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"Walaupun masih kontroversial, jenis kelamin dan umur diduga sebagai faktor prognostik yang mempengaruhi angka kesintasan osteosarkoma (suatu keganasan tulang yang umum terjadi pada anak-anak dan dewasa muda). Oleh karena itu, penelitian ini bertujuan untuk mengetahui angka kesintasan pasien osteosarkoma di RSCM selama periode waktu enam tahun (2006-2011) dan mengaitkannya dengan umur dan jenis kelamin. Studi potong-lintang ini menggunakan rekam medis 167 pasien osteosarkoma di Departemen Ortopedi dan Traumatologi Rumah Sakit Cipto Mangunkusumo (RSCM). Studi ini menunjukkan bahwa usia lebih muda saat didiagnosis berkaitan dengan respon yang lebih baik terhadap kemoterapi (p=0,028). Jenis kelamin perempuan berkaitan secara signifikan dengan stadium penyakit yang lebih rendah (p=0,04), respon yang lebih baik terhadap kemoterapi (p=0,016), dan berkurangnya risiko metastasis (p=0,008). Median waktu kesintasan pada studi ini adalah 12 bulan, yang disebabkan oleh pendeknya masa pemantauan pasien. Walaupun terdapat keterbatasan, angka kesintasan pasien perempuan lebih baik secara signifikan daripada pasien laki-laki. Angka kesintasan pada golongan usia yang lebih muda menunjukkan kecenderungan lebih baik, walau tidak signifikan secara statistik. Hasil uji multivariate tidak menunjukkan bukti tentang adanya keterkaitan stadium penyakit, respon kemoterapi, dan metastasis terhadap kesintasan. Sebagai kesimpulan, jenis kelamin perempuan berkaitan dengan tumor yang lebih favourable dan angka kesintasan yang lebih tinggi.

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In order to improve the plateaued average 70% survival of osteosarcoma patients, prognostic factors has to be identified to improve adjustment according to patient's characteristics. Female gender and younger age at diagnosis have been suggested as good prognostic factors though inconclusive. Therefore, this study aims to determine the survival rate of osteosarcoma patients admitted to Cipto Mangunkusumo Hospital from 2006 to 2011 and correlate it with age and gender. This cross-sectional study used the medical records of osteosarcoma patients admitted in the department of Orthopedics and Traumatology Cipto Mangunkusumo Hospital. Records of 167 patients were retrieved for this study.

This study shown that younger age was associated with better chemotherapeutic response (p=0,028). Meanwhile, female gender was associated with less advanced disease at presentation (p=0,04), better chemotherapeutic response (p=0,016), and less risk for metastasis (p=0,008). The median survival in this study was 12 months, an underestimation due to short followup duration. Still, female patients survived longer than males. We showed a trend of better survival for younger patients, however the result was not significant. Multivariate analysis failed to show any correlation between various tumor-related variables with survival."

"LATAR BELAKANG: Medulloblastoma memiliki prognosis baik jika pasien menjalani tatalaksana multimodalitas lengkap, terdiri dari operasi, radioterapi, dan kemoterapi. Radioterapi dan kemoterapi memiliki banyak efek samping, namun dosisnya dapat dikurangi pada kelompok pasien dengan faktor prognosis tertentu. Saat ini belum diketahui faktor prognosis medulloblastoma di Indonesia. Penulis bertujuan mengetahui karakteristik medulloblastoma di RSUPN Cipto Mangunkusumo dan menganalisis hubungannya dengan luaran mortalitas. METODE: Penelitian retrospektif ini didasarkan pada rekam medis dan register pasien medulloblastoma yang menjalani operasi pengangkatan tumor di RSUPN Cipto Mangunkusumo pada tahun 2011 - 2018. Cox regression analysis dipakai untuk mengetahui kemaknaan statistik dari hubungan antara demografi (usia dan jenis kelamin), karakteristik tumor (ukuran tumor praoperasi, lokasi tumor, komponen kistik, keterlibatan batang otak), serta tatalaksana (luas reseksi dan waktu pelaksanaan diversi liquor serebrospinal (LCS)) dengan luaran mortalitas. HASIL: Dari 44 pasien medulloblastoma yang dioperasi pada tahun 2011 – 2018, mortalitas didapatkan pada 84,1% pasien, dengan median survival time 13 (8,67 – 17,32) bulan. Terdapat hubungan bermakna antara usia, jenis kelamin, dan luas reseksi dengan luaran mortalitas. Didapatkan HR (95% CI) untuk usia sebesar 0,44 (0,22 – 0,88; p = 0,022), untuk jenis kelamin 0,001 (0,000 – 0,27; REF: perempuan; p = 0,015), dan untuk luas reseksi berupa biopsi 31,52 (1,09 – 910,56; REF: Gross Total Resection (GTR); p = 0,044). SIMPULAN: Terdapat hubungan bermakna secara statistik antara usia, jenis kelamin, dan luas reseksi dengan mortalitas. Tidak terdapat hubungan bermakna antara ukuran tumor praoperasi, lokasi tumor, komponen kistik, keterlibatan batang otak, dan waktu pelaksanaan diversi LCS.

