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Simanjuntak, Bonauli
Hubungan antara microsatellite instability (MSI) terhadap kesintasan tiga tahun pada pasien kanker kolorektal = Correlation between microsatellite instability (MSI) and five years survival rate in colorectal cancer
"ABSTRAK
Latar Belakang: Prognosis dan tatalaksana kanker kolorektal sangat dipengaruhi olehstadiumnya. Pada tahun 2012, the European Society for Medical Oncology mempublikasikan pedoman yang menyarankan evaluasi terhadap microsatellite instability MSI untuk menentukan perjalanan penyakit kanker kolorektal. Penelitian ini bertujuan untuk menginvestigasi faktor prognostik MSI-H pada kadar kesintasan 3 tahun. Metode: Penelitian ini menggunakan data sekunder dari penelitian sebelumnya oleh Setyaningsih, dkk. yang berjudul ldquo;Penelitian Microsattelite Instability Melalui Ekspresi PMS2 dan MSH6 serta Tumor-Infiltrating Lymphocyte pada Kanker Kolorektal Kiri dan Kanan rdquo;. Kami memasukkan total 90 pasien yang didiagnosis sebagai kanker kolorektal yang menjalani bedah reseksi dari tahun 2008 hingga 2013 di RSUPN Cipto Mangunkusumo. Kami menganalisa status MSI sebagai faktor prognosis untuk menentukan kadar kesintasan 3 tahun yang disesuaikan dengan ukuran dan tipe tumor, metastasis, dan umur pasien. Hasil: Dari 90 pasien, 47 orang dapat dilakukan follow up. Mayoritas pasien didiagnosis dengan kanker kolorektal stadium III n=29; 61,7 , 8 pasien didiagnosis sebagai stadium IV, 9 pasien didiagnsosis sebagai stadium II, dan 1 pasien didiagnosis dengan stadidum I. Kesintasan tiga tahun untuk pasien MSI-H adalah 33,3 , 22,2 , dan 20 untuk stadium II, III, dan IV; dibandingkan dengan kesintasan tiga tahun untuk pasien MSI-L yaitu 0 , 5 , dan 0 p = 0,003 . Selain itu, berdasarkan analisis multivariate, kami menemukan bahwa MSI-L memiliki hazard ratio 2,421 1,991-2,851 dibandingkan dengan MSI-H p = 0,004 . Kesimpulan: MSI-H adalah faktor prognosis yang penting untuk menentukan kesintasan tiga tahun pada pasien kanker kolorektal. Kami menemukan bahwa pasien dengan MSI-H memiliki prognosis yang lebih baik dibandingkan dengan pasien MSI-L. Temuan ini sejalan dengan pedoman dan penelitian sebelumnya yang menyarankan penggunaan MSI untuk menentukan perjalanan penyakit dan pilihan terapi pada pasien kanker kolorektal.
ABSTRACT Background The prognosis and treatment of colorectal cancer is based on its stadium. Due to its features, the prognosis stage II colorectal cancer is still considered inexact with the survival rates ranging from 87,5 in stage IIA to 58.4 in stage IIC.The European Society for Medical Oncology published a guideline in 2012 which suggests that microsatellite instability MSI should be evaluated to determine the course of the colorectal cancer. This study is aimed to investigate prognostic factor of MSI ndash H for 3 years survival rates. Method This study used secondary data from a previous study performed by Setyaningsih, et al. titled ldquo Penelitian Microsattelite Instability Melalui Ekspresi PMS2 dan MSH6 serta Tumor Infiltrating Lymphocyte pada Kanker Kolorektal Kiri dan Kanan rdquo . We included a total of 90 patients diagnosed with colorectal cancer who underwent resection surgery from 2008 to 2013 in RSUPN Cipto Mangunkusumo. We analyzed the MSI status as a prognosticfactor to determine 3 years survival rate, adjusted with the size and types of the tumor, metastasis, and age. Results Among 90 patients, 47 have been followed up. The median age was 47 years. The majority of the patients was diagnosed with stage III colorectal cancer n 29 61.7 , 8 patients were diagnosed with stage IV, 9 patients were diagnosed with stage II colorectal cancer, and 1 patient was diagnosed with stage I colorectal cancer. Three years survival rates for patients with MSI H are 33.3 , 22.2 , and 20 for stage II, III, and IV respectively, compared to 5 years survical rates for MSI L patients which are 0 , 5 , and 0 p 0.003 . Futhermore, with multivariate analysis, we found that MSI L has 2.421 1.991 2.851 hazard ratio compared to MSI H p 0.004 . Conclusions MSI H is an important prognostic factor to determine 3 years survival rate in colorectal cancer patients.We found that patient with MSI H have more favourable prognosis compared to MSI L patients This findings complements previous guidelines and studies which suggested the use of MSI to determine the disease course and treatment options in colorectal cancer."
