Skip to main content

Advertisement

Prognostic role of the ABO blood types in Chinese patients with curatively resected non-small cell lung cancer: a retrospective analysis of 1601 cases at a single cancer center

Chinese Journal of Cancervolume 34, Article number: 54 (2015) | Download Citation

Abstract

Background

A positive association between the ABO blood types and survival has been suggested in several malignancies. The aim of this study was to assess the role of the ABO blood types in predicting the prognosis of Chinese patients with curatively resected non-small cell lung cancer (NSCLC).

Methods

We retrospectively analyzed 1601 consecutive Chinese patients who underwent curative surgery for NSCLC between January 1, 2005 and December 31, 2009. The relationship between the ABO blood types and survival was investigated. In addition, univariate and multivariate analyses were performed.

Results

Group 1 (patients with the blood type O or B) had significantly prolonged overall survival (OS) compared with group 2 (patients with the blood type A or AB), with a median OS of 74.9 months versus 61.5 months [hazard ratio (HR) 0.83; 95% confidence interval (CI) 0.72–0.96; P = 0.015]. Additionally, group 1 had significantly longer disease-free survival (DFS; HR 0.86; 95% CI 0.76–0.98; P = 0.022) and locoregional relapse-free survival (LRFS; HR 0.79; 95% CI 0.64–0.98; P = 0.024) than group 2. The association was not significantly modified by other risk factors for NSCLC, including smoking status, pathologic tumor-node-metastasis stage, pT category, pN category, and chemotherapy.

Conclusions

There is an association between the ABO blood types and the survival of Chinese patients with resected NSCLC. Patients with the blood type O or B had significantly prolonged OS, DFS, and LRFS compared with those with the blood type A or AB.

Background

Globally, lung cancer remains the most common cancer for both men and women and accounts for 13% of total cases and 18% of total deaths [1]. Lung cancer has also been the top one malignancy in terms of incidence and mortality in China [2, 3]. Non-small cell lung cancer (NSCLC) accounts for 80%–85% of 1.1 million newly diagnosed lung cancer cases annually [4]. Although surgical resection with curative intent was available, 40%–75% of patients died within 5 years [5]. Understanding the etiology of this typically fatal disease and identifying novel prognostic factors are essential for early diagnosis, prognosis evaluation, and more appropriate treatment.

The ABO blood type is determined by terminal carbohydrates expressed on red blood cells, which are attached to a protein backbone, the H antigen. The glycosyltransferase, which is encoded by the ABO gene on chromosome 9q34, can catalyze the transfer of donor sugars to the H antigen to form the ABO blood type antigens [6, 7]. A genome-wide association study (GWAS) of pancreatic cancer identified a genetic variation in the ABO locus of 9q34 that was associated with susceptibility to pancreatic cancer [8, 9]. The positive association between the ABO blood types and survival has been suggested in several malignancies [10], including pancreatic cancer [11, 12], breast cancer [13, 14], renal cell carcinoma [15], nasopharyngeal carcinoma [16], and colon cancer [17]. Although the study by Lee et al. [18] investigated the survival of patients with curatively resected NSCLC within the context of the ABO blood types, the aim of their study was to investigate the prognostic role of the expression of blood group antigen A in tumor cells.

We conducted this study to investigate the relationship between the ABO blood types and the survival of patients who underwent primary curative resection. We also evaluated the associations between the ABO blood types and other clinicopathologic features of NSCLC to determine whether the ABO blood types are independent prognostic factors. In the present paper, we report results from Chinese patients with curatively resected NSCLC.

Patients and methods

Patient selection and data collection

A retrospective analysis was performed on consecutive patients who underwent curative surgery for NSCLC at the Sun Yat-sen University Cancer Center between January 1, 2005 and December 31, 2009. This study was approved by the Medical Ethics Committee and Clinical Trial Review Committee of this cancer center. All patients had postoperatively, pathologically confirmed NSCLC without previous therapy other than complete resection and neoadjuvant chemotherapy. The main exclusion criteria included incomplete resection, previous malignant disease, and perioperative death. Informed consent was obtained from all individual participants included in the study.

Data were collected from electronic and paper patient medical records, and survival data were obtained from the cancer center’s follow-up registry. The data collected included age, sex, Eastern Cooperative Oncology Group (ECOG) performance status, smoking status, pathology, tumor-node-metastasis (TNM) stage, dates of surgery and relapse/metastasis, and the ABO blood type. Patients with insufficient data were excluded from this study. All patients were restaged by using the 7th international system for lung cancer staging [19].

