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"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."

"Latar Belakang: Pada tahun 1998-1999, kesintasan pasien karsinoma hepatoselular (KHS) yang berobat di Rumah Sakit Cipto Mangunkusumo (RSCM) sangat rendah karena sebagian besar datang dalam stadium lanjut dan hanya sedikit pasien yang dapat memperoleh terapi paliatif atau kuratif. Dalam tiga tahun terakhir, RSCM telah memiliki fasilitas tatalaksana KHS yang lebih baik, namun dampaknya terhadap perbaikan kesintasan pasien KHS belum diketahui. Tujuan: Mengetahui perbandingan kesintasan satu tahun pasien KHS yang berobat di RSCM pada periode 2013-2014 dengan periode 1998-1999. Metode: Data 114 pasien KHS yang berobat di RSCM pada periode 2013-2014 dan data sekunder penelitian 77 pasien KHS di RSCM pada tahun 1998-1999 dikumpulkan secara retrospektif lalu dilakukan penilaian karakteristik dan perbandingan kurva kesintasan dengan menggunakan metode Kaplan-Meier yang dilanjutkan dengan uji log-rank. Hasil: Terdapat peningkatan hepatitis B sebagai etiologi KHS dari 32,5% pada 1998-1999 menjadi 67,5% pada 2013-2014. Insidens pasien yang meninggal selama pengamatan adalah 57% (95% interval kepercayaan (IK) = 48-66%) pada periode 2013-2014 dan 61% (95% IK = 49-73%) pada periode 1998-1999. Median kesintasan secara keseluruhan adalah 141 hari. Meskipun terdapat perbaikan dalam fasilitas tatalaksana KHS, angka kesintasan satu tahun pada kedua periode tidak berbeda secara signifikan (29,4% pada 2013-2014 dan 24,1% pada 1998-1999, p=0,913). Hal ini tampaknya disebabkan karena surveilans KHS pada populasi risiko tinggi masih rendah. Simpulan: Tidak ada perbedaan kesintasan satu tahun pasien KHS pada periode 2013-2014 dengan periode 1998-1999.

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Background: In 1998-1999, the survival of hepatocellular carcinoma (HCC) patients in Cipto Mangunkusumo Hospital was very poor because most patients came in advanced stage and only few patients could receive palliative or curative treatment. In the last three years, Cipto Mangunkusumo Hospital has improved its facilities for HCC treatment. It is unclear whether this effort has resulted in improvement of patients? survival.

Objectives: To compare one-year survival rate of HCC patients between two periods (2013-2014 and 1998-1999).

Method: We analyzed retrospectively 114 HCC patients who came to our department in 2013-2014 and 77 patients in 1998-1999. We compare the clinical characteristics and treatment between two periods and then we analyze the survival of both groups using Kaplan-Meier method and compare them using log-rank test.

Results: There was an increase in hepatitis B prevalence as the etiology of HCC from 32,5% in 1998-1999 to 67,5% in 2013-2014, causing hepatitis B as the main etiology of HCC in 2013-2014. Incidence rate of patients who died in 2013-2014 was 57% (95% confidence interval (CI) = 48-66%) and in 1998-1999 was 61% (95% CI = 49-73%). Overall median survival was 141 days. Despite improvement in treatment facilities, no significant difference was found in one-year survival rate (29,4% in 2013-2014 versus 24,1% in 1998-1999, p=0,913). It seems that this result was caused by low level of surveillance in high-risk population.

Conclusion: No improvement was seen in one-year survival rate of HCC patients between 2013-2014 and 1998-1999."

"ABSTRAKPendahuluan: 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"