Number of researches dealing with the influence of the ABO blood group antigens on the development of the oral cancer
have hypothesized that people who do not secrete these substances in the saliva are more prone to suffer from this disease.
The objective of this research is to examine this hypothesis. In total 114 subjects were examined, half of which suffered
from oral cancer, while the other half was the healthy control group. All examinees were subjected to clinical examinations
and the experimental group to pathohistological examination. An analysis of the secretor status was carried out using
the Wiener agglutination test. The experimental group consisted of 78,95% of secretors, while the control group consisted
of 82,46% of secretors. This difference is not statistically significant. The starting hypothesis that non-secretors are
more prone to the development of oral cancer was not confirmed

Linda Caser

Margita Belušić

Mate Rogić

Mirna Juretić

Robert Cerović

Sanja Balen

English

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Coll. Antropol. 32 (2008) 2: 509–512Original scientific paperExamining the Presence of ABO(H) Antigensof Blood Types in the Saliva of Patients withOral CancerRobert Cerovi}1, Mirna Jureti}1, Sanja Balen2, Margita Belu{i}1, Linda Caser2 and Mate Rogi}11 Maxillofacial and Oral Surgery Clinic, University Hospital Center, Rijeka, Croatia2 Department of Transfusiology, University Hospital Center, Rijeka, CroatiaA B S T R A C TNumber of researches dealing with the influence of the ABO blood group antigens on the development of the oral cancerhave hypothesized that people who do not secrete these substances in the saliva are more prone to suffer from this disease.The objective of this research is to examine this hypothesis. In total 114 subjects were examined, half of which sufferedfrom oral cancer, while the other half was the healthy control group. All examinees were subjected to clinical examina-tions and the experimental group to pathohistological examination. An analysis of the secretor status was carried out us-ing the Wiener agglutination test. The experimental group consisted of 78,95% of secretors, while the control group con-sisted of 82,46% of secretors. This difference is not statistically significant. The starting hypothesis that non-secretors aremore prone to the development of oral cancer was not confirmed.Key words: secretor status, ABO antigens, oral cancerIntroductionOral cancer has a significant place in the epidemiol-ogy of malignant diseases. Head and neck squamous cellcarcinoma was the eight leading cause of cancer deathworldwide in 20001.The risk factors for oral cancer have been studied indetail. Alcohol, tobacco smoking and nutritional statusare well known factors associated with the increased riskof oral cancer. Other possible factors in the developmentof oral cancer, such as Human Papillomavirus and ABOantigens, are also being researched1,2. Existing resear-ches link these factors with the development of cancer,but the results are different and still only hypothesiswhich have to be proven. A possible risk marker for thesusceptibility to oral cancer is patients’ secretor status.Some people posses the ability to secrete blood groupsubstances in the saliva and they are referred to as »se-cretors«, whereas others who lack such an ability are re-ferred to as »non-secretors«. It has been demonstrated ina number of earlier studies that the patient’s secretorstatus may probably be a factor influencing the develop-ment of systemic oral disease 3.Immunohystochemical studies of oral squamous cellcarcinomas have shown loss of expression of A or B anti-gens in more than 80% of cases. Studies of potentiallymalignant lesion have shown loss of A/B antigen in mostlesions with epithelial dysplasia, and in the half of the le-sions clinically classified as leukoplakia but without his-tological evidence of epithelial dysplasia4,5.Lamey et al. (1994) investigated the secretor status inthe saliva of a group of Sri Lankan patients and