Study endpoints

The following endpoints were estimated: overall survival (OS), defined as the interval from the date of surgery to the date of death from any cause; disease-free survival (DFS), defined as the interval from the date of surgery to the date of disease recurrence or death from any cause; and locoregional relapse-free survival (LRFS) and distant metastasis-free survival (DMFS), defined as the interval from the date of surgery to the date of locoregional relapse and distant metastasis, respectively.

Statistical analysis

All endpoints were estimated by the Kaplan–Meier method and compared by using the log-rank test. Multivariate analyses were carried out by using the Cox proportional hazards model to identify important prognostic factors for OS. All variables reaching a significance of 0.1 in univariate analyses were tested in the Cox model. Two-sided P values of <0.05 were considered statistically significant. All analyses were performed using the SPSS16.0 software (SPSS Inc., Chicago, IL, USA).

Results

Patient population

A total of 1601 patients with NSCLC who underwent curative resection were included in this study (Table 1; Fig. 1). In the present study, blood types A, B, O, and AB were reported in 27.7%, 26.5%, 39.2%, and 6.6% of the patients, respectively, which were similar to those frequencies reported previously for the Guangdong population (type A, 25.02%; type B, 25.91%; type O, 42.96%; and type AB, 6.11%) [20]. As shown in Table 1, there were no significant differences in the basic characteristics of our study population based on the blood type. Overall, more than one-half of the patients were presented with adenocarcinoma, and most of the patients were males. Current smokers made up approximately half of all patients.

Table 1 Basic characteristics in distinct ABO blood type groups of patients with non-small cell lung cancer (NSCLC)
Full size table
Fig. 1
figure1

The process of patient selection in this study. A total of 1601 patients with non-small cell lung cancer who underwent curative resection were included in this study

Full size image

Associations between the ABO blood type and survival

The median follow-up was 81.0 months [95% confidence interval (CI) 78.9–83.1 months] for the entire study population. By the time of analysis (January 15, 2015), 360 instances of locoregional relapse, 371 instances of distant metastases, and 810 instances of death had occurred. The median OSs for patients with blood types O, B, A, and AB were 75.4, 72.9, 62.6, and 56.5 months, respectively (P = 0.083; Fig. 2a); the median DFSs were 48.9, 49.3, 37.9, and 33.8 months for those with blood types O, B, A, and AB, respectively (P = 0.128, Fig. 2b). We found that patients with the blood type O or B had longer OS and DFS compared with those with the blood type A or AB, whereas OS and DFS were similar between patients with the blood types O and B as well as between those with the blood types A and AB. Therefore, we divided the entire cohort into group 1 (patients with the blood type O or B) and group 2 (patients with the blood type A or AB).

Fig. 2
figure2

Kaplan–Meier survival curves stratified by the ABO blood type in 1601 patients with curatively resected non–small cell lung cancer. a Overall survival for four groups stratified by the ABO blood type. b Disease-free survival for four groups stratified by the ABO blood type

Full size image

The OS, DFS, LRFS, and DMFS curves are shown in Fig. 3. Group 1 had significantly prolonged OS compared with group 2, with a median OS of 74.9 months compared with 61.5 months, respectively [hazard ratio (HR) 0.83; 95% CI 0.72–0.96; P = 0.015; Fig. 3a]. Additionally, group 1 had a significantly longer DFS (HR 0.86; 95% CI 0.76–0.98; P = 0.022; Fig. 3b) and LRFS (HR 0.79; 95% CI 0.64–0.98; P = 0.024; Fig. 3c) than group 2. However, no significant difference was observed for DMFS between group 1 and group 2 (HR 0.89; 95% CI 0.72–1.10; P = 0.294; Fig. 3d).

