BLOOD-GROUP ANTIGEN A AND FLOW CYTOMETRIC ANALYSIS IN RESECTED EARLY-STAGE NONSMALL CELL LUNG-CANCER

The loss of blood group antigen A on tumor tissue has been reported to be a strong adverse prognostic marker for patients with resected non- small cell lung cancer (NSCLC), Results have varied with respect to th e prognostic significance of flow cytometric data, We sought to confir m the prognostic significance of blood group antigen A loss and flow c ytometry in a large cohort of patients with early-stage NSCLC. Two hun dred and sixty patients with surgically resected stage I(n = 193) and II (rt = 67) NSCLC with at least a 5-year follow-up were identified, U sing paraffin-embedded primary tumor, immunohistochemical stains for b lood group antigen A were performed on 90 patients with blood type A o r AB, The DNA index and percentage of cells in S phase were successful ly obtained on 188 and 152 patients, respectively, The median survival time of the patients with primary tumors negative for blood group ant igen A was 38 months (II = 36), compared with 98 months (n = 54) for t hose with antigen A-positive tumors (P < 0.01), The median disease-fre e survival times for antigen A-negative and -positive tumors were 26 m onths and 98 months, respectively (P < 0.01), The median survival time of the patients with aneuploid tumors was 51 months (n = 131), compar ed with 50 months (n = 57) for those with diploid tumors (P = 0.42), T he median survival time of the patients with S phase >8% was 44 months (n = 105), compared with 60 months (n = 47) for those with S phase le ss than or equal to 8% (P = 0.18), Multivariate analysis showed that t he loss of antigen A, higher N and T stages, and the presence of mucin predicted for poorer disease-free and overall survival, In the subgro up of patients with blood group A or AB, the loss of antigen was the m ost powerful negative predictor of survival, Aneuploidy and percentage of cells in S phase were not of prognostic significance in this group of patients with resected stage I and II NSCLC. The value of blood gr oup antigen A analysis needs to be evaluated in larger and prospective studies of early-stage NSCLC, Alteration of blood group antigen cell surface expression may represent an important marker for more aggressi ve biological and metastatic behavior in NSCLC.