foundthat secretor status does not appear to be an associatedrisk marker for the development of oral cancer2. Fewyears later Vidas et al. (1999) examined the influence ofthe secretor status on certain precancerous lesions inoral cavity and stated that an inability to secrete bloodgroup antigens in saliva could be regarded as a risk factorin the development of oral cancer3.The goal of this research was to examine the hypothesisregarding the influence of secretor status on the develop-ment of oral cancer in a selected Croatian-European pop-ulation.509Received for publication August 29, 2005Materials and Methods57 patients with diagnosed oral carcinoma were ex-amined, along with the same number of people with nopathological changes in the mouth in the control group.The experimental group consisted of 47 men ad 10women. The average age of examinees was 62. The con-trol group consisted of the same number of men andwomen as the experimental group, but the average agewas 60. A biopsy and histopathological analysis has beendone on all the patients, and they have all had a pla-nocellular carcinoma diagnosed. Stages of diseases var-ied a lot, depending on when they had contacted theirmedic. All the patients had primary tumor and none hadbeen previously treated for the same disease.Data were examined with a ÷2 test.Establishing the secretor status in the saliva31 ml of no stimulated saliva has been collected fromeach patient, by a negative pressure suck-pump, into asterile glass jar, and afterwards the saliva was pouredinto a sterile test-tube shut with a rubber or a plasticcover. Test-tube was left to rest for approximately 10minutes in a boiling water bath (to destroy enzymes). Af-ter that, supernatant was extracted by centrifugal forceof 1700 turns through 10 minutes. Applying the Wieneragglutination test the secretor status was analyzed. Testserum used in this experiment, was diluted in a saltedphysiological solution in proportion 1:10, the same pro-portion that the saliva was diluted in.The following antiserum was then placed into test--tubes marked I to IV:I 1 drop of saliva + 1 drop of anti-B serumII 1 drop of saliva + 1 drop of anti-A serumIII 1 drop of physiological solution + 1 drop of anti-BserumIV 1 drop of physiological solution + 1 drop of anti-AserumAfter 10 or more minutes at room temperature, 1drop of 2–3% of suspension A erythrocytes was addedinto sterile tube II and IV, and 1 drop of suspension Berythrocytes into tube I and III. All the test tubes wereshook, and left on room temperature. After one hour theresults were ready for reading.Test-tubes III and IV were control and agglutinationoccurred in them. Agglutination in tube I is a result ofthe presence of substance A2 in a saliva, i.e. of sector A,while the agglutination in tube II is a proof of B sector.The absence of agglutination in tubes I and II designatedAB secretor, and at the same time agglutination in tubesI and II has proven that the person is non-secretor.ResultsMost of our examinees in, both experimental and incontrol group are secretors. The secretor status of pa-tients with oral carcinoma is shown in figure 1, and thestatus of the healthy, control group, is shown in figure 2.In the experimental group 45 examinees out of 57, or78.95%, are secretors while 12 patients, or 21.02% do nothave blood group antigen in saliva.47 people in the control group are secretors, or 82.46%and 10 people are non-secretors, or 17.54%. The differ-ence between control and experimental groups does nothave statistical significance (p>0.05).Table 1 shows test results of the secretor status re-garding sex. We can see that out of total of 47 men in theexperimental group, 8 (17%) are non-secretors, and 39are secretors (83%). In the control group 40 men are se-cretors (85.1%), and 7 are non-secretors (14.9%) Out of10 women in the experimental group 6 of them (60%) aresecretors, and 4 women are non-secretors (40%). 