Fig. 3
figure3

Kaplan–Meier survival curves for 1601 patients with curatively resected non-small cell lung cancer. a Group 1 (patients with the blood type O or B) had significantly prolonged overall survival compared with group 2 (patients with the blood type A or AB). b Group 1 had significantly prolonged disease-free survival compared with group 2. c Group 1 had significantly prolonged locoregional relapse-free survival compared with group 2. d No significant difference was observed for distant metastasis-free survival between groups 1 and 2

Full size image

The association of OS with clinicopathologic characteristics was further analyzed using univariate and multivariate analyses. In the univariate analysis, males, smoking history, pT category of 3/4, pN category of 1/2, stage IIIA, pneumonectomy, no chemotherapy, and the blood type A/AB were identified as negative prognostic factors. When these variables were further analyzed in the multivariate analysis, we found that smoking status, pT category, pN category, pathologic tumor-node-metastasis (pTNM) stage, chemotherapy, and blood group had significant HRs, indicating that they were significant predictors of survival (Table 2).

Table 2 Univariate and multivariate analyses for overall survival (OS) of NSCLC patients
Full size table

Discussion

Recently, the association between the ABO blood type and survival of cancer patients has drawn much attention. When this study was designed, the association between the ABO blood type and survival of patients with curatively resected NSCLC had not yet been explored. In this retrospective study of Chinese patients with completely resected NSCLC, patients with the blood type O or B had longer OS than those with the blood type A or AB. The blood type O or B was also associated with prolonged DFS and LRFS.

Our results of the association between the blood type O and patient survival are consistent with previous studies on other malignancies. The survival advantage of patients with the blood type O has been reported in pancreatic cancer [11, 12], breast cancer [13, 14], renal cell carcinoma [15], and nasopharyngeal carcinoma [16]. The blood type O appears to be a protective factor in the prevention of tumor development [21]. Our results of the association of the blood type A with patient survival are in close agreement with the results from previous studies. The blood type A has been reported to be associated with poor prognosis in patients with pancreatic cancer [11], nasopharyngeal carcinoma [16], and colon cancer [17]. However, controversy still exists about the relation between the ABO blood type and patient survival because many publications reported negative results [22–26]. As our study was completed, the first report concerning the association between the ABO blood type and survival of patients with resected NSCLC was published [27]. The results of that study showed that the ABO blood type was an independent prognostic factor for resected NSCLC, and the blood group A antigen might be associated with poor prognosis of patients with resected NSCLC. The number of patients was relatively small (n = 333), and some patients did not undergo complete resection in their study [27]. In our study, by contrast, the number of patients was relatively large (n = 1601), and all patients received curative resection for NSCLC.

Although the associations of the ABO blood type with cancer risk and survival have been reported in several malignancies [11–17], the genetic or biological mechanisms underlying the associations remain unclear. The ABO gene encodes three glycosyltransferases, which attach N-acetylgalactosamine, d-galactose, and no sugar residue to the H antigen backbone to form blood types A, B, and O, respectively [6]. In addition to their expression on the surface of red blood cells, ABO blood group antigens are expressed on the surface of cells from the gastrointestinal tract, urogenital tract, bronchopulmonary duct, skin, and breast duct [28, 29]. Loss of blood group antigen A/B expression on cancer cells is regulated by hypermethylation of the ABO gene promoter, which is an early event in tumor development [30]. Loss of ABO blood group antigens from tumor cells is associated with poor prognosis and increased metastatic potential in NSCLC [18, 31, 32]. Lee et al. [18] reported that the 28 patients with the blood type A or AB who had antigen A-negative tumors had significantly shorter survival than the 43 patients with the blood type A or AB who had antigen A-positive tumors and the 93 patients with the blood type O or B free of antigen A (median survival: 15 months versus 71 and 39 months, P < 0.001 and P = 0.002, respectively). These results may partially explain the positive association between the blood type A and poor prognosis in patients with NSCLC.

Other potential mechanisms underlying the association between the ABO blood types and patient survival include the host inflammatory state. Single nucleotide polymorphisms (SNPs) at the ABO locus have been reported to be associated with circulating levels of tumor necrosis factor-alpha (TNFα), soluble intracellular adhesion molecule-1 (sICAM-1), E-selectin, and P-selectin [33–36]. These serum molecules are associated with inflammatory responses that are associated with the processes of angiogenesis, tumor growth, invasion, and migration. Tumor development is induced by the inflammatory microenvironment, which consists of inflammatory cells and inflammatory mediators [37]. In particular, chronic inflammatory conditions predispose individuals to multiple types of malignancies and are linked to tumor invasion and metastasis [38]. The study by Suadicani et al. [39] suggested that the predictive values of inflammation-related risk factors for lung cancer mortality, including smoking history, high salt consumption, high alcohol intake, and occupational dust exposure, were high among males with the blood type O compared with those with the blood type A. Thus, the inflammatory state could be a possible mechanism explaining the association between the ABO blood types and patient prognosis.

