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Abstrak :
Latar Belakang: Derajat keparahan karsinoma hepatoselular (KHS) yang dinilai dengan klasifikasi Barcelona Clinic Liver Cancer (BCLC) merupakan faktor prognostik utama KHS. Penilaian kadar serum Vascular Endothelial Growth Factor (VEGF) dianggap dapat mencerminkan tingkat keparahan KHS. Namun, belum ada kesepakatan mengenai hubungan tingkat keparahan KHS dengan kadar serum VEGF. Tujuan : Mengetahui hubungan kadar serum VEGF dengan tingkat keparahan KHS dengan menilai perbedaan rerata kadar serum VEGF pada berbagai tingkat keparahan KHS. Metode : Penelitian ini adalah studi potong lintang untuk menentukan hubungan antara kadar serum VEGF dengan tingkat keparahan KHS berdasarkan klasifikasi BCLC. Penelitian ini dilakukan di Rumah Sakit Cipto Mangunkusumo antara bulan Januari 2015 dan Mei 2015. Uji statistik yang digunakan untuk menilai hubungan kadar serum VEGF dengan klasifikasi BCLC ialah analisis one way ANOVA, dan dilanjutkan dengan analisis post hoc Tukey Schaffe. Hasil : Sebanyak 61 subyek KHS diikutkan dalam penelitian ini. Pada penelitian ini tidak ditemukan subyek dengan BCLC stage 0. Rerata kadar serum VEGF BCLC stage A adalah 288,26±156,6 pg/ml; BCLC stage B: 434±164,8 pg/ml; BCLC stage C: 785,57±194,25 pg/ml; BCLC stage D: 1537,97±660,62 pg/ml. Analisis one way ANOVA menunjukkan perbedaan bermakna (P<0,001) antara kadar serum VEGF dengan tingkat keparahan KHS berdasarkan klasifikasi BCLC. Analisis post hoc dengan Tukey Schaffe menunjukkan adanya perbedaan bermakna antara BCLC stage A dan C (p<0,05) serta BCLC stage A dan D (p< 0.001), BCLC stage B dan D (p<0.001), dan BCLC stage C dan D (p<0.001). Tidak ditemukan perbedaan bermakna antara subyek dengan BCLC stage A dan B, dan antara BCLC stage B dan C. Kesimpulan : Didapatkan kadar serum VEGF yang meningkat sesuai dengan tingkat keparahan KHS berdasarkan klasifikasi BCLC terutama untuk BCLC stage B ke atas.

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Background : The severity of Hepatocellular Carcinoma (HCC) stratified by Barcelona Clinic Liver Cancer (BCLC) staging classification has been one of the main prognostic factors of patients with HCC. Serum vascular endothelial growth factor (VEGF) examination can be reflect to predict the severity of HCC. Although, there is no consensus among experts about the severity of HCC staging and serum VEGF levels. Aim : To determine the association between serum VEGF levels and severity of HCC. Methods : A cross-sectional study to determine the association between serum VEGF levels and the severity of HCC stratified by BCLC staging classification. The study was conducted at Cipto Mangunkusumo Hospital between January 2015 and May 2015. One way ANOVA analysis was used to assess the association between serum VEGF levels and BCLC classification staging. Post hoc analysis will be done using Tukey Schaffe test. Results: There were 61 HCC subjects included to this study. There were no subjects with BCLC stage 0. The mean VEGF serum level in patients with BCLC stage A was 288.26 ± 156.6 pg / ml; BCLC stage B: 434 ± 164.8 pg / ml; BCLC stage C: 785.57 ± 194.25 pg/ml; and BCLC stage D: 1537.97 ± 660.62 pg/ml. One way ANOVA showed significant statistical difference (P <0.001) between mean serum VEGF levels and the severity in all BCLC stages. Post hoc analysis using Tukey Schaffe test showed significant stastical difference between BCLC stage A and C (p<0.05), BCLC stage A and D (p<0.001), BCLC stage B and D (p<0.001), and BCLC stage C and D (p<0.001). There were no significant statistical differences between patients with BCLC stage A and B, and between BCLC stage B and C. Conclusion: We found that increased levels of serum VEGF were associated with the severity of HCC based on BCLC staging classification, especially in patients with BCLC stage B and upwards.