7 wo-men in the control group are secretors (70%) and 3 arenon-secretors (30%).The differences between the controland the experimental group are not statistically signifi-cant (p>0.05).R. Cerovi} et al.: ABO(H) Antigens and Oral Cancer, Coll. Antropol. 32 (2008) 2: 509–512510Exsperimental group21%79%SecretorsNon-secretorsFig. 1. Secretor status of 57 examinees in the experimental group(79%) which consisted of 45 secretors and 12 non-secretors (21%).Control group18%82%SecretorsNon-secretorsFig. 2. Secretor status of 57 examinees in the control group whichconsisted of 47 secretors (82%) and 10 non-secretors (18%).TABLE 1RELATION OF SECRETOR STATUS REGARDING SEXAND AGE OF EXAMINEESExperimental group Control groupSecretors Non-secretors Secretors Non-secretorsMen 39 8 40 7Women 6 4 7 3Total 45 12 47 10DiscussionA number of studies show the relation between theexpression of A or B blood group antigens and malignanttumors4,6–8. Experimental studies of rat colon carcinomacells indicate that cells with A expressions are tumoro-genic but cannot be compared with human carcinoge-nesis because the expression of blood group antigen is op-posite that seen in the human4,8. Studies with humancolon carcinoma cell lines have shown that loss of expres-sion of AB glycosyltransferase can enhance malignancy ofthe cell lines4,9. Studies of bladder cancer indicate thatloss of A/B expression involves the deletion of large chro-mosomal region including the ABO locus at 9q34 1–2,which may contain one or more tumor suppressor ge-nes4,7. In the normal oral cavity, keratinized epitheliumin the palate or gingiva shows little or no expression of Aor B blood group antigen. Since a change from a non--keratinized to a keratinized differentiation pattern is acharacteristic of many oral carcinomas and potentiallymalignant lesions, the lack of expression of blood groupin such lesions could be due to a change in differentiationpattern of the epithelium4. However, it has been demon-strated that half of the leukoplakias that developed inthe buccal mucosa show expression of A antigen, eventough they histologicaly appear as keratinized lesions4,5.These findings indicate that loss of antigen is not neces-sarily associated with hyperkeratinization or even withoral cancer.Lamey et al. (1991) investigated the secretor status insaliva of a group of patients with chronic hyperplasticcandidiasis, and compared with a corresponding controlgroup of healthy examinees. They discovered that 68% ofthose having the disease were non-secretors, whereas thepercentage of non-secretors in the control group was sta-tistically significantly lower. Candidal leukoplakia wasconsidered as belonging to precancerous lesions, there-fore, a hypothesis that the non-secretor status may havean impact in the pathogenesis of oral cancer in non--secretors should be considered3,10.The motive for this research was the article writtenby a group of authors – Vidas et al. (1999), who examinedthe influence of secretor status on certain precancerouslesion in oral cavity3. What is stated in the article is thenotion that non-secretors have a more intensive disease,with higher probability of gaining epithelial dysplasia,what leads us to a conclusion that non-secretors might bemore prone to the development of oral carcinoma. Eventhough such a research was already conducted (Lamey etal. 1994)2, we wanted to examine the patients from thesame population (European) that was examined in theresearch by Vidas et al., because the research by Lameyet al. was conducted on the Sri Lankan population.The results did not show a significant difference be-tween the secretor and non-secretor status in the re-search and the control group (17% non-secretors in theresearch group and 15% in the control group). Similar re-sults can be found in Lamey et al. research of the secretorstatus in the saliva of oral carcinoma patients2.Since the Vidas et al. experiment included mostly fe-male population, and we could not have chosen such asample, because most of oral carcinoma patients aremen, we tested the relation between the secretor statusand the sex of our examinees. Even here we could notfind significant