Short Report
Risk of hepatocellular carcinoma in relation to ABO blood type

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Abstract

Background

Mortality and incidence rates of hepatocellular carcinoma (HCC) parallel the geographical distribution of hepatitis B and C viruses among the general population, however genetic factors modulate individual cancer risk.

Aims

ABO blood type, as a genetic marker, has previously been associated with the risk of several malignancies; we aimed to evaluate whether an association exists with HCC.

Methods

This is a retrospective case-control study based on ABO distribution in 194 patients with HCC, compared with 215 decompensated cirrhotics without HCC listed for liver transplantation, and 90,322 healthy blood donors.

Results

In patients with HCC, prevalence of blood type O was 35%, vs. 44% in cirrhotics (OR: 0.67, 95% CI 0.45–0.99; p = 0.046) and 45% in blood donors (OR: 0.65, 95% CI 0.48–0.88; p = 0.004).

Conclusions

ABO blood type non-O is associated with higher risk of hepatocellular carcinoma, compared to cirrhotics without HCC and healthy subjects.

Introduction

Hepatocellular carcinoma (HCC) is the third most common cause of death from cancer worldwide, its incidence and mortality rates reflect the geographical distribution of the main environmental risk factors [1], [2]. Substantial changes in the epidemiology of HCC are expected to occur because of the prevention of viral hepatitis in most hyperendemic areas, including mass vaccination of newborns which provides a barrier to HCC in subsequent cohorts of adults [3] and control of aflatoxin exposure in China [4]. In parallel, the emergence of HCC related to obesity and diabetes is growing [5], [6]. Moreover, circumstantial evidence indicates that genetic factors are important predictors of cancer risk at the individual level, as suggested by the 3-fold increase in liver cancer among subjects with family history of cancer in first-degree relatives [7]. The ABO blood type, a marker of familial and genetic factors, has previously been associated with the risk of several malignancies, including gastric, epithelial ovarian and pancreatic cancer [8], [9], [10], [11], [12]. A reduced risk of pancreatic cancer has been demonstrated in blood type O, whereas an excess risk of gastric cancer was found in blood type A individuals and an excess risk of ovarian cancer in those with blood type B [8], [9], [10], [11], [12]. However, except for a case-control study performed in China among patients with chronic hepatitis B, where the distribution of blood type A was slightly higher among HCC patients than among controls with chronic hepatitis, there is little data on the association between ABO type and HCC risk [13].

Aim of this study was to evaluate whether an association exists between ABO blood type and HCC.

Section snippets

Methods

This retrospective case–control study enrolled HCC patients who were admitted for any reason in our department between January 2005 and March 2014. All hospital discharges with HCC-related codes (primary or secondary diagnosis) according to the International Classification of Diseases, Ninth Revision, clinical modification (ICD-9CM) who received transfusion of any blood component (erythrocytes, platelets and plasma), according to the procedure codes retrieved from hospital database were

Results

Overall 90,731 subjects were enrolled: 194 with HCC, 215 cirrhotics and 90,322 healthy blood donors. Table 1 reports the characteristics of subjects included in the analysis. We considered all HCC patients with an available blood type admitted to the in-patient department: all were cirrhotic and mean age was 66 years, 75% males and the most frequent aetiology of cirrhosis was HCV (50%), followed by alcohol abuse (17%). Eighty-six patients (45%) were admitted in good general condition (PS 0-1,

Discussion

We demonstrated the existence of a relationship between the ABO blood type and HCC in a Western population. Non-O blood types showed increased risk of HCC development, as previously shown for pancreatic, gastric and epithelial ovarian cancers [9], [10], [11], [12]. The results were of borderline significance when comparing HCC to cirrhotic patients without HCC, due to the relatively limited sample size, but highly significant when compared to a much larger cohort of healthy blood donors.

One

Conflict of interest

None declared.

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