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"ABSTRAKTujuan: Mengetahui batasan nilai PSA untuk memprediksi adanya metastasis tulang pada pasien kanker prostat di RS Sardjito. Metode: Penelitian retrospektif, dengan mengumpulkan rekam medis pasien kanker prostat telah dilakukan bone scintigraphy di RS Sardjito tahun 2006 - 2011.Hasil: Dari 83 pasien kanker prostat yang telah dilakukan bone scintigraphy, terdapat 55 pasien (66%) mengalami metastasis tulang dan terdapat 28 pasien (34 %) yang tidak mengalami metastasis tulang. Dari 55 pasien yang mengalami metastasis tulang, terdapat 11 pasien (20 %) dengan PSA kurang dari 20 ng/ml dan terdapat 44 pasien (80 %) yang memiliki PSA lebih dari 20 ng/ml. Cut-off point PSA 17.65 ng/ml memiliki sensitivitas terbesar yaitu 85.5% dan spesifisitas 53.6%.Kesimpulan: Pemeriksaan bone scintigraphy dianjurkan pada pasien dengan PSA > 17.65 ng/ml, sedangkan pada pasien dengan PSA < 17.65 dianjurkan pada pasien dengan gejala klinis nyeri tulang.

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ABSTRACTObjective: Prostate cancer shows a strong predilection to spread to the bones, with bone metastases identified at autopsy in up to 90 % of patients dying from prostate cancer. Serum prostate specific antigen (PSA) concentration has been widely applied as a biomarker to diagnose and monitor prostate cancer. Technetium-99m methylene diphosphate (Tc—99m MDP) whole body bone scintigraphy is currently a well-accepted diagnostic procedure for bone metastasis in malignancy. The aim of this study was to establish a useful serum PSA cut-off value to predict the presence of bone metastasis in men with prostate cancer. Material and Methods: Consecutive male patients diagnosed with prostate cancer were retrospectively analyzed. All of the subjects had received Tc-99m MDP whole body bone scintigraphy and had their serum PSA concentration measured at Sardjito Hospital, Yogyakarta. The proper cut-off value was established based on statistical analysis in order to predict the possibility of bone metastasis among prostate cancer patients.Results: In total, 83 consecutive male patients with prostate cancer were enrolled, and 55 patients (66 %) were confirmed by scintigraphic findings to have bone metastases. A serum PSA concentration of 17,65 ng/ml gave the best sensitivity (78,33 %) and specificity (65,21 %). The positive predictive value, negative predictive value were 85,45 % and 53,57 %, respectively (p<0,05).Conclusion: A cut-off value of 17,65 ng/ml appears to be an appropriate benchmark for stratifying metastatic bone disease in prostate cancer patients at Sardjito Hospital, Yogyakarta, such that if a patient with newly diagnosed prostate cancer and without any skeletal symptoms has a serum PSA concentration of less than 17,65 ng/ml,we suggest that they would not need to undergo bone scintigraphy."

"Insiden osteosarkoma di seluruh dunia mencapai 3,4 kasus per satu juta penduduk per tahun. Sebanyak 10%-20% pasien osteosarkoma ditemukan telah mengalami metastasis. Kemampuan metastasis yang tinggi pada osteosarkoma ini didukung dengan karakteristik populasi selnya yang memiliki tingkat proliferasi yang tinggi, serta peran cancer stem cells (CSC) dalam proses tumorigenesis dan metastasis osteosarkoma. Salah satu metode untuk mendeteksi CSC adalah dengan mendeteksi marker permukaan dan ekspresi stem-like gene, antara lain CD133 dan CXCR4. Tujuan penelitian ini untuk mengetahui hubungan kadar CD133 dan CXCR4 dengan kejadian metastasis pada pasien osteosarkoma. Penelitian ini menggunakan pendekatan cross sectional, dengan sampel serum darah pasien yang didiagnosis osteosarkoma berdasarkan hasil histopatologi di RSCM dan RSUP Prof. Dr. I.G.N.G. Ngoerah. Pemeriksaan kadar CD133 dan CXCR4 menggunakan KIT ELISA Reed Biotech dengan menilai absorbansi secara kuantitatif. Data metastasis diperoleh dari rekam medik. Hubungan kadar CD133 dan CXCR4 dengan kejadian metastasis pada osteosarkoma dianalisis dengan uji chi-square dengan tingkat kemaknaan p<0,05 dianggap signifikan. Penelitian ini melibatkan 40 orang dengan 80% diantaranya berusia <40 tahun. Rerata kadar CD133 yang diperolah sebesar 0.23±0.02 pg/ml, sedangkan rerata kadar CXCR4 yang diperoleh sebesar 6015.82±2345.55 pg/ml. Dari penelitian ini didapatkan adanya hubungan yang signifikan antara kadar CD133 dan CXCR4 dengan kejadian metastasis.