differences between the control and theresearch group.Authors of previously mentioned article tested a cou-ple of changes that can be considered as pre-cancerous le-sions, leukoplakia and lichen ruber planus and erosivus.However, only a few of those changes have strong epithe-lial dysplasia and those that do contain such a pathohis-tological component, rarely alter into malign. Precancer-ous lesion that has a more significant malign alteration iserythroplakia11,12, but Vidas et al. research did not in-clude a single examinee with such an alteration in oralcavity. Authors state that there is significantly largerpercentage of non-secretors found in patients that haveprecancerous lesion with strong epithelial dysplasia,therefore more non-secretors can be found among pa-tients with oral carcinoma3. The results of this study donot confirm this hypothesis.ConclusionThough existing laboratory and clinic researches donot show the correlation between ABO blood group anti-gens and the development of oral carcinoma, this is notclinically confirmed. A few existing clinic researcheshave been conducted on a small number of examineesand results vary a lot. Based on this brief research we cannot state that there is a correlation between the presenceof ABO antigens in the saliva and the development oforal carcinoma. The starting hypothesis that non- secre-tors are more prone to development of oral carcinoma isnot confirmed.R E F E R E N C E S1. RAGIN CCR, MODUGNO F, GOLLIN SM, J Dent Res, 86 (2007)104. — 2. LAMEY PJ, DOUGLAS PS, NAPIER SS, Br J Oral MaxillofacSurg, 32 (1994) 214. — 3. VIDAS I, DELAJLIJA M, TEMMER VB, STI-PETIC MM, CINDRIC N, MARICIC D, J Oral Rehabil, 26 (1999) 177. —4. DABELSTEEN E, GAO S, J Dent Res, 84 (2004) 21. — 5. GAO S,BENNET EP, REIBEL J, CHEN XC, CHRISTENSEN ME, KROHDAHLA, APMIS, 112 (2004) 11. — 6. MANDEL U, LANGKILDE NC, ORN-TOFT TF, THERDKILSEN MH, KARKOV J, REIBEL J, Int J Cancer, 52(1992) 7. — 7. ORLOW I, LACOMBE L, PELLICER I, RABBANI F, DEL-GADO R, ZHANG ZF, Int J Cancer, 75 (1998) 819. — 8. MARINNEAU S,MOLLAC VB, LE PENDU J, Glycobiology, 12 (2002) 851. — 9. ICHIKA-WA D, HANDA K, WITHERS DA, HAKOMORI S, Cancer Res, 57 (1997)3092. — 10. LAMEY PJ, DARWAZEH AMG, FISHER BM, SAMARAYA-NAKE LP, MACFARLANE TW, J Oral Pathol Med, 20 (1991) 67. — 11.SILVERMAN S, GORSKY M, LOZADA F, Cancer, 53 (1984) 563. — 12.SHAFER WG, WALDRON CA, 36 (1975) 1921.R. Cerovi} et al.: ABO(H) Antigens and Oral Cancer, Coll. Antropol. 32 (2008) 2: 509–512511R. Cerovi}Maxillofacial and Oral Surgery Department, Clinical Hospital Center Tome Stri`i}a 3, 51000 Rijeka, Croatiae-mail: robert.cerovicºri.t-com.hrISPITIVANJE PRISUTNOSTI ABO(H) ANTIGENA KRVNIH GRUPA U SLINI BOLESNIKAOBOLJELIH OD ORALNOG KARCINOMAS A @ E T A KU malobrojnim, do sada objavljenim istra`ivanjima o uticaju ABO antigena krvnih grupa na razvoj oralnog kar-cinoma, postavljena je hipoteza da bi osobe koje nemaju sposobnost lu~enja tih supstanci u slini (nesekretori), moglebiti sklonije obolijevanju od te bolesti. Cilj ovog istra`ivanja bio je ispitati navedenu hipotezu. Ukupno je ispitano 114ispitanika, od kojih je polovica bolovala od oralnog karcinoma, dok su drugu, kontrolnu grupu sa~injavali zdravi ispi-tanici. Svi su ispitanici klini~ki pregledani, a eksperimentalnoj grupi u~injena je patohistolo{ka dijagnoza. Ispitivanjesekretornog statusa u~injeno je pomo}u Wienner-ovog testa aglutinacije. U eksperimentalnoj grupi bilo je 78,95% se-kretora, dok je u kontrolnoj grupi bilo 82,46% sekretora. Ta razlika nije statisti~ki zna~ajna. Po~etna hipoteza da sunesekretori skloniji obolijevanju od oralnog carcinoma nije potvr|ena.R. Cerovi} et al.: ABO(H) Antigens and Oral Cancer, Coll. Antropol. 32 (2008) 2: 509–512512

Examining the Presence of ABO(H) Antigens of Blood Types in the Saliva of Patients with Oral Cancer

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Examining the Presence of ABO(H) Antigens of Blood Types in the Saliva of Patients with Oral Cancer

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