2017
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UI - Tugas Akhir  Universitas Indonesia Library
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Chandra Dewi Kartika Setyaningsih
Penilaian microsatellite instability melalui ekspresi PMS2 dan MSH6 serta tumor infiltrating-lymphocytes pada kanker kolorektal kiri dan kanan = Assessment of microsatellite instability trough PMS2 and MSH6 expression and tumor infiltrating-lymphocytes in left and right sided colorectal cancer
"ABSTRAK
Latar Belakang :
Karsinoma kolorektal (KKR) merupakan penyebab kematian kedua di dunia dari seluruh jenis
kanker. KKR dapat disebabkan oleh defek dari MMR DNA. Microsatellite instability (MSI)
adalah penanda defek MMR DNA. KKR MSI-H memiliki gambaran karakteristik tertentu.
Tumor-infiltrating-lymphocyte (TIL) merupakan faktor prognosis. Hilangnya ekspresi PMS2 dan
MSH6 dapat sebagai penanda MSI. Penelitian ini bertujuan untuk menilai terjadinya MSI pada
KKR di sisi kiri dan sisi kanan kolon melalui Hilangnya ekspresi PMS2 dan MSH6, serta
mengetahui hubungan antara TIL dengan MSI-H.
Bahan dan Metode :
Dilakukan pulasan IHK PMS2 dan MSH6, serta penghitungan TIL. Penilaian dilakukan dengan
menghitung hilangnya ekspresi PMS2 dan MSH6 pada inti sel dan dikelompokkan ke dalam
kelompok mutasi dan tidak mutasi .Penghitungan TIL juga dikelompokkan ke dalam TIL tinggi
dan rendah, berdasarkan nilai titik potong
Hasil :
Didapatkan 27,8% kasus menunjukkan hilangnya ekspresi PMS2 dan MSH6 dengan 14,4%
kasus di distal kolon. TIL terbanyak di distal kolon 30% kasus. Tidak terdapat perbedaan
bermakna antara mutasi PMS2 dan MSH6 dengan lokasi (p=0,829) dan TIL (p=0,187). Terdapat
perbedaan bermakna antara usia dan lokasi (p=0,020) serta peningkatan ekspresi PMS2 dengan
MSH6 (p=0,06).
Kesimpulan :
MSI-H ditemukan pada 27,8% kasus. Penggunaan PMS2 dan MSH6 pada penelitian ini belum
dapat menggantikan 4 panel IHK. Terdapat kecenderungan dimana adenokarsinoma NOS
memiliki frekuensi mutasi lebih tinggi dari adenokarsinoma musinosum.
ABSTRACT
Background : Colorectal carcinoma (CRC) is the world second leading cause of death from all types of cancer.
CRC can be caused by a defect of MMR DNA. Microsatellite instability (MSI) is a marker of
DNA MMR defect. CRC MSI-H has a certain characteristic figures. Tumor-infiltrating
lymphocytes (TIL) isone of prognostic factor. Loss expression of the PMS2 and MSH6 can be
use as a marker of MSI. This study aims to assess the occurrence of MSI in CRC on the left side
and the right side of the colon through the loss of expression of PMS2 and MSH6, and
determine the relationship between TIL with MSI-H.