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The incidence of osteosarcoma worldwide reaches 3.4 cases per million population per year. As many as 10%- 20% of osteosarcoma patients are found to have experienced metastasis. The high metastatic ability in osteosarcoma is supported by the characteristics of its cell population which has a high proliferation rate, as well as the role of cancer stem cells (CSC) in the process of tumorigenesis and metastasis of osteosarcoma. One method to detect CSC is to detect surface markers and stem-like gene expression, including CD133 and CXCR4. The purpose of this study was to determine the relationship between CD133 and CXCR4 levels and the incidence of metastasis in osteosarcoma patients. This study used a cross-sectional approach, with blood serum samples from patients diagnosed with osteosarcoma based on histopathology results at RSCM and Prof. Dr. I.G.N.G. Ngoerah Hospital. Examination of CD133 and CXCR4 levels using the Reed Biotech ELISA KIT by assessing absorbance quantitatively. Metastasis data were obtained from medical records. The relationship between CD133 and CXCR4 levels with the incidence of metastasis in osteosarcoma was analyzed using the chi-square test with a significance level of p<0.05 considered significant. This study involved 40 people with 80% of them aged <40 years. The average CD133 level obtained was 0.23±0.02 pg/ml, while the average CXCR4 level obtained was 6015.82±2345.55 pg/ml. From this study, a significant relationship was found between CD133 and CXCR4 levels with the incidence of metastasis."

"Latar Belakang: Kanker payudara merupakan jenis kanker yang paling sering terjadi pada wanita di seluruh dunia dan menyumbangkan angka mortalitas yang tinggi akibat risiko metastasis. Metastasis dapat terjadi meskipun pasien telah diterapi secara adekuat. Epitel-mesenchymal transition (EMT) adalah salah satu mekanisme utama terjadinya metastasis. Sel yang mengalami perubahan fenotip menjadi mesenkimal bersifat agresif, motil dan potensial menjadi metastasis. Vimentin merupakan salah satu biomarker spesifik yang muncul ketika sel mengadopsi fenotip mesenkim. Vimentin dapat memprediksi metastasis dan survival pada kanker payudara. Tujuan: Mengetahui hubungan antara ekspresi vimentin terhadap kejadian metastasis dan survival pada pasien kanker payudara. Metode: Desain studi ini adalah kohort retrospektif. Subjek berasal dari pasien kanker payudara di RSUP dr. Ciptomangunkusumo periode 2017–2018. Dilakukan pemeriksaan imunohistokimia untuk mengetahui ekspresi vimentin. Pasien diobservasi selama 4 tahun untuk mengetahui keluaran metastasis dan survival. Hasil: Terdapat 43 subjek, terdiri dari 39 ekspresi vimentin positif (90,7%), 10 subjek metastasis (23,3%), 16 subjek meninggal (37,2%). Pasien dengan ekspresi vimentin positif memiliki risiko 2,99 kali terjadi metastasis. Rerata overall survival (OS) pasien ekspresi vimentin positif lebih rendah dibandingkan negatif (162,0 minggu vs 174,5 minggu). Namun, secara statistik tidak terdapat hubungan bermakna antara vimentin terhadap kejadian metastasis (p=1,000) dan survival (p=0.971). Kesimpulan: Ekspresi vimentin tidak berhubungan dengan kejadian metastasis dan survival. Namun, ekspresi vimentin positif memiliki kecenderungan meningkatkan risiko metastasis dan mortalitas yang lebih cepat pada pasien kanker payudara.