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BACKGROUND: The current prognosis of medulloblastoma is better in patients who underwent complete treatment consisting of surgery, radiotherapy, and chemotherapy. Radiotherapy and chemotherapy is widely associated with multiple side effects, but reduction of dosage is advisable in patients with certain prognostic factors. No study of prognostic factors of medulloblastoma had been conducted in Indonesia. The author aimed to study the characteristics of medulloblastoma patients in Cipto Mangunkusumo National Referral Hospital, and to analyze its association with mortality.

METHOD: This retrospective study was based on medical record and patient registry of medulloblastoma patients who underwent removal tumor in Cipto Mangunkusumo National Referral Hospital between 2011 – 2018. Cox regression analysis was used to determine statistical significance of patients’ demography (age and gender), tumor characteristics (preoperative size, location, cystic component, brainstem involvement), and treatment (extend of resection and timing of cerebrospinal fluid (CSF) diversion) with mortality as the outcome.

RESULT: 44 medulloblastoma patients were analyzed. The incidence of mortality is 84.1% and median survival time is 13 (8.67 – 17.32) months. Significant statistical association between age, gender, and extend of resection with mortality was identified, with HR (95% CI) for age was 0.44 (0.22 – 0.88; p = 0.022), gender was 0.001 (0.000 – 0.27; REF: female; p = 0.015), and biopsy was 31.52 (1.09 – 910.56; REF: gross total resection (GTR); p = 0.044).

CONCLUSION: There was significant statistical association identified between age, gender, and extend of resection with mortality. No significant statistical association was found between tumor size, location, cystic component, brainstem involvement, and timing of CSF diversion."

"Latar belakang: Kanker kolorektal merupakan kanker ketiga tersering di seluruh dunia dan menyebabkan hingga 700.000 kematian setiap tahunnya. Angka kematian akibat kanker kolorektal paling tinggi di negara berkembang yaitu sebesar 52%. Pasien kanker kolorektal memiliki tingkat kesakitan yang tinggi akibat rekurensi maupun metastasis kanker.Faktor-faktor tersebut kemudian memengaruhi luaran akhir pasien-pasien dengan kanker kolorektal yaitu kesintasan hidup. Studi ini menilai kesintasan pasien kanker kolorektal di RSCM.Metode Penelitian ini merupakan suatu penelitian kohort retrospektif dengan analisis survival. Data pasien kanker kolorektal diperoleh dari rekam medis Departemen Medik Ilmu Bedah Fakultas Kedokteran Universitas Indonesia RSCM selama periode Januari 2014 – Desember 2016. Seleksi data dilakukan sesuai kriteria inklusi dan eksklusi hingga jumlah minimal subyek penelitian terpenuhi.Hasil Sebanyak 142 subyek diikutsertakan pada penelitian ini. Kelompok usia terbanyak kanker kolorektal adalah usia ≥45 tahun (73,2%) dan didominasi oleh jenis kelamin laki-laki (55,6%). Komorbiditas pasien pada penelitian ini antara lain diabetes melitus (85,2%), hipertensi (66,9%), dan obesitas (53,5%). Tingkat keparahan penyakit terbanyak pada penelitian ini adalah kanker kolorektal dengan derajat stadium IV (52,1%). Kesintasan lima tahun pasien kanker kolorektal adalah sebesar 43%. Stadium II (HR 5,19; p=0,008; 95%CI 1,524-17,692) dan III (HR 3,72; p=0,006; 95%CI 1,446-9,574) menentukan kesintasan lima tahun dan terapi definitif merupakan faktor protektif terhadap kematian dalam kurun waktu lima tahun (HR 0,117; p=0,000; 95%CI 0,096-0,519).Kesimpulan Angka kesintasan keseluruhan KKR dalam kurun waktu 5 tahun di RSCM adalah sebesar 43%. Faktor-faktor yang memengaruhi kesintasan pasien adalah stadium klinis dan operasi definitif berupa reseksi massa tumor primer.

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Background Colorectal cancer is the third most common cancer all over the world and cause more than 700.000 death anually. Mortality rate of colorectal cancer is higher in developing country compared to developed country. Patients with colorectal cancer have high morbidity due to recurrence or metastatis. Those factors determine the survival rate of patients with colorectal cancer. This study assess survival of patients with colorectal cancer in RSCM.

Method This study was a retrospective cohort with survival analysis. The patients data were from medical record from Surgery Departement in RSCM from January 2014-December 2016. Data selection was done based on inclusion and exclusion criterias.

Result There were 142 patients included in this study. Most of the patients were men (55,6%) with aged ≥45 tahun (73,2%). The most common comorbid found in this study were diabetes melitus (85,2%), hypertension (66,9%), and obesity (53,5%). There were 52,1% patients with high grade cancer/stadium IV. Five years survival of patients with colorectal cancer in this study was 43%. Stadium II (HR 5,19; p=0,008; 95%CI 1,524-17,692) and III (HR 3,72; p=0,006; 95%CI 1,446-9,574) determined five years survival and surgery is the protective factor to death for patients with colorectal cancer in five years (HR 0,117; p=0,000; 95%CI 0,096-0,519).