This study nevertheless has several limitations that should be noted. The crucial disadvantage of this analysis is its retrospective nature. Because all patients were in-hospital, the possibility of selection bias cannot be ruled out. Another limitation is that East Asians constitute most of our study population. The monotonicity of the study population limits the universality of our results. Furthermore, only limited variables could be included in the multivariate analysis. Other factors, such as anaplastic lymphoma kinase (ALK) rearrangement status, may be significant prognostic factors for NSCLC, but these data are not currently available. Future well-designed studies that include diverse ethnic populations are warranted to further investigate the prognostic role of the ABO blood types in NSCLC patients. Additionally, other potential clinicopathologic factors should be considered.

Conclusions

The ABO blood types were associated with survival of Chinese patients with curatively resected NSCLC. Patients with the blood type O or B had significantly longer OS, DFS, and LRFS than those with the blood type A or AB. Potential mechanisms underlying this association warrant further investigation.

Abbreviations

NSCLC:

non-small cell lung cancer

HR:

hazard ratio

CI:

confidence interval

OS:

overall survival

DFS:

disease-free survival

LRFS:

locoregional relapse-free survival

DMFS:

distant metastasis-free survival

TNM:

tumor-node-metastasis

GWAS:

genome-wide association study

ECOG:

Eastern Cooperative Oncology Group

TNFα:

tumor necrosis factor-alpha

sICAM-1:

soluble intracellular adhesion molecule-1

SNP:

single nucleotide polymorphism

ALK:

anaplastic lymphoma kinase

References

  1. 1.

    Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69–90.

  2. 2.

    Chen W, Zheng R, Zhang S, Zhao P, Li G, Wu L, et al. The incidences and mortalities of major cancers in China, 2009. Chin J Cancer. 2013;32(3):106–12.

  3. 3.

    Du JL, Lin X, Zhang LF, Li YH, Xie SH, Yang MJ, et al. Secular trend analysis of lung cancer incidence in Sihui city, China between 1987 and 2011. Chin J Cancer. 2015;34:33.

  4. 4.

    D’Addario G, Fruh M, Reck M, Baumann P, Klepetko W, Felip E. Metastatic non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21(Suppl 5):v116–9.

  5. 5.

    Fry WA, Phillips JL, Menck HR. Ten-year survey of lung cancer treatment and survival in hospitals in the United States: a national cancer data base report. Cancer. 1999;86(9):1867–76.

  6. 6.

    Yamamoto F, Clausen H, White T, Marken J, Hakomori S. Molecular genetic basis of the histo-blood group ABO system. Nature. 1990;345(6272):229–33.

  7. 7.

    Haslam DB, Baenziger JU. Expression cloning of Forssman glycolipid synthetase: a novel member of the histo-blood group ABO gene family. Proc Natl Acad Sci USA. 1996;93(20):10697–702.

  8. 8.

    Amundadottir L, Kraft P, Stolzenberg-Solomon RZ, Fuchs CS, Petersen GM, Arslan AA, et al. Genome-wide association study identifies variants in the ABO locus associated with susceptibility to pancreatic cancer. Nat Genet. 2009;41(9):986–90.

  9. 9.

    Xu HL, Cheng JR, Zhang W, Wang J, Yu H, Ni QX, et al. Re-evaluation of ABO gene polymorphisms detected in a genome-wide association study and risk of pancreatic ductal adenocarcinoma in a Chinese population. Chin J Cancer. 2014;33(2):68–73.

  10. 10.

    Zhang BL, He N, Huang YB, Song FJ, Chen KX. ABO blood groups and risk of cancer: a systematic review and meta-analysis. Asian Pac J Cancer Prev. 2014;15(11):4643–50.

  11. 11.

    Ben Q, Wang K, Yuan Y, Li Z. Pancreatic cancer incidence and outcome in relation to ABO blood groups among Han Chinese patients: a case-control study. Int J Cancer. 2011;128(5):1179–86.

  12. 12.

    Rahbari NN, Bork U, Hinz U, Leo A, Kirchberg J, Koch M, et al. ABO blood group and prognosis in patients with pancreatic cancer. BMC Cancer. 2012;12:319.

