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"Kanker payudara merupakan kanker paling umum pada wanita di seluruh duniadengan insiden lebih dari dua juta orang setiap tahunnya. Kanker payudarastadium lanjut lokal adalah jenis kanker payudara invasif yang terbatas padapayudara regional dan kelenjar getah bening. Salah satu terapi adalah kemoterapineoadjuvan (KN) yang efikasinya dapat dievaluasi secara respons patologisdengan Miller Payne. Penting untuk mengidentifikasi biomarker sebagai prediktorrespons patologis setelah KN. Limfosit CD8+ diperiksa sebagai prediktorkeberhasilan KN lanjut lokal. Dengan menggunakan metode cross-sectional,penelitian ini dilakukan di laboratorium patologi anatomi dan divisi bedahonkologi RSUPN Dr. Cipto Mangunkusumo antara bulan Januari-Juni 2022.Subjek penelitian ini adalah pasien kanker payudara stadium lanjut lokal yangmenjalani operasi pengangkatan payudara dengan terapi KN dari bulan September2015- Februari 2022. Subjek penelitian ini didominasi luminal B, grade 2, ER+dan kemoterapi berbasis antrasiklin. Ekspresi limfosit CD8+ tinggi dan tidak adahubungan dengan faktor klinikopatologi. Sebagian besar pasien memberikanrespon patologis positif terhadap kemoterapi dan terdapat hubungan yangbermakna antara ekspresi limfosit T CD8+ dengan respon patologis Miller-Payne.Diperlukan penelitian lebih lanjut mengenai ekspresi limfosit CD8+ sebagai faktorprediktif dalam respon kemoterapi neoadjuvan.......Breast cancer is the most common cancer in women worldwide with an incidenceof more than two million people annually. Locally advanced breast cancer is atype of invasive breast cancer limited to the regional breast and lymph nodes. Oneof the treatments is neoadjuvant chemotherapy (NC) whose efficacy can beevaluated by the Miller Payne method. It is important to identify biomarkers topredict pathological responses after NC. CD8+ lymphocyte was examined as apredictor of advanced local NC successfulness. Using cross-sectional method, thisresearch was done in the laboratory of anatomical pathology and divisionsurgical oncology RSUPN Dr. Cipto Mangunkusumo between January-June 2022.The subjects were locally advanced breast cancer patients who receivedneoadjuvant breast removal surgery from September 2016- February 2022. 35 outof 40 subjects had clinical stage T4 mostly NST, luminal B, grade 2, ER+ andanthracycline-based chemotherapy. The expression of CD8+ lymphocytes washigh and there was no association with clinicopathological factors. Most of thepatients respond positively to chemotherapy and there is a significant relationshipbetween the expression of CD8+ T lymphocytes with Miller Payne pathologicalresponse. Further research on CD8+ lymphocyte expression"

"Latar Belakang: Respons patologis kanker payudara terhadap terapi neoadjuvan masih relatif rendah, khususnya di RSCM. Intensitas sTIL dan ekspresi PD-L1 telah diteliti sebagai prediktor respons terapi neoadjuvan. Penelitian ini menilai peran intensitas sTIL dan ekspresi PD-L1 terhadap repons terapi neoadjuvan kanker payudara. Data tersebut dapat dimanfaatkan sebagai data awal di Indonesia, untuk perencanaan terapi pasien kanker payudara yang lebih baik, terlebih dengan sudah tersedianya imunoterapi anti-PD-1/PD-L1.Tujuan: Mengetahui intensitas sTIL dan ekspresi PD-L1 sebagai prediktor respons patologis kanker payudara terhadap terapi neoadjuvan di RSCM.Metode: Penelitian berdesain kohort retrospektif, analitik observasional, pada kasus kanker payudara yang mendapatkan terapi neoadjuvan dan mastektomi di RSCM periode Januari 2014-Desember 2021. Dilakukan