Conclusion Survival rate of patients with colorectal cancer in five years was 43%. Factors that influence survival rate were clinical stadium and surgery of primary tumor mass."

"Latar belakang: Kanker ovarium khususnya jenis epitelial merupakan salah satu kanker tersering yang diderita oleh perempuan dengan angka mortalitas dan morbiditas yang tinggi. Hingga saat ini, beberapa penelitian telah meneliti berbagai faktor prognostik pada kanker ovarium, khususnya trombosit yang secara patofisiologi memiliki hubungan dengan berbagai marker inflamasi pada kanker. Tujuan: (1) Membuktikan bahwa trombositosis sebagai faktor prognosis pada pasien kanker ovarium jenis epitelial (2) Membuktikan angka OS selama 3 tahun pada pasien kanker ovarium jenis epitelial dengan trombositosis lebih buruk dibandingkan tanpa trombositosis. Metode: Penelitian ini menggunakan studi kohort retrospektif menggunakan data rekam medis pasien kanker ovarium epitelial yang terdaftar pada cancer registry Departemen Obstetri dan Ginekologi Divisi Onkologi Rumah Sakit Cipto Mangunkusumo pada tahun Januari 2014- Juli 2016. Pengamatan dilakukan saat subjek pertama kali didiagnosis kanker ovarium hingga terjadi peristiwa hidup, meninggal, atau hilang dari pengamatan dalam waktu 3 tahun. Hasil: Didapatkan 220 subjek penelitian yang merupakan populasi terjangkau dan memenuhi kriteria inklusi dan eksklusi. Dari 220 subjek penelitian, 132 (60%) dari 220 subjek penelitian merupakan pasien dengan kanker ovarium stadium lanjut (Stadium II/III/IV). Trombositosis didapatkan pada 94 orang subjek penelitian (42,7%). Pasien dengan kanker stadium lanjut memiliki risiko trombositosis yang lebih tinggi dibandingkan subjek pada stadium awal (p=0,005;OR=2,329). Meski begitu, ada atau tidaknya trombositosis secara statistik tidak bermakna pada OS selama 3 tahun (p=0,555). Terdapat mean time survival yang lebih rendah pada pasien dengan trombositosis tetapi tidak ada perbedaan hazard ratio yang bermakna antara subjek dengan atau tanpa trombositosis (p=0,399). Pada penelitian ini, didapatkan faktor prognostik yang bermakna pada OS selama 3 tahun antara lain adalah ada tidaknya asites (HR=3,425; p=0,025), stadium (HR=9,523; p=0,029) dan residu tumor ≥ 1 cm (HR=4,137; p=0,015) dengan stadium kanker ovarium merupakan faktor independen (HR=9,162; p=0,033). Sensitivitas dan spesifisitas trombositosis terhadap kanker ovarium stadium lanjut didapatkan sebesar 50,75% dan 69,32%. Kesimpulan: Trombositosis sebagai faktor prognostik pada pasien kanker ovarium jenis epitelial tidak dapat dibuktikan dan angka OS selama 3 tahun pada pasien dengan trombositosis dibandingkan dengan pasien tanpa trombositosis tidak bermakna secara statistik.

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Background: Ovarian cancer, especially, epithelial ovarian cancer is one of the most common cancer in women with high rate of mortality and morbidity. Some studies have found that some biological factors that can be used as a prognostic factor for epithelial ovarian cancer, particularly, thrombocytes which pathophysiologically correlates with inflammation markers in cancer. Aim: (1) To determine thrombocytosis as a prognostic factor for epithelial ovarian cancer. (2) To determine that 3-year overall survival in epithelial ovarian cancer with thrombocytosis is significantly shorter than patients without thrombocytosis. Method: This study is a retrospective cohort study using medical record of patients with epithelial ovarian cancer which are registed in the cancer registry of Oncology Division in Obstetric and Gynecology Department, Cipto Mangunkusumo Hospital from January 2014 until July 2016. Datas were collected when subjects were first diagnosed with epithelial ovarian cancer until diseases outcomes (survive, death, or loss to follow up) were identified in 3 years. Result: Out of 220 subjects, 132 (60%) were patients with advanced stage epithelial ovarian cancer (stage II/III/IV). 94 (42,7%) subjects had thrombocytosis. Patients with advanced stage of disease had higher risk of having thrombocytosis than the ones with earlier stage (p=0,005;OR=2,329). Correlation between thrombocytosis and 3-year overall survival was known to be insignificant (p=0,555). There was shorter mean time survival between patients with thrombocytosis and the ones without but the there was no significant difference in hazard ratio between the two groups. In this study, several prognostic factors of epithelial ovarian cancer were identifed such as ascites (HR=3,425; p=0,025), stage of disease (HR=9,523; p=0,029), and post-operative residual tumor ≥ 1 cm (HR=4,137; p=0,015) with stage of disease being the independent prognostic factor (HR=9,162; p=0,033). Sensitivity and specificity of thrombocytosis to advance stage of epithelial ovarian cancer were found to be 50,75% and 69,32%, respectively. Conclusion: Thrombocytosis as a prognostic factor in patients with epithelial ovarian cancer cannot be proven statistically. There is also no significant difference of 3-year overall survival between patients with or without thrombocytosis."

