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Abstrak :
Latar Belakang: Karsinoma nasofaring (KNF) adalah karsinoma yang berasal dari epitel permukaan nasofaring dengan angka insidensi yang tinggi di Tiongkok dan Asia Selatan. KNF masih menjadi masalah kesehatan di Indonesia dan prognosisnya dilaporkan buruk terkait dengan penanganan yang sering tidak optimal karena kebanyakan (60-95%) pasien berobat dalam stadium lanjut. Saat ini berkembang penelitian terhadap tumor microenvironment yang dapat dinilai melalui tumor infiltrating lympochyte (TIL) yang berkaitan dengan respons terapi pada beberapa tumor, termasuk KNF. Beberapa penelitian menyebutkan bahwa TIL salah satunya dapat dinilai dengan Foxp3. Foxp3 diketahui sebagai penanda sel T regulator (Treg) yang turut berperan dalam immunoregulator lingkungan sel-sel tumor dan dapat digunakan sebagai salah satu faktor prognosis. Hubungan antara ekspresi Foxp3 dengan respons terapi dapat dipertimbangkan menjadi salah satu faktor yang mempengaruhi prognosis KNF. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan antara ekspresi Foxp3 dengan respons terapi karsinoma nasofaring. Metode: Penelitian analitik dengan desain potong lintang pada sediaan KNF tidak berkeratin di Departemen Patologi Anatomik FKUI/RSCM selama periode Januari 2018 hingga Desember 2020. Pengambilan sampel penelitian dilakukan secara consecutive sampling dari kasus yang memenuhi kriteria inklusi dan eksklusi sesuai perhitungan besar sampel untuk masing-masing kelompok. Pemeriksaan imunohistokimia menggunakan antibodi primer monoklonal Foxp3. Data imunoekspresi dianalisis untuk mengetahui hubungannya dengan respons terapi karsinoma nasofaring. Hasil: Dari 60 kasus yang terdiagnosis KNF, sebanyak 40 kasus (66,7%) berjenis kelamin laki-laki dan 20 kasus lainnya (33,3%) berjenis kelamin perempuan dengan rasio 2:1. Terdapat perbedaan bermakna ekspresi Foxp3 intratumoral dengan respons terapi (p=0,01). Tidak terdapat perbedaan bermakna ekspresi Foxp3 peritumoral dengan respons terapi (p=0,114). Kesimpulan: Ekspresi Foxp3 mempunyai hubungan yang bermakna secara statistik dengan hasil evaluasi respons pasca kemoradiasi karsinoma nasofaring. ......Background: Nasopharyngeal carcinoma (NPC) is a carcinoma originating from the surface epithelium of the nasopharynx with a high incidence in Tiongkok and South Asia. NPC still become main health issue in Indonesia and the prognosis is reported to be poor due to suboptimal treatment because most of the patients (60-95%) are treated at an advanced stage. Currently, many research are developing on the tumor microenvironment that can be assessed by tumor infiltrating lymphochyte (TIL) which is associated with the treatment response in several tumors, including NPC. Some studies explore that TIL can be assessed with Foxp3. Foxp3 is known as a regulatory T cell (Treg) marker that plays a role in the immunoregulator environment of tumor cells and can be used as a prognostic factor. The relationship between Foxp3 expression and treatment response can be considered as one of the factors that influence the prognosis of NPC. Aims: This study aims to determine the relationship between Foxp3 expression and treatment response of NPC. Methods: An analytical study with a cross-sectional design on non-keratinizing NPC diagnosed at Anatomical Pathology Department of FKUI/RSCM during January 2018 until December 2020. The research sample was taken by consecutive sampling of cases that met the inclusion and did not include the exclusion criteria according to the calculation of the sample size for each group. Immunohistochemical examination using Foxp3 monoclonal antibody. Immunoexpression data were analyzed to determine its relationship with the treatment response of NPC. Results: From 60 selected cases diagnosed with NPC, there were consisted of 40 male patients (66,7%) and 20 female patients (33,3%) with ratio 2:1. There was a significant difference in intratumoral Foxp3 expression with treatment response (p=0.01). There was no significant difference in peritumoral Foxp3 expression with treatment response (p=0.114). Conclusion: Foxp3 expression had a statistically significant relationship with response therapy after chemoradiation.

