Los antígenos del grupo sanguíneo ABO influyen en la adhesión celular, la inflamación y los procesos metastásicos, lo que despierta el interés en su posible función pronóstica en el cáncer colorrectal.
Sin embargo, estudios previos han informado resultados inconsistentes.
Este estudio evaluó la asociación entre el grupo sanguíneo ABO y la supervivencia global (SG) en pacientes con cáncer de colon en estadio temprano que se sometieron a cirugía curativa. Esta cohorte retrospectiva incluyó a pacientes con adenocarcinoma de colon en estadio patológico II-III tratados quirúrgicamente entre 2016 y 2024 en un centro único. Se recopilaron datos demográficos, clinicopatológicos y de laboratorio, incluido el grupo sanguíneo ABO. La SG se analizó mediante los métodos de Kaplan-Meier y la prueba de rangos logarítmicos, y los factores pronósticos independientes se evaluaron con regresión de Cox multivariable.
Se incluyó un total de 158 pacientes (edad media de 59 años; 63,3% hombres). La distribución de los grupos sanguíneos fue: O (39,2%), A (38,6%), B (12,7%) y AB (9,5%). Durante un seguimiento medio de 31 meses, el 17,7% de los pacientes fallecieron. El grupo sanguíneo B demostró una SG significativamente más corta en comparación con el grupo O (p = 0,014 en la prueba de rangos logarítmicos).
En el análisis multivariable, solo el grupo sanguíneo B siguió siendo un predictor independiente de una peor SG (HR = 1,99; IC del 95%: 1,11-3,60; p = 0,022). El grupo sanguíneo B se asocia de forma independiente con una peor supervivencia en el cáncer de colon en estadio temprano. La tipificación ABO puede representar un posible marcador pronóstico complementario, lo que justifica su validación en cohortes prospectivas más amplias.
The ABO blood group system consists of glycoprotein antigens expressed on erythrocytes as well as on various epithelial surfaces, including gastrointestinal mucosa. These antigens participate in cell adhesion, intercellular signaling, inflammatory pathways, and metastatic behavior of tumor cells.[1],[2] Biologically, ABO antigens located on gastrointestinal epithelial membranes and tumor surfaces may influence cellular adhesion, membrane signaling, proliferation, and metastatic capacity.[3] Moreover, polymorphisms in the ABO gene locus have been associated with inflammatory and adhesion-related molecules such as TNF-α, ICAM-1, and P-selectin, potentially modulating immune surveillance and contributing to tumor progression.[4] Previous studies have also suggested that non-O blood groups, including blood group B, may exhibit stronger associations with inflammatory and endothelial activation pathways, which could partially explain their relationship with adverse oncologic outcomes.
These mechanisms suggest that ABO antigens may influence the development and progression of gastrointestinal malignancies. Although AJCC TNM staging remains the cornerstone of prognostic stratification in colon cancer, clinically relevant heterogeneity in outcomes may still exist among patients within the same stage category. Therefore, additional prognostic biomarkers may help improve individualized risk assessment. However, studies evaluating the prognostic significance of ABO blood groups in colorectal cancer have reported heterogeneous results. For instance, Cao et al[5] reported improved survival among patients with blood group AB, whereas Franchini et al[6] found no significant association. Limited data from Türkiye have suggested a possible link between blood group A and liver metastasis; however, these studies were based on relatively small retrospective cohorts and primarily focused on metastatic patterns rather than long-term survival outcomes in early-stage disease. Therefore, the prognostic significance of ABO blood groups in Turkish patients with non-metastatic colon cancer remains insufficiently characterized.[7]
The present study aimed to investigate the association between ABO blood group and overall survival (OS) in patients with early-stage (pathologic stage II–III) colon cancer undergoing curative surgery, and to determine whether ABO blood type retains independent prognostic significance alongside established clinicopathological factors.
Materials and Methods
Study Design and Patient Selection
This study is a retrospective cohort analysis based on the archive records of the SBÜ İstanbul Bakırköy Dr. Sadi Konuk Medical Oncology Clinic, including patients with histologically confirmed colon adenocarcinoma who underwent curative surgery between 2016 and 2024 and had pathologic stage II–III disease. Patients with rectal tumors, synchronous or metachronous malignancies, metastatic disease at diagnosis, or insufficient survival/follow-up information in the institutional records were excluded from the study.### Data Collection
Demographic data (age, sex, family history), tumor characteristics (localization, histologic grade, perineural invasion, lymphovascular invasion, tumor perforation), stage according to the AJCC 8th edition, number of lymph nodes retrieved, baseline serum CEA and CA19-9 levels, adjuvant treatment status, and ABO blood group were recorded. ABO blood group was categorized as A, B, and AB, with group O serving as the reference category. Age was categorized using a cutoff of 50 years based on its common use in colorectal cancer literature to distinguish early-onset disease from conventional-onset disease.[8]### Statistical Analysis
Continuous variables were summarized as median (minimum–maximum), while categorical variables were presented as counts and percentages. Survival analyses were performed using the Kaplan–Meier method, and differences between groups were assessed with the Log rank test. Multivariable Cox regression analysis was used to evaluate the independent effects of prognostic factors. The clinically prioritized model included stage, ABO blood group, lymphovascular invasion, perineural invasion, retrieval of ≥12 lymph nodes, adjuvant treatment status, and age >50 years. Results were reported as hazard ratios (HRs) with 95% confidence intervals (CIs) and p-values. P-values in the univariable analysis were derived from Log rank tests. A p-value 50 years. Results were reported as hazard ratios (HRs) with 95% confidence intervals (CIs) and p-values. P-values in the univariable analysis were derived from Log rank tests. A p-value
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