"Latar Belakang: Pada tahun 2012, lebih dari 50% pasien kanker payudara di RSCM berada pada stadium lanjut. Five years survival pasien kanker payudara stadium 3 sebesar 72% sedangkan pada stadium 4 hanya 22% meski telah mendapat terapi adekuat. Neoangiogenesis merupakan faktor biologimolekuler yang paling berperan dalam survival rate pasien kanker. Terdapat banyak marker terjadinya neoangiogensis di manusia, namun hanya CD105 yang spesifik menandakan angiogenesis intratumoral. Metode penelitian: Dilakukan studi kohort retrospektif analitik menggunakan 32 data rekam medis pasien RS Kanker Dharmais dari tahun 2011 – 2014 yang telah dipilih secara random. Sediaan sel kanker dari pasien dibuat blok parafin dan dibaca lalu dilakukan analisis univariate dan multivariat memakai SPSS versi 17.0 dan MedCalc. Hasil: Hasil analisis bivariat antara ekspresi CD105 dengan survival rate adalah: crude HR 1,724 (IK 95% 0,693-4,288) dengan nilai p= 0,241. Median survival kelompok ekspresi CD105 positif 1113 hari dan kelompok CD105 negatif 794 hari. Dilihat dari klinikopatologi, didapatkan hubungan bermakna antara usia dan ekspresi CD105 (p= 0,034). Terdapat lebih banyak subjek dengan CD105 negatif dibanding yang positif baik pada grade 3B maupun 4 (69% dan 63,3%). Terdapat hubungan terbalik antara ekspresi CD105 dengan reseptor hormonal dan hubungan antara ekspresi PR dengan ekspresi CD105 (p = 0,042) serta terdapat hubungan positif antara ekspresi HER2 dengan CD105. Kesimpulan: Pada penelitian ini, CD105 belum dapat digunakan sebagai faktor prognostik pada pasien kanker payudara stadium lanjut, namun CD105 yang tinggi memiliki survival yang lebih rendah dibanding dengan CD105 rendah, serta ditemukan hubungan antara ekspresi CD105 dengan usia dan PR.

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Background: In 2012, more than 50% of breast cancer patients in Cipto Mangunkusumo Hospital were advanced breast cancer patients. Stage 3 breast cancer patients have five years survival rate by 72%, while whose in stage 4 only by 22% even after receiving adequate treatment. Neoangiogenesis is the most important biomolecular factor which affect the survival rate of cancer patients. There are many angiogensis maker which has proven can describe neoangiogenesis occurrence ini human body, but only CD105, which is specifically describe the intratumoral angiogenesis occurence.

Methods: We studied a retrospective cohort analytic uses 32 randomized datas from patient medical records Dharmais Cancer Hospital from year 2011 - 2014 for the survival analysis and prognostic factors. The preparate of the patient's cancer cells were made into paraffin blocks and and the results analized using univariate and multivariate analysis taking SPSS version 17.0 and medcalc.

Results: The results of the bivariate analysis between the expression of CD105 with the survival rate is: crude HR 1.724 (95% CI 0.693 to 4.288), with p = 0.241. Median survival of CD105 positive group is 1113 when the negative group was 794 days. From the clinicopathologic side, there was a significant relationship between age and CD105 expression (p = 0.034). There is far more subject to the negative than positive CD105 either on grade 3B and 4 (69% and 63.3%). There is an inverse relationship between the expression of CD105 with hormonal receptors and the relationship between the expression of CD105 with PR expression was statistically significant (p = 0.042), meanwhile there’s positive relation between HER2 and CD105 expression.

Conclusion: In this experiment, CD105 cannot be used as prognostic factor in late stage breast cancer patients, but patients with high CD105 has lower survival rate than the low CD105 ones. There are significant relationship between CD105 expression with age and PR."

"Sindrom mielodisplasia (Myelodysplastic Syndrome, MDS) adalah sejumlah gangguan yang terjadi akibat sumsum tulang tidak mampu menghasilkan sel-sel darah yang sehat.1 Diferensiasi sel prekursor darahterganggu, 2 dan apoptosis meningkat dengan signifikan sehingga sel-sel darah menjadi abnormal yang tidak sepenuhnya berkembang. 3 Gen PI-PLCß1 terlibat dalam proliferasi dan diferensiasi. Mutasi gen PI-PLCß1 dapat memengaruhi peningkatan proliferasi sel blast pada MDS dan cenderung bertransformasi menjadi Leukemia Mieloblastik Akut (Acute Myeloblastic Leukemia, AML). Diketahui PI-PLCβ1 berperan dalam kontrol siklus sel pada transisi G1/S dan perkembangan G2/M. Disregulasi ekspresi gen PI-PLCß1 menyebabkan gangguan pada jalur pensinyalan yang melibatkan proses diferensiasi sel, sehingga terjadi perubahan diferensiasi sel prekursor darah yang menyimpang. Banyak faktor yang menyulitkan pengamatan dalam pemeriksaan sitogenetika pada pasien MDS. Sehingga pemeriksaan ekspresi gen PI-PLCß1 diharapkan akan menjadi pengkajian awal dalam menilai prognostik MDS. Desain penelitian deskriptif dan analitik pada 4 subjek penelitian (3 pasien MDS-MLD, 1 pasien MDS yang telah menjadi AML), dan kontrol pasien dengan kelainan hematologi lain (Multiple Mieloma) sebanyak 1 pasien, serta 1 kontrol sehat. Sebanyak 3/5 (80%) memiliki kelainan kariotip kompleks, dan 1/5 (20%) memiliki kelainan kariotip ganda, dan 1/5 (20%) memiliki kelainan kariotip tunggal. Ekspresi gen PI-PLCß1 lebih rendah pada 4 pasien (MDS dan AML). Sedangkan pada 1 kontrol pasien dengan kelainan hematologi lainnya memiliki ekspresi gen PI-PLCß1 lebih tinggi dibandingkan dengan kontrol sehat. Ekspresi gen PI-PLCß1 lebih rendah pada pasien MDS dengan prognosis yang lebih buruk menurut skoring IPSS-R.