Abstrak :
Latar belakang: Karsinoma nasofaring (KNF) adalah tumor ganas yang jarang terjadi pada anak-anak. KNF pada anak prevalensinya kurang dari 1%, tetapi mewakili 20-50% tumor ganas pada anak yang berasal dari nasofaring. Pada orang dewasa Penelitian telah menemukan bahwa latent membrane protein -1  (LMP1) yang diekspresikan oleh virus Epstein-Barr (EBV) mendorong terjadinya perkembangan dan metastasis karsinoma nasofaring (KNF) dan berhubungan dengan sifat agresif dan invasive, namun pada anak belum ada penelitian yang meneliti bagaiamana ekspresi dan peranan LMP-1 tersebut. Metode penelitian: Penelitian ini menggunakan desain potong lintang pada 30 blok paraffin dari subjek KNF anak di Rumah Sakit Cipto Mangunkusumo Jakarta. Blok Parafin kemudian dilakukan ekstraksi dan pemeriksaan PCR LMP-1, kemudian dibandingkan dengan respons terapi. Hasil penelitian: Hasil LMP-1 positif sebanyak 28 subjek dan negatif sebanyak 2 subjek, dari 30 subjek hanya 27 subjek yang dapat dianalisis karena 2 subjek meninggal saat sebelum menyelesaikan terapi dan 1 subjek belum melakukan evaluasi pasca terapi. LMP-1 positif  sebanyak 17 subjek menunjukkan respons (16 respons komplit dan 1 respons parsial), sedangkan 8 subjek menunjukkan tidak ada respons (2 respons stabil 6 respons progresif). Terdapat 2 subjek dengan hasil LMP-1 negatif, seluruhnya memiliki respons terapi (p=1,000). Kesimpulan: Tidak terdapat hubungan antara ekspresi LMP-1 dan respons terapi. ......Background: Nasopharyngeal carcinoma (NPC) is a rare malignant tumor in children. KNF in children has a prevalence of less than 1%, but represents 20-50% of malignant tumors in children originating from the nasopharynx. In adults, studies have found that latent membrane protein -1 (LMP1) expressed by Epstein-Barr virus (EBV) promotes the occurrence, progression, and metastasis of nasopharyngeal carcinoma (NPC) and is associated with aggressive and invasive properties, but in children, no studies have examined the expression and role of LMP-1. Method: This study used a cross-sectional design on 30 paraffin blocks from pediatric NPC subjects at Cipto Mangunkusumo Hospital Jakarta. Paraffin blocks were then DNA extracted and PCR examination of LMP-1 was performed, then compared with the response to therapy. Result: LMP-1 positive was 28 subjects and negative was 2 subjects, and from 30 subjects, only 27 subjects can be analyzed because 2 subjects died before completing therapy and 1 subject has not conducted a post-therapy evaluation. LMP-1 positive as many as 17 subjects showed a response (16 complete responses and 1 partial response), while 8 subjects showed no response (2 stable responses 6 progressive responses). There were 2 subjects with negative LMP-1 results, all of whom responsded to therapy (p = 1.000). Conclusion: There was no association between LMP-1 expression and therapeutic response.