Abstrak :
Hepatocellular carcinoma (HCC) merupakan kanker terbanyak kedua setelah kanker paru. Diagnosa keperawatan yang paling utama dan sering muncul pada pasien kanker adalah nyeri. Manajemen nyeri merupakan salah satu cara yang digunakan dibidang kesehatan untuk mengatasi nyeri. Manajemen nyeri yang dapat dilakukan dengan farmakologi dan non farmakologi. Salah satu terapi non farmakologi yang bisa dilakukan oleh perawat secara mandiri adalah dengan melakukan hand massage therapy. Metode penelitian yang dilakukan adalah dengan studi kasus untuk menganalisis intervensi tindakan hand massage therapy. Tujuan tindakan hand massage therapy untuk mengurangi ketegangan, meningkatkan relaksasi fisik dan psikologi yang dapat menurunkan rasa nyeri. Implementasi non farmakologi ini dinilai lebih efektif untuk mengurangi nyeri dibandingkan dengan terapi nonfarmakologi yang lain. Pada pasien Tn. J yang mengalami HCC pre-op anterior right segmentectomy dengan pain cancer, intervensi yang sudah dilakukan dengan hand massage therapy yang dilakukan selama 3 hari dimana dalam sekali intervensi hanya membutuhkan waktu sekitar 10 menit. Dari intervensi yang telah dilakukan memperlihatkan adanya penurunan skala nyeri yang dirasakan oleh klien. Sehingga diharapkan terapi ini dapat dipraktikkan oleh perawat dalam mengatasi nyeri yang dialami oleh pasien kanker, terutama Hepatoceluller Carcinoma (HCC). Selain itu, penulis merekomendasikan apabila intervensi ini dikombinasikan dengan foot massage menjadi hand-foot massage dalam mengatasi nyeri kronis pada pasien kanker. 

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Hepatocellular carcinoma (HCC) is the second most common cancer after lung cancer. The most common and frequent nursing diagnosis in cancer patients is pain. Pain management is one method used in the health sector to treat pain. Pain management that can be treated with pharmacology and non pharmacology. One of the non-pharmacological therapies that nurses can do independently is by doing hand massage therapy. The research method used is a case study to analyze the intervention of hand massage therapy. The purpose of hand massage therapy is to reduce tension, increase physical and psychological relaxation that can reduce pain. This non-pharmacological implementation is considered to be more effective in reducing pain compared to other non-pharmacological therapies. Mr. J, who had HCC pre-op anterior right segmentectomy with pain cancer, shown a decrease in the scale of his pain after nurse give interventions hand massage therapy for 3 days where in one intervention it only took about 10 minutes. Hoped that this therapy can be practiced by nurses in dealing with pain experienced by cancer patients, especially Hepatocellular Carcinoma (HCC).In addition, the authors recommend that this intervention be combined with foot massage into hand-foot massage therapy in treating chronic pain  cancer.