  13. 13.

    Holdsworth PJ, Thorogood J, Benson EA, Clayden AD. Blood group as a prognostic indicator in breast cancer. Br Med J (Clin Res Ed). 1985;290(6469):671–3.

  14. 14.

    Costantini M, Fassio T, Canobbio L, Landucci M, Resasco M, Boccardo F. Role of blood groups as prognostic factors in primary breast cancer. Oncology. 1990;47(4):308–12.

  15. 15.

    Kaffenberger SD, Morgan TM, Stratton KL, Boachie AM, Barocas DA, Chang SS, et al. ABO blood group is a predictor of survival in patients undergoing surgery for renal cell carcinoma. BJU Int. 2012;110(11 Pt B):E641–6.

  16. 16.

    Ouyang PY, Su Z, Mao YP, Liu Q, Xie FY. Prognostic value of ABO blood group in southern Chinese patients with established nasopharyngeal carcinoma. Br J Cancer. 2013;109(9):2462–6.

  17. 17.

    Cao X, Wen ZS, Sun YJ, Li Y, Zhang L, Han YJ. Prognostic value of ABO blood group in patients with surgically resected colon cancer. Br J Cancer. 2014;111(1):174–80.

  18. 18.

    Lee JS, Ro JY, Sahin AA, Hong WK, Brown BW, Mountain CF, et al. Expression of blood-group antigen A—a favorable prognostic factor in non-small-cell lung cancer. N Engl J Med. 1991;324(16):1084–90.

  19. 19.

    Goldstraw P, Crowley J, Chansky K, Giroux DJ, Groome PA, Rami-Porta R, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol. 2007;2(8):706–14.

  20. 20.

    Chen ZY, Zhao TM, Zhang GL. The distribution of ABO blood group in Chinese. Yichuan. 1982;4(2):4–7 (in Chinese).

  21. 21.

    Jaff MS. Higher frequency of secretor phenotype in O blood group—its benefits in prevention and/or treatment of some diseases. Int J Nanomedicine. 2010;5:901–5.

  22. 22.

    Bryne M, Eide GE, Lilleng R, Langmark F, Thrane PS, Dabelsteen E. A multivariate study of the prognosis of oral squamous cell carcinomas. Are blood group and hemoglobin new prognostic factors? Cancer. 1991;68(9):1994–8.

  23. 23.

    Adam SI, Wilson KM, Overholser SM, Khabbaz E, Moreno K, Patil YJ. Are laryngeal squamous cell carcinoma incidence and patient mortality a function of ABO blood grouping? A retrospective study. J Laryngol Otol. 2012;126(2):180–4.

  24. 24.

    Gates MA, Xu M, Chen WY, Kraft P, Hankinson SE, Wolpin BM. ABO blood group and breast cancer incidence and survival. Int J Cancer. 2012;130(9):2129–37.

  25. 25.

    Nozoe T, Ezaki T, Baba H, Kakeji Y, Maehara Y. Correlation of ABO blood group with clinicopathologic characteristics of patients with esophageal squamous cell carcinoma. Dis Esophagus. 2004;17(2):146–9.

  26. 26.

    Yu J, Gao F, Klimberg VS, Margenthaler JA. ABO blood type/Rh factor and the incidence and outcomes for patients with triple-negative breast cancer. Ann Surg Oncol. 2012;19(10):3159–64.

  27. 27.

    Fukumoto K, Taniguchi T, Usami N, Kawaguchi K, Fukui T, Ishiguro F, et al. The ABO blood group is an independent prognostic factor in patients with resected non-small cell lung cancer. J Epidemiol. 2015;25(2):110–6.

  28. 28.

    Le Pendu J, Marionneau S, Cailleau-Thomas A, Rocher J, Le Moullac-Vaidye B, Clement M. ABH and Lewis histo-blood group antigens in cancer. APMIS. 2001;109(1):9–31.

  29. 29.

    Strauchen JA, Bergman SM, Hanson TA. Expression of A and B tissue isoantigens in benign and malignant lesions of the breast. Cancer. 1980;45(8):2149–55.

  30. 30.

    Gao S, Worm J, Guldberg P, Eiberg H, Krogdahl A, Liu CJ, et al. Genetic and epigenetic alterations of the blood group ABO gene in oral squamous cell carcinoma. Int J Cancer. 2004;109(2):230–7.