Abstrak :
Latar Belakang. Insidens Limfoma Non-Hodgkin (LNH) meningkat pada populasi usia lanjut. Kemoterapi merupakan modalitas utama terapi LNH. Profil kesintasan dan respons terapi pasien usia lanjut dengan LNH yang menjalani kemoterapi belum diketahui di Indonesia. Tujuan. Mengetahui profil kesintasan 1 tahun dan respons terapi pasien usia lanjut dengan LNH yang menjalani kemoterapi di Indonesia. Metode. Penelitian deskriptif ini dilakukan secara kohort retrospektif di Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo. Sampel diambil secara total sampling dari rekam medik bulan Januari 2017 – Desember 2019. Melalui telaah rekam medik, data pasien yang dikumpulkan berupa demografi subjek, profil kesintasan 1 tahun, skrining gizi, status kemandirian, komorbiditas, laboratorium, patologi anatomi, gejala toksisitas, dan respons terapi. Hasil. Dari 78 subjek, didapatkan hasil mayoritas kelompok usia 60-69 tahun (74,35%; n=58), median usia 66 tahun (rentang 60-91; SB 5,91), berjenis kelamin laki-laki (61,54%; n=48), kesintasan 1 tahun 58,7%. 17 subjek hanya dihitung persentase kelompok jenis kelamin, usia, dan dicatat angka kesintasannya dari electronic medical record karena tidak didapatkan data rekam medis, 61 subjek dapat ditelaah keseluruhan datanya. Dari 61 subjek didapatkan mayoritas subjek berisiko malnutrisi sebelum menjalani kemoterapi (80,33%; n=49), termasuk kategori pasien mandiri sebelum menjalani kemoterapi (55,74%; n=34), komorbiditas terbanyak hipertensi (54,10%; n=33), memiliki multikomorbid (34,43%; n=21), memiliki kadar Hb ≤11 sebelum menjalani kemoterapi (42,62%), merupakan tipe LNH agresif (65,57%; n=40), mengalami toksisitas sistem gastroenterologi (68,85%; n=42) dan hematologi (63,93%; n=39), mengalami respons komplit setelah 6 siklus kemoterapi (34,43%; n=21). Kesimpulan. Mayoritas pasien usia lanjut dengan LNH yang menjalani kemoterapi lini pertama di Indonesia memiliki profil median usia 66 tahun, berjenis kelamin laki-laki, merupakan tipe LNH agresif, berisiko mengalami malnutrisi, termasuk kategori yang mandiri, memiliki multikomorbid dengan komorbiditas terbanyak adalah hipertensi, mengalami anemia, kesintasan 1 tahun 58,7%, dan mengalami toksisitas gastroenterologi dan hematologi. ......Background. The incidence of Non-Hodgkin's Lymphoma (LNH) is increasing in the elderly population. Chemotherapy is the main modality of LNH therapy. The characteristics of the profiles of survival rate and response rate of elderly patients with LNH undergoing chemotherapy are not known in Indonesia. Objective. The objective of the study is to understand the profile, 1-year survival, and response rate of elderly patients with LNH undergoing chemotherapy in Indonesia. Method. This descriptive study was carried out in a retrospective cohort method at the Dr. Cipto Mangunkusumo National General Hospital. Samples were taken by total sampling from medical records in January 2017 - December 2019. Through a review of medical records, patient data that were collected consisted of subject demographics, 1-year survival, nutritional screening, independence status, comorbidities, laboratory, anatomical pathology, toxicity of chemotherapy, and responses evaluation. Results. Of the 78 subjects, the largest age group is 60-69 years (74.35%; n=58), with a median age of 66 years (range 60-91; SD 5.91), male (61,54%; n=48), the 1-year survival rate is 58.7%. 17 subjects were only included data in gender, age, and survival percentage calculation due to lack of medical record, the entire data of 61 subjects can be analyzed . Of the 61 subjects, the majority of subjects are at risk of malnutrition before undergoing chemotherapy (80.33%; n=49), are included in the category of independent patients before undergoing chemotherapy (55.74%; n=34), has hypertension as the most recorded comorbidity (54.10%; n=33) and has more than 1 comorbid (34.43%; n=21), has Hb levels ≤11 before undergoing chemotherapy (42,62%), are aggressive LNH types (65.57%, n=40), are experiencing gastroenterological system toxicity (68.85%; n=42) and hematology (63.93%; n=39), and are experiencing complete responses after 6 cycles of chemotherapy (34.43%; n=21). Conclusion. The majority of elderly patients with LNH who undergo first-line chemotherapy in Indonesia has a profile median age of 66 years old, are male, are aggressive LNH type, are at risk of malnutrition, are independent, have multimorbidities with the most comorbidity is hypertension, have anemia, 1-year survival 58.7%, have gastroenterological and hematological toxicity.