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Background: Breast cancer is the most common of cancer in women around the world and contributes to a high mortality rate because of the risk of metastases. Metastases can still occur even if the patient has been adequately treated. Epithelial-mesenchymal transition (EMT) is one of the main mechanisms of metastasis. Cells that have a phenotypic change to mesenchymal are aggressive, motile, and prone to become metastatic. Vimentin is the specific biomarker that appears when cells have changed to mesenchymal phenotype. Vimentin can predict metastasis and survival in breast cancer. Aim: to find the association between vimentin expression with metastases and survival in breast cancer patients. Methods: This study design is a retrospective cohort. The subjects are breast cancer patients at Dr. Ciptomangunkusumo from 2017 to 2018. Immunohistochemical staining was performed to analyze the expression of vimentin. Patients were followed-up for 4 years to determine metastasis event and survival outcome. Results: There were 43 subjects, consist of 39 positive vimentin expressions (90.7%), 10 metastases (23.3%), and 16 death (37.2%). Patients with positive vimentin expression have 2.99-times the risk of developing metastases. The mean overall survival (OS) of patients with positive was lower than negative vimentin expression (162.0 weeks vs. 174.5 weeks). However, the association between vimentin with metastatic (p=1,000) and survival (p=0.971) outcome was not statistically significant. Conclusion: Vimentin expression is not associated with metastatic events and survival outcome. However, positive vimentin expression tends to increase the risk of metastasis and increase mortality rates in breast cancer patients."

"Pasien kanker kolorektal (KKR) dengan stadium yang sama dapat mengalami hasil luaran berbeda, yang disebabkan berbagai faktor antara lain faktor imunitas pasien (sel T-CD3 dan CD8) dan lingkungan mikrotumor (tumor budding). Tujuan dari penelitian ini adalah menganalisis hubungan densitas sel T-CD3 dan CD8, status MMR, TB dengan gambaran klinikopatologi (usia, jenis kelamin, diferensiasi, lokasi, kedalaman invasi tumor, penyebaran kelenjar getah bening), metastasis dan kesintasan KKR. Penelitian observasional, kohort, retrospektif selama 36 bulan, menggunakan 68 blok parafin kasus KKR yang menjalani pengangkatan tumor sebagai pengobatan pertama. Pemeriksaan imunohistokimia digunakan untuk menentukan densitas sel T-CD3, CD8, MLH1, MSH6 dan TB. Pasien laki-laki lebih banyak dari perempuan, rerata usia 56,2 tahun. TB dengan kedalaman invasi tumor (pT), penyebaran kelenjar getah bening dan metastasis ditemukan hubungan bermakna. Selain itu ditemukan hubungan bermakna usia dengan status MMR, metastasis dengan TB, kesintasan dengan pT dan kesintasan dengan metastasis. Densitas sel T-CD8 dan metastasis dapat digunakan sebagai faktor prognostik kesintasan pasien KKR. Densitas sel T-CD8 tinggi dan metastasis organ dapat dipakai sebagai faktor prognosis kesintasan pada pasien KKR. TB tinggi sesuai dengan kedalaman invasi tumor, penyebaran kelenjar getah bening dan metastasis organ. Status MMR tidak berhubungan dengan gambaran klinikopatologi tapi dapat digunakan untuk menentukan jenis pengobatan.