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Myelodysplastic syndrome (MDS) is a number of disorders that occur due to the bone marrow is not able to produce healthy blood cells. 1 The differentiation of blood precursor cells is impaired, 2 and apoptosis increases significantly that the blood cells become abnormal and do not fully develop. 3 The PI-PLCß1 gene is involved in proliferation and differentiation. PI-PLCß1 gene mutations can affect the increase in blast cell proliferation in MDS and tend to transform into Acute Myeloid Leukemia (AML). It is known that PI-PLCβ1 plays a role in cell cycle control in the G1/S transition and G2/M development. Dysregulation of PI-PLCß1 gene expression causes disruption of signaling pathways that involve the process of cell differentiation, resulting in aberrant changes in blood precursor cell differentiation. Many factors complicate observations in the cytogenetic studies of MDS patients. Therefore, it is hoped that the examination of PI-PLCß1 gene expression will be an initial assessment in assessing the prognostic value of MDS. The study design was descriptive and analytic in 5 study subjects (3 MDS-MLD patients, 1 AML patient, and 1 MM patient). Most of the patients had complex karyotype abnormalities, the rest had multiple karyotype abnormalities and single karyotype abnormalities. PI-PLCß1 gene expression was decreased in all MDS and AML patients. Meanwhile, MM patients had normal PI-PLCß1 gene expression. However, the increase in IPSS-R scores in patients was not significantly associated with a decrease in the expression of the PI-PLCß1 gene."

"Pendahuluan. Kematian akibat luka bakar di Indonesia mencapai 195.000 kasus setiap tahunnya. Berdasarkan data dari Kementerian Kesehatan Republik Indonesia, insidensi luka bakar didominasi usia 1—4 tahun. Mortalitas luka bakar pediatrik di rumah sakit tersier mencapai 37,26%. Penelitian ini bertujuan untuk mengetahui hubungan antara faktor prognostik mortalitas pada kasus luka bakar pediatrik di karakteristik populasi Indonesia.Metode. Desain penelitian ini adalah analitik retrospektif meliputi seluruh pasien luka bakar pediatrik di RSUPN Dr. Cipto Mangunkusumo pada periode 1998 hingga 2010. Fokus penelitian ini adalah mengatami variabel pemeriksaan dalam 72 jam pertama pascaadmisi dan diekstraksi dari rekam medis.Hasil. Dari 609 luka bakar pediatrik, insidensi mortalitas adalah 37,8%. Variabel yang berhubungan bermakna dengan mortalitas adalah TBSA, cedera inhalasi, lama rawat inap, kadar hemoglobin 0-jam, hematokrit 24-jam dan 48-jam, INR 0-jam, dan 48-jam, keseimbangan cairan 24-jam, defisit basa, serum laktat, edema pulmonal, systemic inflammatory response syndrome (SIRS) + multiorgan failure(MOF), dan acute coronary syndrome (ACS) (p <0,05). Berdasarkan analisis multivariat, variabel yang bermakna adalah lama rawat inap <14 hari, SIRS+MOF, kadar hematokrit 0-jam, dan kadar laktat serum abnormal.Kesimpulan. Semakin banyak faktor prognostik yang teridentifikasi pada pasien akan meningkatkan risiko mortalitas. Selain itu, resusitasi cairan yang berlebih dapat meningkatkan risiko edema pulmonal, SIRS+MOF, dan komplikasi ACS, yang berujung dengan peningkatan risiko mortalitas.

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Introduction. In Indonesia, burn injuries cause about 195,000 deaths annually. According to data from the Ministry of the Health Republic of Indonesia, the incidence of burns predominated at 1-4 years old. The mortality of pediatric burn patients in a tertiary hospital was 37.26%. This study aimed to find an association between known and unknown prognostic factors of mortality in Indonesian-specific characteristics.

Method. A retrospective analytical study included all pediatric burns admitted to Dr. Cipto Mangunkusumo General Hospital (CMGH) from 1998 to 2010. Variables within a period of the first 72 hours of admission were the focus of interest and were extracted from the medical record.

