International Urology and Nephrology 24 (4), pp. 417-- 423 (1992)
Prognostic Variables in Patients with Prostate Cancer: Influence of Blood Group ABO (H), the Rhesus System, Age, Differentiation, Tumour Stage and Metastases E. KVIST, J. KROGH, P. HJORTBERG Department of Urology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark (Accepted September 25, 1991) Among 279 patients with carcinoma of the prostate no relationship was observed in survival between Mood groups ABO (H) or the rhesus system. Age at diagnosis is relevant for the outcome of the disease, but grade of differentiation, tumour stage and metastases are more important predictors of survival. In Denmark, carcinoma of the prostate (Ca-P) is the second most common cancer in men, and most epidemiologic surveys suggest that the incidence is increasing [4]. A significant number of these patients will present with advanced disease [14] and up to 45 per cent have metastases at the time of diagnosis [4, 6]. The overall survival rate is between 30% and 43% at 5 years [7, 17]. Only little progress has been made in understanding the mechanisms and factors responsible for the development of the cancer. One limiting aspect of managing a patient with Ca-P is the difficulty of finding reliable prognostic factors. Markers such as histological differentiation, tumour stage, prostate-specific antigen, acid phophatase and nuclear D N A analysis have provided some guidance for treatment and prognosis [4, 5, 11, 12, 13, 16]. Recent studies of patients with bladder tumours have shown a relationship between prognosis and blood group ABO (H) [8]. The ABO (H) system is genetically determined, and as the prostate as well as the bladder except the trigone (mesodermal) is of endodermal origin [10] a correlation between the ABO (H) system and development of cancer of the prostate likewise could be possible. Turowska et al. [15] found that the phenotype A was more frequent in patients with Ca-P compared to healthy controls. In view of this we wanted to examine the relationships of Ca-P, blood groups ABO and the rhesus system and, if a correlation was found, to evaluate in what way the blood groups influenced the clinical and morphological pattern of disease. Material and methods
The study comprised 279 males, treated at the Department of Urology, Bispebjerg Hospital, Copenhagen, in the years 1980-1983. The mean age was 75.6 years (range 58-94). Of these, 232 patients (83 %) were older than 70 and 47 VSP, Utrecht Akad~miai Kiad6, Budapest
418
Kvist et aL : Prognostics o f prostate cancer
were younger than 70. In all cases the diagnosis of carcinoma of the prostate was established by histological examination and the histological grade was classified into three main groups: well differentiated, moderately differentiated and poorly differentiated. Tumour staging was done by rectal examination using the TNM system. Lymph node staging was not performed. Only patients with symptoms of bone metastases were investigated with radioisotopic bone scan and plain film and at diagnosis 61 patients (21%) had symptomatic bone metastases. Patients without symptoms after initial outflow tract surgery or biopsy received no further treatment and were managed by a deferred treatment policy. Patients having symptomatic progression due to bone metastases but unrelated to bladder outflow obstruction received hormone therapy (LHRH agonist, Zoladex| or orchiectomy). In all the records the patients' blood group ABO (H) as well as the rhesus system were available. Actuarial survival curves were calculated according to the Kaplan-Meier method and compared by the log rank method. P values below 5 % were considered statistically significant. Results
The blood group distribution is similar to that of the Danish population (Table 1), with blood group O and A being the most frequent. Figures 1 and 2 illustrate survival in patients with blood group ABO (H) (P = 0.33) and the rhesus system (P = 0.96). Figures 3 and 4 show survival according to grades of differentiation and tumour stages. The poorly differentiated tumours had a 5-year survival of 22 70, compared to 46 % in patients with well-differentiated tumour (P < 0.05) (Table 2), and tumour stage T Oand T1 had a 5-year survival of about 41%, compared to 13 % in patients with tumour stage T 4 (P < 0.05) (Table 3). Comparing low-stage t u m o u r s ( T 0 _ l _ 2; 178 = 63 %) with high-stage tumours (T3_ 4; 37%) a significantly higher 5-year survival rate was found in the former group (P = 0.00005). During the observation period (1980-1988), 69 patients developed metastatic disease, so totally 130 patients (46.5 %) had or developed symptomatic Table 1 Distribution of blood groups ABO (H) and the rhesus system in patients with prostate cancer and in the general population Blood
groups
Material (%) Danish population (~) 5-year survival (%) (material)
A
B
AB
Rh pos.
Rh neg.