total sampling sebanyak 60 kasus. Ekspresi PD-L1 (imunohistokimia, klon 22C3) dan intensitas sTIL (histopatologi) diperiksa pada spesimen biopsi. Dilakukan analisis multivariat regresi linear untuk mendapatkan prediktor independen respons terapi neoadjuvan.Hasil: Didapatkan 60 pasien perempuan, median usia 46 tahun, 91,7% karsinoma invasif no special type. Median intensitas sTIL 10% (1%-70%). Intensitas sTIL rendah (≤10%) pada 58,3% sampel. Ekspresi PD-L1 positif (CPS ≥1) pada 28,3% sampel. Hanya 8,3% sampel mencapai pCR, 90% tergolong RCB kelas II-III. Didapatkan prediktor independen skor RCB: Setiap peningkatan 1% intensitas sTIL, tidak adanya invasi limfovaskular, dan pemberian kemoterapi berbasis taksan diprediksi menurunkan skor RCB sebanyak 0,058 (0,039-0,078), 0,781 (0,241-1,321), dan 0,594 (0,037-1,152). Ekspresi PD-L1 yang positif berhubungan dengan tercapainya pCR-RCB kelas I (p=0,048), tetapi skor CPS bukan merupakan prediktor skor RCB pada analisis multivariat regresi linear.Kesimpulan: Intensitas sTIL merupakan prediktor respons patologis kanker payudara terhadap terapi neoadjuvan di RSCM. Ekspresi PD-L1 berhubungan dengan tercapainya pCR-RCB kelas I, tetapi skor CPS bukan prediktor skor RCB.Kata kunci: PD-L1, programmed-death ligand 1, sTIL, stromal tumour infiltrating lymphocyte, kanker payudara, kemoterapi neoadjuvan, respons patologis......Background: Pathological responses to neoadjuvant therapy were still relatively poor, especially in RSCM. Studies had been done to search for predictors of response such as sTIL intensity and PD-L1 expression, which is known to block sTIL action in killing cancer cells. This research assessed sTIL intensity and PD-L1 expression as predictors of response to neoadjuvant therapy in breast cancer. The preliminary data might be used to better tailored breast cancer patient therapy, considering the availability of anti-PD-1/PD-L1 immunotherapy nowadays.Objective: To assess TIL intensity, PD-L1 expressions, and their roles as pathological predictors of breast cancer reponse to neoadjuvant therapy in RSCM.Method: This was an observational analytic retrospective cohort study on breast cancer patients receiving neoadjuvant therapy and mastectomy in RSCM from January 2014 to December 2021. Total sampling was done. PD-L1 expression (immunohistochemistry, clone 22C3) and sTIL intensity (histopathology) was examined in the biopsy specimen. Linear regression analysis was done to determine the independent predictors of neoadjuvant therapy response (evaluated in the mastectomy specimen with residual cancer burden/RCB score).Results: There were 60 female patients, median age 46 years old. 91,7% had invasive carcinoma of no special type. Median sTIL intensity was 10% (1%-70%). 58,3% patients had low sTIL intensity (≤10%). 28,3% patients had positive PD-L1 expression (CPS ≥1). Only 8,3% patients had pCR, while 90% patients had RCB class II-III. Every 1% increase in sTIL intensity, no lymphovascular invasion, and taxane chemotherapy were predicted to lower RCB score by 0,058, 0,781, dan 0,594, respectively. PD-L1 expression associated with pCR-RCB class I (p=0,048), but CPS score was not a predictor of RCB score in linear regression analysis. Conslusion: sTIL intensity was an independent predictor of breast cancer response to neoadjuvant therapy in RSCM. PD-L1 expression associated with pCR-RCB class I, but CPS score was not a predictor of RCB score. Keywords: PD-L1, programmed death ligand 1, sTIL, stromal tumour infltrating lymphocyte, breast cancer, neoadjuvant therapy, pathological response"