Abstrak :
ABSTRACT
Background: increased serum alpha fetoprotein (AFP) levels are often found in patients with advanced hepatocellular carcinoma (HCC). Cluster Differentiation 44 (CD44) and CD90 are stem cell biomarkers that have been assumed as the early HCC markers and associated with onset and progressivity of HCC. The study related to HCC stem cell has not been available in Indonesia. The present study aimed to evaluate the expression of cancer stem cell markers (CD44, CD90) and AFP levels in patients with advanced liver disease. Methods: an observational study was conducted in 41 patients with chronic hepatitis B and/or C infection, liver cirrhosis, and HCC at dr. Saiful Anwar General Hospital. CD44 and CD90 expressions were measured with flow cytometry, and AFP serum levels with ELISA. Data on patient characteristics were evaluated using bivariate and multivariate statistical analysis (One-way ANOVA, Mann-Whitney, Chi-Square, Kruskal-Wallis). Data of CD44, CD90 and AFP were analyzed using Kruskal Wallis test with a significance value of p<0.05, and diagnostic power was analyzed using receiver operating characteristic (ROC). Results: the subjects of our study were 16 patients with chronic hepatitis, 15 patients with liver cirrhosis, and 10 patients with HCC. There was a significant difference regarding CD44+CD90+ and AFP among those three groups (p=0.001; p=0.000) specifically in chronic hepatitis compared to liver cirrhosis (p=0.002; p=0.000) and HCC (p=0.002; p=0.000) respectively. ROC analysis showed the best diagnostic power for the combination of CD44+CD90+ and AFP (AUC=0.981; p=0.000). Conclusion: there are higher expressions of CD44+CD90+ and serum AFP levels in patients with HCC compared to the other two groups (those with chronic hepatitis and liver cirrhosis). The combination of both parameters has the best diagnostic power of HCC.

Abstrak :
ABSTRAK
Pendahuluan: Alfa fetoprotein AFP merupakan penanda tumor yang mengalami peningkatan pada karsinoma hepatoselular KHS namun dapat juga normal pada 40 kasus. Peningkatan AFP dikatakan menghasilkan diferensiasi tumor yang buruk. Kasus KHS yang datang ke RSCM cenderung lanjut dengan karakteristik tersendiri. Penelitian ini bertujuan menilai korelasi AFP terhadap derajat diferensiasi KHS di RSCM.Metode: Data 32 kasus KHS di RSCM yang dilakukan hepatektomi dikumpulkan secara retrospektif dari 2010-2016. Data dasar karakteristik pasien dinilai berdasarkan nilai AFP dan derajat diferensiasi. Lalu dilakukan analisis untuk melihat korelasi nilai AFP dengan derajat diferensiasi KHS.Hasil: Nilai rata-rata AFP adalah 20183 ng/mL, usia 51,75 tahun, 81 kasus terjadi pada laki-laki, 59,4 berdiferensiasi buruk, 50 berukuran >5-10 cm, 50 kasus sirosis, dan 68,8 terdapat invasi pembuluh darah. Diferensiasi buruk 42 pada laki-laki, 47,4 pada HbsAg positif, 50 pada Anti HCV positif, 31,2 sirosis, dan 40,9 mengalami invasi pembuluh darah. Nilai AFP 20 ng/mL 42,1 berdiferensiasi buruk. Pada analisis orelasi didapatkan r=0,203 dengan p>0,05.Kesimpulan: AFP tidak dapat memprediksi derajat diferensiasi karsinoma hepatoseluler pada karakteristik kasus KHS di tempat kami.

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ABSTRACT<>br> Background AFP is a tumor marker which is increased in HCC, but might be found normal in 40 cases. Increased AFP implies a worsen tumor differentiation. Correlation between AFP with HCC managed in RSCM Ciptomangunkusumo hospital remains unclear. This study aimed to find the correlation between histological differentiation grade of HCC and AFP serum level.Method A total of 32 of HCC cases following hepatectomy in RSCM during 2010 2016 were enrolled in a retrospective study. Subject characteristics, AFP levels and histological differentiation grade were the variables in this study, and subjected to statistical analysis. Significancy found if p 5 10cm in diameter, 50 subjects were cirrhotic, and 68.8 subjects with microvascular invasion. AFP level found in range of 0.5 400000 ng mL 20183 SD75580.08 . Among all the subjects 12.5 were well differentiated, 28.1 were moderate differentiated, and 59.4 were poorly differentiated. AFP level 20ng mL was 42.1 . Correlation analysis revealed an r 0.203 with p 0.05.Conclusion There is no correlation between AFP serum level and histological differentiation grade of HCC in our study

