Blood group antigens and bladder carcinoma: a perspective.

A review of the current literature relative to the measurement of blood group antigens on bladder epithelium is presented. The determination of the presence or absence of such antigens on bladder tumors has enabled us to separate patients into two predictive groups at a time when their routine histologic patterns are identical. Group I consists of those patients with detectable blood group antigens by specific red cell adherence testing (SRCA). Regardless of the grade of their lesion, these patients have a low incidence (0-19%) of the ultimate development of invasive disease. Group II consists of those patients without demonstrable blood group antigens on their bladder carcinomas. These patients have a 60 to 93 per cent change of invasive disease developing within five years. Treatment thus can be predicated not only on the grade and stage, but also on a prediction of future behavior. Studies mapping cystectomy specimens, as well as those studying random mucosal biopsies, have shown that when the primary tumor lacks demonstrable blood group antigens, other areas of the bladder are also SRCA negative. These findings may help explain the frequent recurrences and ultimate development of invasive lesions in some of these patients. The role of the measurments of blood group antigens in urine cytology is reviewed, as well as those situations in which red cell adherence may be less definitive, i.e., those patients with carcinoma in situ, after radiotherapy, or thiotepa, and in those patients with blood group O. Future areas of usefulness of blood group antigens are discussed including other organs, i.e., kidney, renal pelvis, testes, and prostate.