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Colorectal cancer (CRC) patients with the same stage produce different outcomes, which are caused by various factors including patient immunity factors (CD3 and CD8-T cells) and the microenvironment tumor (tumor budding). The purpose of this study was to analyze the relationship between CD3 and T-CD8 cell density, MMR status, TB with clinicopathological features, metastasis and CRC survival. This study is observational, cohort, 36 months retrospective on 68 Formalin-Fixed Paraffin-Embedded (FFPE) of CRC, who underwent tumor removal as the first treatment. Immunohistochemical examination was used to determine T-CD3 cells, CD8, MLH1, MSH6 and TB. There were more male patients than female patients, the average age was 56.2 years.TB with the depth of tumor invasion (pT), lymph node and metastasis were significantly related. There was a significant relationship between age and MMR status, metastasis with TB, survival with pT and survival with metastasis. T-CD8 cell density and metastasis used as prognostic factors for survival of CRC patients. High CD8 T-cell density and metastasis used as prognostic factors for survival in CRC patients. High TB in accordance with the depth of tumor invasion, lymph node and metastasis. MMR status is not related to clinicopathological features but used to determine the appropriate treatment."

"Latar belakang: Insidens metastasis otak lebih tinggi dibanding tumor primer otak dan berisiko menimbulkan kematian dengan penyebab terbanyak berasal dari kanker paru (36,5%) di RSUPN Cipto Mangunkusumo (RSCM). Keterlambatan diagnosis berisiko menyebabkan herniasi otak, sehingga terjadi kecacatan dan kematian. Dibutuhkan data mengenai durasi penegakan diagnosis di RSCM.Metode penelitian: Penelitian ini merupakan studi deskriptif analitik dengan rancangan kohort retrospktif untuk mengetahui kesesuaian antara durasi penegakan diagnosis tumor otak metastasis akibat kanker paru dengan pedoman praktik klinis (durasi ≤2 minggu). Subjek merupakan pasien rawat inap di RSCM pada Januari 2019 s/d Desember 2021.Hasil: Terdapat 12 subjek (30%) dapat ditegakkan dalam waktu ≤2 minggu dengan  median durasi 18,5 hari (IQR (12-34 hari). Selain itu didapatkan durasi 7 hari (IQR 4-11 hari) untuk sampai didapatkannya massa di paru,  durasi 8 hari (IQR 4.5-13 hari) sampai dilakukannya biopsi, dan 6 hari (IQR 3.5-7 hari) sampai keluarnya hasil patologi anatomi. Tidak terdapat hubungan yang bermakna secara statistik antara variabel yang dinilai dengan durasi penegakan diagnosis ≤2 minggu (14 hari).Kesimpulan: Hanya 30% subjek dengan durasi yang sesuai dengan panduan praktik klinis di RSCM. Dibutuhkan diseminasi hasil dan kolaborasi antar bagian agar penegakan diagnosis lebih cepat.

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Background: Incidence of brain metastases is higher than primary brain tumors, with lung cancer as common etiology (36.5%) at Cipto Mangunkusumo General Hospital (RSCM). Delay in diagnosis can cause brain herniation, resulting in disability and death. Data is needed regarding the duration of diagnosis in RSCM.

Method: This is a descriptive analytic study with a retrospective cohort design to determine the conformity between the duration of diagnosis of metastatic brain tumors due to lung cancer in daily clinical practice with clinical practice guidelines (duration 2 weeks). Subjects were inpatients at RSCM from January 2019 to December 2021

Results: There were 12 subjects (30%) who could be diagnosed within 2 weeks with a median duration of 18.5 days (IQR (12-34 days). Duration of 7 days (IQR 4-11 days) to obtain a lung mass, 8 days (IQR 4.5-13 days) until a biopsy was performed, and 6 days (IQR 3.5-7 days) until anatomic pathology results were released. There is no statistically significant relationship between the variables assessed and the duration of diagnosis 2 weeks.

Conclusion: Only 30% of subjects with the duration matched the clinical practice guidelines at RSCM. Dissemination of results and collaboration between departments is needed to make diagnosis faster."