Results. Of 609 pediatric burns, the mortality rate is 37.8%. Some contributing variables significantly associated with the mortality were TBSA, inhalation injury, length of hospitalization, hemoglobin 0-h level, hematocrit 24-h and 48-h level, INR 0-h, and 48-h, fluid balance 24-h, base deficit, serum lactate, pulmonary edema, systemic inflammatory response syndrome (SIRS) + multiorgan failure (MOF), and acute coronary syndrome (ACS) (p <0.05). On multivariate analysis, the significant variable was length of hospitalization <14 days, SIRS+MOF, abnormal hematocrit 0-h level, and abnormal serum lactate level.

Conclusion. The more identified prognostic factors a patient finds, the more the mortality risk. In addition, excessive fluid resuscitation leads to a high likelihood of pulmonary edema, SIRS+MOF, and ACS complications, followed by increased mortality risk."

"ABSTRAKObjektif: Pembedahan merupakan tatalaksana paliatif utama dari kanker periampular stadium lanjut, namun hal tersebut memiliki angka komplikasi postoperatif, rekurensi penyakit, dan mortalitas yang tinggi. Objektif dari penelitian ini yaitu untuk mengetahui faktor prognostik dan sintasan penyakit selama 1 tahun dari kanker periampular stadium lanjut pada Rumah Sakit Cipto Mangunkusumo. Metode: Penelitian ini merupakan uji analisis sintas dengan desain kohort retrospektif. Data dikumpulkan dari pendaftaran per bulan dari Divisi Bedah Digestif dan rekam medis dari Rumah Sakit Cipto Mangunkusumo dari Januari 2015 hingga Desember 2017. Sintasan penyakit satu tahun dianalisis dengan metode Kaplan-Meier. Dilakukan analisis bivariat dan multivariat dari masing-masing variabel pada sintasan satu tahun pasien. Hasil: Sintasan penyakit selama 1 tahun dari pasien post-double bypass yaitu 19% dengan median (minimal-maksimal) sintasan yaitu 159 (2-365) hari. Berdasarkan perbandingan antarkelompok sintasan pasien, hemoglobin (p=0,013) dan klasifikasi ASA (p=0,001) memiliki estimasi sintasan yang bermakna secara statistik. Pada analisis multivariat, jenis kelamin (p=0,250, HR=3,910) dan nilai laboratorium preoperatif (albumin (p=0,350, HR=0,400), aspartat aminotransferase (AST) (p=0,13, HR=5,110) dan alanin aminotransferase (ALT) (p=0,280, HR=0,05)) berhubungan dengan sintasan. Kesimpulan: Sintasan selama 1 tahun pada pasien post-double bypass pada Rumah Sakit Cipto Mangunkusumo rendah. Laju mortalitas satu bulan yang rendah mengindikasikan bahwa double bypass merupakan prosedur yang aman. Faktor prognostik yang berhubungan dengan sintasan yang rendah yaitu jenis kelamin perempuan dan nilai laboratorium preoperatif (albumin, AST, ALT).

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ABSTRACTObjective: Surgery is the main palliative treatment of advanced periampullary cancer, however it has high number of post-operative complication, disease recurrence and mortality. The objective of the current study was to examine prognostic factors and one year survival rate of advanced stage periampullary cancer in Cipto Mangunkusumo Hospital. Methods: This is a survival analysis test study with retrospective cohort design. Data were collected from monthly registration of Digestive Surgery Division and medical records from Cipto Mangunkusumo Hospital from January 2015 until December 2017. One year survival rate were analyzed with Kaplan-Meier method. Bivariate and multivariate analysis of each variable on one year survival of the patient were done. Result: One year survival rate of the post-double bypass patients is 19% with median (min-max) survival 159 (2-365) days. From the comparison of survival rate based patients grouping, hemoglobin (p=0.013) and ASA classification (p=0.001) have significant survival estimation statistically. In multivariate analysis, gender (p=0.250, HR=3.910) and preoperative laboratory values (albumin (p=0.350, HR=0.400), aspartate aminotransferase (AST) (p=0.13, HR=5.110) and alanine aminotransferase (ALT) (p=0.280, HR=0.05)) are associated with survival rate. Conclusion: One year survival rate of post double bypass patients in Cipto Mangunkusumo hospital is low. Low one month mortality rate indicates double bypass is a safe procedure. Prognostic factors that associated with lower survival are woman gender and preoperative laboratory value (albumin, AST, ALT)."