44.0
86
14
38.7
12.2
(33-45)
(7-17)
41
1l
4
44
85
15
34.3
28
27.1
30.5
32
32
International Urology and Nephroloyy 24, 1992
5.0
O
(3-8)
(38-50) (82-90) (10-19)
419
K v i s t et al. : Proynostics o f prostate cancer
tO0 k
90
-5>
A (n=108)
80
~\~\
B ( n = 34)
70
-~
AB(n=
6O . : k ~ \
14)
...... O (n=123)
' ~ ' "~ ' ~
Prognostic Variables in Patients with Prostate Cancer: Influence of Blood Group ABO (H), the Rhesus System, Age, Differentiation, Tumour Stage and Metastases E. KVIST, J. KROGH, P. HJORTBERG Department of Urology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark (Accepted September 25, 1991) Among 279 patients with carcinoma of the prostate no relationship was observed in survival between Mood groups ABO (H) or the rhesus system. Age at diagnosis is relevant for the outcome of the disease, but grade of differentiation, tumour stage and metastases are more important predictors of survival. In Denmark, carcinoma of the prostate (Ca-P) is the second most common cancer in men, and most epidemiologic surveys suggest that the incidence is increasing [4]. A significant number of these patients will present with advanced disease [14] and up to 45 per cent have metastases at the time of diagnosis [4, 6]. The overall survival rate is between 30% and 43% at 5 years [7, 17]. Only little progress has been made in understanding the mechanisms and factors responsible for the development of the cancer. One limiting aspect of managing a patient with Ca-P is the difficulty of finding reliable prognostic factors. Markers such as histological differentiation, tumour stage, prostate-specific antigen, acid phophatase and nuclear D N A analysis have provided some guidance for treatment and prognosis [4, 5, 11, 12, 13, 16]. Recent studies of patients with bladder tumours have shown a relationship between prognosis and blood group ABO (H) [8]. The ABO (H) system is genetically determined, and as the prostate as well as the bladder except the trigone (mesodermal) is of endodermal origin [10] a correlation between the ABO (H) system and development of cancer of the prostate likewise could be possible. Turowska et al. [15] found that the phenotype A was more frequent in patients with Ca-P compared to healthy controls. In view of this we wanted to examine the relationships of Ca-P, blood groups ABO and the rhesus system and, if a correlation was found, to evaluate in what way the blood groups influenced the clinical and morphological pattern of disease. Material and methods
The study comprised 279 males, treated at the Department of Urology, Bispebjerg Hospital, Copenhagen, in the years 1980-1983. The mean age was 75.6 years (range 58-94). Of these, 232 patients (83 %) were older than 70 and 47 VSP, Utrecht Akad~miai Kiad6, Budapest
418
Kvist et aL : Prognostics o f prostate cancer
were younger than 70. In all cases the diagnosis of carcinoma of the prostate was established by histological examination and the histological grade was classified into three main groups: well differentiated, moderately differentiated and poorly differentiated. Tumour staging was done by rectal examination using the TNM system. Lymph node staging was not performed. Only patients with symptoms of bone metastases were investigated with radioisotopic bone scan and plain film and at diagnosis 61 patients (21%) had symptomatic bone metastases. Patients without symptoms after initial outflow tract surgery or biopsy received no further treatment and were managed by a deferred treatment policy. Patients having symptomatic progression due to bone metastases but unrelated to bladder outflow obstruction received hormone therapy (LHRH agonist, Zoladex| or orchiectomy). In all the records the patients' blood group ABO (H) as well as the rhesus system were available. Actuarial survival curves were calculated according to the Kaplan-Meier method and compared by the log rank method. P values below 5 % were considered statistically significant. Results
The blood group distribution is similar to that of the Danish population (Table 1), with blood group O and A being the most frequent. Figures 1 and 2 illustrate survival in patients with blood group ABO (H) (P = 0.33) and the rhesus system (P = 0.96). Figures 3 and 4 show survival according to grades of differentiation and tumour stages. The poorly differentiated tumours had a 5-year survival of 22 70, compared to 46 % in patients with well-differentiated tumour (P < 0.05) (Table 2), and tumour stage T Oand T1 had a 5-year survival of about 41%, compared to 13 % in patients with tumour stage T 4 (P < 0.05) (Table 3). Comparing low-stage t u m o u r s ( T 0 _ l _ 2; 178 = 63 %) with high-stage tumours (T3_ 4; 37%) a significantly higher 5-year survival rate was found in the former group (P = 0.00005). During the observation period (1980-1988), 69 patients developed metastatic disease, so totally 130 patients (46.5 %) had or developed symptomatic Table 1 Distribution of blood groups ABO (H) and the rhesus system in patients with prostate cancer and in the general population Blood
groups
Material (%) Danish population (~) 5-year survival (%) (material)
A
B
AB
Rh pos.
Rh neg.
44.0
86
14
38.7
12.2
(33-45)
(7-17)
41
1l
4
44
85
15
34.3
28
27.1
30.5
32
32
International Urology and Nephroloyy 24, 1992
5.0
O
(3-8)
(38-50) (82-90) (10-19)
419
K v i s t et al. : Proynostics o f prostate cancer
tO0 k
90
-5>
A (n=108)
80
~\~\
B ( n = 34)
70
-~
AB(n=
6O . : k ~ \
14)
...... O (n=123)
' ~ ' "~ ' ~