  31. 31.

    Graziano SL, Tatum AH, Gonchoroff NJ, Newman NB, Kohman LJ. Blood group antigen A and flow cytometric analysis in resected early-stage non-small cell lung cancer. Clin Cancer Res. 1997;3(1):87–93.

  32. 32.

    Matsumoto H, Muramatsu H, Shimotakahara T, Yanagi M, Nishijima H, Mitani N, et al. Correlation of expression of ABH blood group carbohydrate antigens with metastatic potential in human lung carcinomas. Cancer. 1993;72(1):75–81.

  33. 33.

    Barbalic M, Dupuis J, Dehghan A, Bis JC, Hoogeveen RC, Schnabel RB, et al. Large-scale genomic studies reveal central role of ABO in sP-selectin and sICAM-1 levels. Hum Mol Genet. 2010;19(9):1863–72.

  34. 34.

    Melzer D, Perry JR, Hernandez D, Corsi AM, Stevens K, Rafferty I, et al. A genome-wide association study identifies protein quantitative trait loci (pQTLs). PLoS Genet. 2008;4(5):e1000072.

  35. 35.

    Pare G, Chasman DI, Kellogg M, Zee RY, Rifai N, Badola S, et al. Novel association of ABO histo-blood group antigen with soluble ICAM-1: results of a genome-wide association study of 6,578 women. PLoS Genet. 2008;4(7):e1000118.

  36. 36.

    Qi L, Cornelis MC, Kraft P, Jensen M, van Dam RM, Sun Q, et al. Genetic variants in ABO blood group region, plasma soluble E-selectin levels and risk of type 2 diabetes. Hum Mol Genet. 2010;19(9):1856–62.

  37. 37.

    Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420(6917):860–7.

  38. 38.

    Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008;454(7203):436–44.

  39. 39.

    Suadicani P, Hein HO, Gyntelberg F. ABO phenotypes and inflammation-related predictors of lung cancer mortality: the Copenhagen Male Study—a 16-year follow-up. Eur Respir J. 2007;30:13–20.

Download references

Authors’ contributions

NL, MX, and SYW designed the study. SYW and MX supervised the study. NL, MX, CFL, WO, BXW, SLZ, PFX, and CY collected data. NL, MX, and SYW analyzed the data and drafted the manuscript. All authors read and approved the final manuscript.

Acknowledgements

We would like to thank Prof. Qing Liu for his excellent statistical assistance.

Compliance with ethical guidelines

Competing interests The authors declare that they have no competing interests.

Author information

Author notes

    Affiliations

    1. Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, P.R. China

      • Ning Li
      • , Miao Xu
      • , Chao-Feng Li
      • , Wei Ou
      • , Song-Liang Zhang
      • , Peng-Fei Xu
      • , Cheng Yuan
      •  & Si-Yu Wang

    2. Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China

      • Ning Li
      • , Wei Ou
      • , Song-Liang Zhang
      • , Peng-Fei Xu
      • , Cheng Yuan
      •  & Si-Yu Wang

    3. Department of Experimental Research, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China

      • Ning Li
      •  & Miao Xu

    4. Department of Information Technology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China

      • Chao-Feng Li

    5. Breast Tumor Center, Sun Yat-sen Memorial Hospital, Guangzhou, 510120, Gaungdong, P.R. China

      • Bao-Xiao Wang

    6. Department of Thyroid and Breast Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, Guangdong, P.R. China

      • Qun-Ai Huang

    Authors

    1. Search for Ning Li in:

    2. Search for Miao Xu in:

    3. Search for Chao-Feng Li in:

    4. Search for Wei Ou in:

    5. Search for Bao-Xiao Wang in:

    6. Search for Song-Liang Zhang in:

    7. Search for Peng-Fei Xu in:

    8. Search for Cheng Yuan in:

    9. Search for Qun-Ai Huang in:

    10. Search for Si-Yu Wang in:

    Corresponding author

    Correspondence to Si-Yu Wang.

    Additional information

    Ning Li and Miao Xu contributed equally to this work

    Rights and permissions

    Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

    Reprints and Permissions

    About this article

    Verify currency and authenticity via CrossMark

    Keywords

    • The ABO blood types
    • Lung cancer
    • Prognosis
    • Survival

    Cancer Communications

    ISSN: 2523-3548

    Contact us