlation Between ABO Blood Type And Prognosis Of Primary Non-muscle Invasive Bladder Cancer

ObjectivesA number of studies indicate that ABO blood type is associated with the prognosis of many malignancies such as pancreatic cancer,gastrointestinal cancer,breast cancer,lung cancer,renal cell carcinoma and prostate cancer,but little known about ABO blood type and bladder cancer.Therefore we aim to explore the correlation between ABO blood type and clinicopathological features as well as prognosis in patients with primary non-muscle invasive bladder cancer(NMIBC).MethodsWe included 2,045 NMIBC patients treated at two medical centers between 2012 and 2016.Inclusion criteria were complete clinical data,primary bladder cancer,receiving transurethral resection of the bladder tumor(TURBT)and postoperative pathology confirmed non-muscle invasive bladder urothelial carcinoma,postoperative adjuvant Intravesical chemotherapy with Oxycamptothecin 20 mg or Epirubicin 50 mg or Gemcitabine 50mg;exclusion criteria were incomplete or missing clinical data,recurrent non-muscle invasive bladder cancer,secondary non-muscle invasive bladder cancer,muscle invasive bladder cancer,concomitant upper tract urothelial carcinoma or distant metastasis,receiving radical cystectomy within 3 months after TURBT,and no regular intravesical chemotherapy after surgery.All patients underwent transurethral resection of the bladder tumor and postoperative adjuvant Hydroxycamptothecin or Epirubicin or Gemcitabine intravesical instillation chemotherapy.Variables included age,gender,ABO blood type,T stage,tumor grade,concomitant carcinoma in situ or not,differentiation or not,number of tumors,tumor size,Intravesical instillation chemotherapy,follow-up interval,recurrence time,progression time,risk group.We use chi-square test or Fisher's exact test to analyse the relationship between ABO blood type and clinicopathological features.The cumulative incidence was analyzed using the Kaplan-Meier survival analysis and log-rank test.Cox regression models were used to assess the relationship of ABO blood type with disease recurrence and progression.ResultsAll in all,505(24.7%),679(33.2%),628(30.7%)and 233(11.4%)patients expressed blood type A,B,O and AB,respectively.A total of 471(23.0%)patients died and 59(2.9%)died of urothelial carcinoma of the bladder.No association was observed between ABO blood type and clinicopathological features except for number of tumors(P=0.005).The 5-year cumulative recurrence and progression rates of patients with blood type B were the highest,which were 49.3% and 18.5%,respectively;the 5-year cumulative recurrence and progression rates of patients with blood type A were 44.8% and 14.4%,respectively;the 5-year cumulative recurrence and progression rates of patients with blood type O were 38.7% and 12.7%,respectively;the 5-year cumulative recurrence and progression rates of patients with blood type AB were the lowest,35.2% and 9.1%,respectively.Log-rank test showed that there were significant differences in recurrence(P<0.001)and progression(P=0.008)between different blood types.Multivariable analysis showed that blood type B had higher risk of recurrence and progression than those with type O(P=0.009,P=0.012)and type AB(P=0.003,P=0.004).In the subgroup analysis,ABO blood type was not associated with bladder cancer recurrence and progression in the intermediate-risk and low-risk groups(P-values were all greater than 0.05),whereas in the high-risk group,ABO blood type had significant association with bladder cancer recurrence(P<0.001)and progression(P=0.008)ConclusionsABO blood type is associated with bladder cancer risk.Patients with blood type B had the highest risk of recurrence and progression.ABO blood type may be an appropriate biomarker to predict the prognosis of urothelial carcinoma of the bladder.Future studies should clarify the specific mechanism between ABO blood type and bladder cancer.