Abstrak :
Hati adalah organ terbesar dalam tubuh dan organ metabolisme yang sangat penting. Hepatocelullar Carcinoma (HCC) merupakan pertumbuhan abnormal dari hepatosit yang ditandai dengan peningkatan jumlah hepatosit yang mampu membelah dan menyertai perubahan sel hati yang menjadi ganas. Karsinoma hepatoselular berisiko terjadi retensi cairan karena rusaknya sel hepatosit yang mengakibatkan terganggunya aliran darah menuju ke hati sehingga menimbulkan distensi pembuluh darah dan terganggunya aliran tersebut juga mengakibatkan terganggunya produksi albumin untuk bisa mempertahankan tekanan onkotik. Asites, varises gastroesofagus yang tidak ditangani segera dapat menurunkan kualitas hidup bahkan kematian. Asites dan edema merupakan penyebab yang paling sering ditemukan pada pasien yang harus menjalani perawatan di rumah sakit. Penulisan karya ilmiah ini menggunakan metode studi kasus dengan menggunakan pemantauan cairan dan nutrisi dibuktikan bahwa pemantauan ini efektif untuk menangani kelebihan volume cairan dibuktikan dengan tidak bertambahnya komplikasi yang terjadi pada pasien. ......The liver is the largest organ in the body and a very important metabolic organ. Hepatocellullar Carcinoma (HCC) is an abnormal growth of hepatocytes which is characterized by an increase in the number of hepatocytes capable of dividing and accompanying changes in liver cells that become malignant. Hepatocellular carcinoma is at risk of fluid retention due to damage to hepatocyte cells which results in disruption of blood flow to the liver, causing distension of blood vessels and disruption of this flow also results in disruption of albumin production to maintain oncotic pressure. Ascites, gastroesophageal varices that are not treated immediately can reduce the quality of life and even death. Ascites and edema are the most common causes in hospitalized patients. The writing of this scientific paper using a case study method using fluid and nutrition monitoring proved that this monitoring is effective for treating excess fluid volume as evidenced by not increasing complications that occur in patients.

Abstrak :
Latar Belakang: Sarkopenia mempengaruhi prognosis karsinoma sel hati (KSH). Dalam penilaian klasifikasi Barcelona Clinic Liver Cancer (BCLC) terkandung penilaian status performa Eastern Cooperative Oncology Group (ECOG). Status performa ECOG merupakan penilaian aktivitas fisik terkait sarkopenia. Pemeriksaan baku emas sarkopenia pada KSH mahal dan membutuhkan banyak waktu. Pemeriksaan tebal otot paha dapat digunakan sebagai modalitas yang baru. Studi ini bertujuan untuk menilai hubungan antara status performa ECOG dengan sarkopenia pada KSH, mengetahui perbedaan rerata antara tebal otot paha pasien status performa ECOG rendah dengan status performa ECOG tinggi pada KSH, dan mengetahui perbedaan rerata antara tebal otot paha pasien sarkopenia dengan non sarkopenia pada KSH. Metode: Studi ini dilakukan di RS tersier selama Januari – Oktober 2021. Analisis statistik dilakukan untuk memperoleh hubungan antara status performa ECOG, tebal otot paha, dan status sarkopenik pasien KSH. Hasil: Delapan puluh lima subjek pasien KSH (usia median, 52 tahun) dilakukan analisis. Sarkopenia diamati pada 30,6% pasien KSH. Setelah melalui analisis multivariat, status performa ECOG buruk berhubungan dengan sarkopenia