Materials and Methods :
Immunohistochemical staining using two marker, there is PMS2 and MSH6. We also counting
the number of TIL. Assessment by calculating the loss expression of PMS2 and MSH6 in the cell
nuclei and divided into two groups, the mutations and non mutations . TIL result also grouped
into high and low, based on the cutoff point.
Result :
There are 27.8% of cases showed loss of expression of PMS 2 and MSH6 with 14.4% of cases in
the distal colon. About 30% TIL cases located in distal colon. There were no significant
differences between PMS2 and MSH6 mutation with the location (p = 0.829) and TIL (p =
0.187). There are significant differences between age and location (p = 0.020) and increased
expression of PMS2 with MSH6 (p = 0.06). \
Conclusion :
MSI-H was found in 27.8% of cases. The use of PMS2 and MSH6 in this study have not been
able to replace 4 panels of IHC. There is a tendency where the adenocarcinoma NOS have a
higher mutation frequency than mucinous adenocarcinoma. ;Background :
Colorectal carcinoma (CRC) is the world second leading cause of death from all types of cancer.
CRC can be caused by a defect of MMR DNA. Microsatellite instability (MSI) is a marker of
DNA MMR defect. CRC MSI-H has a certain characteristic figures. Tumor-infiltrating
lymphocytes (TIL) isone of prognostic factor. Loss expression of the PMS2 and MSH6 can be
use as a marker of MSI. This study aims to assess the occurrence of MSI in CRC on the left side
and the right side of the colon through the loss of expression of PMS2 and MSH6, and
determine the relationship between TIL with MSI-H.
Materials and Methods :
Immunohistochemical staining using two marker, there is PMS2 and MSH6. We also counting
the number of TIL. Assessment by calculating the loss expression of PMS2 and MSH6 in the cell
nuclei and divided into two groups, the mutations and non mutations . TIL result also grouped
into high and low, based on the cutoff point.
Result :
There are 27.8% of cases showed loss of expression of PMS 2 and MSH6 with 14.4% of cases in
the distal colon. About 30% TIL cases located in distal colon. There were no significant
differences between PMS2 and MSH6 mutation with the location (p = 0.829) and TIL (p =
0.187). There are significant differences between age and location (p = 0.020) and increased
expression of PMS2 with MSH6 (p = 0.06). \
Conclusion :
MSI-H was found in 27.8% of cases. The use of PMS2 and MSH6 in this study have not been
able to replace 4 panels of IHC. There is a tendency where the adenocarcinoma NOS have a
higher mutation frequency than mucinous adenocarcinoma. ;Background :
Colorectal carcinoma (CRC) is the world second leading cause of death from all types of cancer.
CRC can be caused by a defect of MMR DNA. Microsatellite instability (MSI) is a marker of
DNA MMR defect. CRC MSI-H has a certain characteristic figures. Tumor-infiltrating
lymphocytes (TIL) isone of prognostic factor. Loss expression of the PMS2 and MSH6 can be
use as a marker of MSI. This study aims to assess the occurrence of MSI in CRC on the left side
and the right side of the colon through the loss of expression of PMS2 and MSH6, and
determine the relationship between TIL with MSI-H.
Materials and Methods :
Immunohistochemical staining using two marker, there is PMS2 and MSH6. We also counting
the number of TIL. Assessment by calculating the loss expression of PMS2 and MSH6 in the cell
nuclei and divided into two groups, the mutations and non mutations . TIL result also grouped
into high and low, based on the cutoff point.
Result :
There are 27.8% of cases showed loss of expression of PMS 2 and MSH6 with 14.4% of cases in
the distal colon. About 30% TIL cases located in distal colon. There were no significant
differences between PMS2 and MSH6 mutation with the location (p = 0.829) and TIL (p =
0.187). There are significant differences between age and location (p = 0.020) and increased
expression of PMS2 with MSH6 (p = 0.06). \
Conclusion :
MSI-H was found in 27.8% of cases. The use of PMS2 and MSH6 in this study have not been
able to replace 4 panels of IHC. There is a tendency where the adenocarcinoma NOS have a
higher mutation frequency than mucinous adenocarcinoma. "
Depok: Fakultas Kedokteran Universitas Indonesia, 2015
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library