"[ABSTRAKLatar Belakang: Karsinoma papiler tiroid (KPT) merupakan keganasan terseringorgan endokrin dengan prognosis yang sangat baik, namun pada beberapa kasusdapat terjadi rekurensi dan mortalitas. Beberapa faktor prognostik dan mutasi Btyperapidly accelerated fibrosarcoma V600E (BRAF V600E) dikatakanberhubungan dengan prognosis yang lebih buruk. Pemeriksaan imunohistokimiaprotein BRAF V600E dipercaya dapat mendeteksi adanya mutasi denganspesifisitas 100% dan sensitivitas 89%. Tujuan penelitian ini untuk mengetahuiimunoekspresi BRAF V600E dan hubungannya dengan faktor-faktor prognostik.Bahan dan Cara: Penelitian dilakukan secara retrospektif, desain deskriptifanalitik studi potong lintang. Sampel penelitian berasal dari RSCM berjumlah 50kasus KPT yang dinilai ulang untuk menentukan faktor-faktor prognostik secaramikroskopik. Pemeriksaaan mutasi BRAF V600E menggunakan tehnikimunohistokimia dan penilaian menggunakan H score.Hasil: Nilai H score ³ 326,5 ditentukan sebagai mutasi BRAF V600E positif dan< 326,5 sebagai mutasi BRAF V600E negatif. Terdapat 17 (34%) kasus positifmengalami mutasi BRAF V600E. Rerata usia pada kasus dengan mutasi BRAF V600Epositif adalah 44,71 tahun. Ukuran tumor pada kasus dengan mutasi BRAF V600E positifberkisar antara 0,1-4cm. Tujuh belas kasus yang mengalami mutasi, 6 dlaki-laki dan 11perempuan. Tujuh kasus dengan perluasan keluar tiroid, 11 kasus dengan metastasiskelenjar getah bening (KGB), dan 8 kasus dengan varian histopatologik tall cell.Kesimpulan: Terdapat hubungan bermakna antara mutasi BRAF V600E denganperluasan keluar tiroid, metastasis kelenjar getah bening (KGB), dan varianhistopatologik tall cell. Tidak terdapat hubungan bermakna antara mutasi BRAFV600E dengan usia, jenis kelamin, dan ukuran tumor.

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ABSTRACTBackgroud: Papillary Thyroid Carcinoma (PTC) is the most common malignantneoplasm of the endocrine organ with an excellent prognosis, but in some casespresent with recurrency and mortality. There are prognostic factors and BRAFV600E mutation that related to worse prognosis. Immunohistochemicalinvestigetion of BRAF V600E protein believe can detect mutation wth 100%specificity and 89% sensitivity. Recent study suggest PTC with BRAF V600Emutation do thyroidectomy with prophylactic lymph node dissection. BRAFV600E specific inhibitor effective to the patient with advance stadium, patientwith metastases, and resistant to iodium radioactive. Aim of this study is to obtainBRAF V600E and the relation with prognostic factors.Material and Methods: This is a retrospective descriptive-analytic crosssectionalstudy. Fifty patient with PTC comes from Ciptomangunkusumo Hospitaland reviewed to determine prognostic factors microscopicaly. BRAF V600Emutation detected by immunohistochemical staining and assesed with H score.Result: H score ³ 326,5 determined as positive BRAF V600E mutation and <326,5 as negative BRAF V600E mutation. BRAF V600E mutation was detectedin 17 (34%) cases by immunohistochemistry. The mean age of the cases withpositive BRAF V600E mutation was 44.71 years, while the negative 41.58. Thesize of the tumor in cases with BRAF V600E mutation positive range between0,1-4cm, while negative 0,1-9cm. Seventeen cases have mutations, 6 of them sexmale and 11 female. Seven cases with extrathyroidal extension (ETE), 11 caseswith lymph node metastasis (KGB), and 8 cases with tall cell variant.Conclusion: There are significant correlation between BRAF V600E mutationwith extrathyroidal extension, lymph node metastases, and tall cell variant. Thereare no significant correlation between BRAF V600E mutation with age, gender,and size of the tumor, Backgroud: Papillary Thyroid Carcinoma (PTC) is the most common malignantneoplasm of the endocrine organ with an excellent prognosis, but in some casespresent with recurrency and mortality. There are prognostic factors and BRAFV600E mutation that related to worse prognosis. Immunohistochemicalinvestigetion of BRAF V600E protein believe can detect mutation wth 100%specificity and 89% sensitivity. Recent study suggest PTC with BRAF V600Emutation do thyroidectomy with prophylactic lymph node dissection. BRAFV600E specific inhibitor effective to the patient with advance stadium, patientwith metastases, and resistant to iodium radioactive. Aim of this study is to obtainBRAF V600E and the relation with prognostic factors.Material and Methods: This is a retrospective descriptive-analytic crosssectionalstudy. Fifty patient with PTC comes from Ciptomangunkusumo Hospitaland reviewed to determine prognostic factors microscopicaly. BRAF V600Emutation detected by immunohistochemical staining and assesed with H score.Result: H score ³ 326,5 determined as positive BRAF V600E mutation and <326,5 as negative BRAF V600E mutation. BRAF V600E mutation was detectedin 17 (34%) cases by immunohistochemistry. The mean age of the cases withpositive BRAF V600E mutation was 44.71 years, while the negative 41.58. Thesize of the tumor in cases with BRAF V600E mutation positive range between0,1-4cm, while negative 0,1-9cm. Seventeen cases have mutations, 6 of them sexmale and 11 female. Seven cases with extrathyroidal extension (ETE), 11 caseswith lymph node metastasis (KGB), and 8 cases with tall cell variant.Conclusion: There are significant correlation between BRAF V600E mutationwith extrathyroidal extension, lymph node metastases, and tall cell variant. Thereare no significant correlation between BRAF V600E mutation with age, gender,and size of the tumor]"