pada KSH (adjusted OR = 6,35, IK 95% 2,06-19,60). Terdapat perbedaan signifikan rerata tebal otot paha pasien status performa ECOG rendah dengan status performa ECOG tinggi pada KSH (p < 0,001). Terdapat juga perbedaan signifikan rerata tebal otot paha pasien sarkopenia dan non sarkopenia (p < 0,001). Kesimpulan: Terdapat hubungan antara status performa ECOG tinggi dengan sarkopenia pada KSH (aOR = 6,35, IK 95% 2,06-19,60). Rerata tebal otot paha pasien status performa ECOG rendah lebih besar dibanding dengan status performa ECOG tinggi pada karsinoma sel hati. Rerata tebal otot paha pasien non sarkopenia lebih besar dibanding dengan sarkopenia pada karsinoma sel hati. ......Background: Sarcopenia affects hepatocellular carcinoma (HCC) prognosis. HCC staging consists of Eastern Cooperative Oncology Group performance status (ECOG-PS). ECOG-PS is an assessment of physical activity related to sarcopenia. Gold standard examinations for sarcopenia in HCC are expensive and time-consuming. Thigh muscle thickness can be used as a new modality. This study was aimed to explore the association between ECOG-PS with sarcopenia, to seek thigh muscle thickness difference between poor and good performance status, and to know thigh muscle thickness difference between sarcopenic and non-sarcopenic patients with HCC. Methods: The study was conducted in a tertiary hospital during January – October 2021. Statistical analysis was performed to obtain an association between ECOG-PS, thigh muscle thickness, and sarcopenic status of HCC patients. Results: Eighty-five HCC patients (median age, 52 years) were analyzed. Sarcopenia was observed in 30,6% of HCC patients. On multivariate binary regression analysis, a poor ECOG-PS remained independently associated with sarcopenia in HCC (adjusted OR = 6,35, 95% CI 2,06-19,6, p < 0,001). There was a significant difference in thigh muscle thickness between good and poor performance status (p < 0,001). There was also a significant difference in thigh muscle thickness between sarcopenic and non-sarcopenic patients (p < 0,001). Conclusion: There were association between ECOG-PS and sarcopenia in HCC (aOR = 6,35, IK 95% 2,06-19,60). Mean thigh muscle thickness was larger in HCC patients with good ECOG-PS than poor ECOG-PS. Mean thigh muscle thickness was larger in non-sarcopenic HCC patients than sarcopenic ones.

Abstrak :
Latar Belakang: Kanker hati adalah penyebab paling umum kedua kematian akibat kanker di seluruh dunia, dan kejadian keganasan hati 'primer' telah meningkat secara signifikan, terutama Hepatocellular Carcinoma/ HCC. Karakteristik jaringan pada keganasan biasanya lebih padat/ kaku dibandingkan jaringan normal. Ultrasonografi dengan teknologi shear wave (gelombang geser) adalah metode perhitungan kekakuan jaringan, saat ini terdapat dua tipe; elastografi gelombang geser titik (pSWE) dan elastografi gelombang geser dua dimensi (2D-SWE). Belum ada studi yang menggunakan dua tipe gelombang geser tersebut pada lesi HCC yang sama untuk melihat kesesuaian antara nilai keduanya. Tujuan: Mengetahui derajat korelasi antara nilai USG pSWE dan nilai USG 2D-SWE pada HCC. Metode: Sebanyak 17 subjek penelitian dengan diagnosis HCC dilakukan pemeriksaan USG pSWE dan dilanjutkan dengan 2D-SWE (pada hari yang sama atau maksimal tujuh hari setelahnya) pada lesi HCC untuk menentukan nilai kekakuan jaringan (dalam satuan kPa dan m/s). Setelah itu dilakukan analisis korelasi antara nilai USG pSWE dengan USG 2D-SWE, dan dilanjutkan dengan mencari formula regresi di antara kedua nilai tersebut. Hasil: Pada lesi HCC terdapat korelasi positif kuat yang signifikan antara hasil USG pSWE dengan 2D-SWE pada perhitungan dengan kPa (R = 0,882 / p < 0,01) dan m/s (R = 0,875 / p < 0,01) , didapatkan pula formula regresi nilai kPa pSWE = 2,99 + 0,75 x kPa 2D-SWE dan nilai m/s pSWE = 0,31 + 0,82 x m/s 2D-SWE. Kesimpulan: Pada lesi HCC, dapat dilakukan pemeriksaan nilai kekakuan jaringan menggunakan pSWE maupun 2D-SWE, baik menggunakan satuan kPa maupun m/s dengan hasil yang setara. ......Background: Liver cancer is the second most common cause of cancer death worldwide, and the incidence of 'primary' liver malignancies has increased significantly, particularly Hepatocellular Carcinoma / HCC. Characteristics of tissue in malignancy are usually denser / stiffer than normal tissue. Ultrasound with shear wave technology is a method of calculating tissue stiffness, currently there are two types; point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE). There have not been studies using these two types of shear waves in the same HCC lesions to see the congruence between the two values. Objective: To determine the degree of correlation between the USG pSWE value and the 2D-SWE USG value on HCC. Methods: A total of 17 study subjects with a diagnosis of HCC were subjected to pSWE ultrasound examination and followed by 2D-SWE (on the same day or a maximum of seven days thereafter) on HCC lesions to determine the value of tissue stiffness (in kPa and m/s units). After that, a correlation analysis was carried out between the USG pSWE and USG 2D-SWE values, and continued by looking for the regression formula between the two values. Results: In HCC lesions, there was a significant positive correlation between pSWE ultrasound results and 2D-SWE in the calculation with kPa (R = 0.882 / p <0.01) and m / s (R ​​= 0.875 / p <0.01), also obtained the regression formula for the kPa pSWE value = 2.99 + 0.75 x kPa 2D-SWE and the m/s pSWE value = 0.31 + 0.82 xm / s 2D-SWE. Conclusion: In HCC lesions, tissue stiffness values ​​can be examined using pSWE and 2D-SWE, using either kPa or m / s units with equivalent results.

Abstrak :
Citra Megavoltage Computed Tomography (MVCT) dapat digunakan sebagai modalitas adaptive planning setelah diregistrasi ke citra Kilovoltage Computed Tomography (KVCT). Hasil adaptive planning pada penelitian terdahulu pada teknik penyinaran konvensional diketahui bahwa adaptive planning dapat mengkoreksi dosis pada PTV dan OAR menjadi lebih optimal, namun pada sebagian kasus, adaptive planning tidak memberikan keuntungan. Sayangnya, penelitian mengenai penggunaan MVCT pada teknik penyinaran fraksinasi rendah (hipofraksinasi) dan dosis tinggi belum banyak dilakukan. Penelitian ini difokuskan untuk mengevaluasi penggunaan MVCT pada 9 pasien kasus kanker hati hipofraksinasi dosis tinggi teknik Stereotactic Body Radiation (SBRT) dengan dosis perfraksi 3-8 Gy dalam 4-10 fraksi. Citra MVCT diregistrasi ke KVCT untuk mendapatkan contour sehingga dapat digunakan untuk modalitas planning. Citra MVCT juga dikirim ke Linac untuk planning untuk mengetahui efek perpindahan pasien Tomoterapi ke Linac. Hasil planning dianalisis menggunakan parameter HI, CI, dan GI. Nilai CI didapatkan pada rentang 0,7-1 (0,95 ± 0,063), nilai HI dalam rentang 0,02-0,53 (0,16 ± 0,12) dan nilai GI dalam rentang 2,6-8,24 (4,09 ± 1,57). Nilai indeks gamma pada keseluruhan planning dengan kriteria DD 3% DTA 3mm sebesar (95,4 ± 5,6). Secara umum, MVCT dapat digunakan untuk adaptive planning dengan perbedaan sebaran dosis PTV dan OAR tidak jauh berbeda dengan hasil planning KVCT pada kasus kanker hati. Perpindahan pasien dari Tomoterapi ke Linac dapat dilakukan dengan tetap mempertahankan capaian dosimetri Tomoterapi ......Many researchers have been proposing Megavoltage Computed Tomography (MVCT) image as adaptive planning modality recently. The adaptive planning results using MVCT in the previous study noted that adaptive planning could optimize the dose in PTV and reduce the OAR dose, but in some cases, adaptive planning did not provide benefits. Unfortunately, research on the use of MVCT in low fractionation