"[ABSTRAKLatar belakang: Malignant peripheral nerve sheath tumor (MPNST) adalah sarkoma jaringan lunak yang sulit dibedakan dengan beberapa sarkoma sel spindel karena morfologinya yang serupa. MPNST bersifat agresif dengan angka rekurensi yang tinggi dan cenderung bermetastasis terutama ke paru. Salah satu tahap metastasis adalah invasi dengan cara mendegradasi matriks ekstraseluler dimana Matrix Metalloproteinase (MMP) memainkan peranan penting dalam proses ini. MMP tipe gelatinase yaitu MMP-2 dan MMP-9 memiliki kemampuan dalam mendegradasi membran basal dan kolagen fibrilar sehingga dapat membuka jalur invasi bagi sel tumor. MMP-2 mampu mendegradasi lebih banyak tipe kolagen dan MES non kolagen dibandingkan MMP-9. Penelitian ini bertujuan untuk menilai hubungan antara peningkatan ekspresi MMP-2 dengan derajat keganasan histologik dan variabel prognostik klinis lainnya.Bahan dan cara: Dilakukan pulasan imunohistokimia MMP-2 pada 39 kasus yang terdiri atas 19 MPNST derajat rendah dan 20 MPNST derajat tinggi. Selanjutnya dilakukan analisis hubungan antara peningkatan ekspresi MMP-2 dengan derajat keganasan dan variabel klinis seperti usia, jenis kelamin, ukuran dan lokasi tumor.Hasil: Peningkatan ekspresi MMP-2 ditemukan pada 19 (95%) kasus MPNST derajat tinggi dan 3 kasus (15,8%) kasus MPNST derajat rendah (p=0.000). Terdapat hubungan yang kuat antara peningkatan ekspresi MMP-2 dengan derajat keganasan MPNST. Tidak ditemukan hubungan antara ekspresi MMP-2 dengan jeni usia, jenis kelamin, ukuran dan lokasi tumor.Kesimpulan: Peningkatan ekspresi MMP-2 sejalan dengan peningkatan derajat histologik, sehingga dapat digunakan untuk membantu menentukan progresifitas MPNST.

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ABSTRACTBackground: Malignant peripheral nerve sheath tumor (MPNST) is a sarcoma that is difficult to differentiate with other spindle cell sarcomas, because of their similar morphology. The behavior of MPNST is aggressive, with a high recurrence and tend to metastases hematogenous, especially to lung. Important step of metastases is invasion by degradating extracellular matrix, in which Matrix Metalloproteinase (MMP) play important role in this process. Gelatinase type of MMP, MMP-2 and MMP-9 have ability to degrade basal membrane and fibriler collagen, in order to open the way of invasion. MMP-2 can degrade type collagen and non collagen extracellular matrix than MMP-9. The aim of this study is to see the correlation between expression of MMP-2 and histopathology grading and other prognostic clinical variables.Methods: This study enrolled 39 cases of consisted of 19 low grade MPNST and 20 high grade MPNST. The case were stained for MMP-2 imunnohistochemistry and the expression of MMP-2 were scored. Analysis the correlation between over expression of MMP-2 and histopathology grading and other clinical variables , such as age, sex, size and location of the tumor.Results: Overexpression of MMP-2 was observed in 19 (95%) cases of high grade MPNST and 3 (15,8%) cases of low grade MPNST (p=0.000). There is a significant correlation between MMP-2 over expression and histopathology grade. There is no correlation between MMP-2 expression and age, sex, siize and location of tumor.Conclusion: High expression of MMP-2 is in parallel with high histologic grade, therefore it may be of additional use as prognostic factor., ackground: Malignant peripheral nerve sheath tumor (MPNST) is a sarcoma that is difficult to differentiate with other spindle cell sarcomas, because of their similar morphology. The behavior of MPNST is aggressive, with a high recurrence and tend to metastases hematogenous, especially to lung. Important step of metastases is invasion by degradating extracellular matrix, in which Matrix Metalloproteinase (MMP) play important role in this process. Gelatinase type of MMP, MMP-2 and MMP-9 have ability to degrade basal membrane and fibriler collagen, in order to open the way of invasion. MMP-2 can degrade type collagen and non collagen extracellular matrix than MMP-9. The aim of this study is to see the correlation between expression of MMP-2 and histopathology grading and other prognostic clinical variablesMethods: This study enrolled 39 cases of consisted of 19 low grade MPNST and 20 high grade MPNST. The case were stained for MMP-2 imunnohistochemistry and the expression of MMP-2 were scored. Analysis the correlation between over expression of MMP-2 and histopathology grading and other clinical variables , such as age, sex, size and location of the tumor.Results:. Overexpression of MMP-2 was observed in 19 (95%) cases of high grade MPNST and 3 (15,8%) cases of low grade MPNST (p=0.000). There is a significant correlation between MMP-2 over expression and histopathology grade. There is no correlation between MMP-2 expression and age, sex, siize and location of tumor.Conclusion: High expression of MMP-2 is in parallel with high histologic grade, therefore it may be of additional use as prognostic factor.]"