radiation techniques (hypofractionation) and high doses have not been widely investigated. This study focused on evaluating the use of MVCT in 9 Hepatocellular Carcinoma (HCC) patients with high-dose hypofractionation using Stereotactic Body Radiation (SBRT) technique (dose/fraction was 3-8 Gy in 4-10 fractions). The MVCT images then registered to Kilovoltage CT (KVCT) for contouring. The MVCT as well as KVCT also have been sent to the Linac planning station to mimic the clinical use of transfer patient treatment from Tomotherapy to Linac. The final plans were analyzed using HI, CI, and GI parameters. CI values found in the range 0.7-1 (0.95 ± 0.063), HI values in the range 0.02-0.53 (0.16 ± 0.12) and GI values in the range 2.6-8.24 (4.09 ± 1.57). The gamma passing rate for the overall planning with a 3% DD 3% DTA criteria is (95.4 ± 5.6). Generally, it was concluded that MVCT could be used for adaptive planning with differences in the distribution of PTV and OAR doses were not much different from the KVCT planning results for HCC cases. Transfer of patients from Tomotherapy to Linac can be done while maintaining the performance of Tomotherapy dosimetry

Abstrak :
Proses kerja pada area Hydro Cracking Complex HCC memiliki risiko bahaya kesehatan kimia dan fisika bagi pekerja. Penelitian ini menilai gambaran bahaya risiko kesehatan dan Health Risk Assessment HRA dengan menggunakan metode semi kuantitatif untuk menentukan skor durasi, eksposure, konsekuensi, dan likelihood yang selanjutnya akan dihitung dalam Risk Assessment Matriks RAM . Pedoman yang digunakan untuk menghitung yaitu International Petroleum Industry Environmental Conservation Association IPIECA dan International Association of Oil Gas Producers OGP tahun 2006. Berdasarkan hasil perhitungan proritas pengendalian risiko di area HCC bahaya kesehatan fisika dan kimia berada pada 4 tingkat yaitu: tidak perlu dilakukan tindakan segera, prioritas pertama, kedua, dan ketiga untuk dilakukan tindakan.Penilaian HRA menunjukkan terdapat bahaya fisika berupa bahaya pencahayaan, heat stress, dan bising. Sedangkan bahaya kimia yang ditemukan yaitu uap Hidrocarbon, Fuel Gas CO, Fuel Gas H2S, Fuel Gas CO2, Ammonia NH3 , Benzene Toluene Xylene BTX , Soda Api NaOH , Katalis, Steam H2, Ceceran fuel oil, N2, SO2, LPG, Indoor Air Quality CO, CO, O2,Nox, SOx , dan Lube oil. Tingkat risiko bahaya kesehatan dapat dikurangi dengan melakukan hirarki kontrol, yaitu dengan mengeliminasi bahaya, menambah intensitas cahaya, pembatasan area kerja, rotasi pekerja, penggunaan APD yang sesuai, dan perhitungan kadar paparan bahan kimia. ......Working processess at Hydro Cracking Complex HCC have chemical dan physical hazards for the workers. This study asssessed about health risk hazard and Health Risk Assessment HRA by using semiquantitative method to determine score, exposure, consequence, and likelihood, then we rsquo ll calculate them into Risk Assessment Matriks RAM . The guideline that we use is from International Petroleum Industry Environmental Conservation Association IPIECA and the International Association of Oil Gas Producers OGP. Based on the calculation we found 4 level of risk hazard control for chemical dan physical hazards, there are, no need immediate action, first, second, and third priority of action.HRA result shows there are some physical hazards, lighting, heat stress and noise. There were also found chemical hazards, they are Hidrocarbon, Fuel Gas CO, Fuel Gas H2S, Fuel Gas CO2, Ammonia NH3 , Benzene Toluene Xylene BTX , NaOH, Katalis, Steam H2, fuel oil, N2, SO2, LPG, Indoor Air Quality CO, CO, O2,Nox, SOx , and Lube oil. The level of risk can be reduced by applying control of hierarchy, such as eliminating hazard, increasing light intensity, limiting working area, worker rotation, using appropriate PPE, and measure chemical hazard exposure.