Abstrak :
Latar Belakang: Nilai ADC pra terapi dari tumor dilaporkan dapat memprediksi respons terapi keganasan. Namun untuk nilai prognostik ADC pra terapi pada karsinoma nasofaring di Indonesia masih belum jelas diketahui. Tujuan: Melakukan perbandingan nilai rerata ADC serta mendapatkan nilai titik potong ADC pra terapi antara pasien karsinoma nasofaring dengan luaran respons terapi buruk dan respons terapi baik, kemudian menyusun model prediksi respons terapi pasien karsinoma nasofaring dengan melibatkan peran nilai titik potong ADC pra terapi serta variabel lainnya. Metode: Penelitian dilakukan dengan desain studi pendahuluan kasus kontrol tidak berpasangan menggunakan data sekunder. Jumlah subjek penelitian sebanyak 33 pasien dimana 16 pasien dengan luaran respons terapi buruk sebagai kelompok kasus dan 17 pasien dengan luaran respons terapi baik sebagai kelompok kontrol. Penentuan titik potong nilai ADC pra terapi dilakukan dengan analisis ROC dan perhitungan AUC beserta 95% interval kepercayaannya, lalu dibuat kurva sensitivitas dan spesifisitas. Kekuatan hubungan sebab-akibat diukur dengan menghitung nilai Odds Ratio dengan 95% interval kepercayaan. Penyusunan model prediksi luaran respons terapi dilakukan dengan metode analisis regresi logistik. Batas kemaknaan statistik yang dipergunakan adalah alpha 5%. Hasil: Didapatkan hubungan yang bermakna antara nilai ADC pra terapi serta volume tumor dengan luaran respons terapi dengan nilai p 0,000. Nilai titik potong ADC yang optimal sebesar 0,801 x 10^{-3 mm2/s dengan sensitivitas 87,5% dan spesifisitas 88,2%. Pasien dengan nilai ADC ≥ 0,801 x 10-3 mm2/s berisiko mengalami luaran respons terapi yang buruk sebesar 52,5 kali lebih tinggi dibandingkan pasien dengan nilai ADC < 0,801 x 10-3 mm2/s. Didapatkan juga nilai titik potong volume tumor yang optimal sebesar 45,7 cm3 dengan sensitivitas 93,8% dan spesifisitas 75%. Pasien dengan volume tumor ≥ 45,7 cm3 berisiko mengalami luaran respons terapi buruk sebesar 36 kali lebih tinggi dibandingkan pasien dengan volume tumor < 45,7 cm3. Kesimpulan: Nilai ADC pra terapi dan volume tumor dapat dijadikan prediksi luaran respons terapi karsinoma nasofaring. Diperlukan penelitian lanjutan dengan jumlah subjek yang lebih banyak lagi untuk memperkecil interval kepercayaan 95% odds ratio dan memperkuat hasil yang didapatkan. ......Background: Pre-treatment ADC values ​​of tumors are reported to be able to predict the response to malignancy therapy. However, the prognostic value of pre-treatment ADC in nasopharyngeal carcinoma in Indonesia is still unclear. Objective: To compare the average ADC value and obtain the pre-treatment ADC cut-off value between nasopharyngeal carcinoma patients with poor response and good response to therapy, then develop a prediction model for therapy response to nasopharyngeal carcinoma patients involving the role of pre-treatment ADC cut-off value and other variables. Methods: The study was conducted with an unpaired case-control preliminary study design using secondary data. The number of study subjects was 33 patients, 16 patients with poor response to therapy served as the case group and 17 patients with good response as the control group. Determination of the cut-off value for pre-treatment ADC values ​​was carried out by ROC analysis and AUC calculations along with their 95% confidence intervals, then sensitivity and specificity curves were made. The strength of the causal relationship is measured by calculating the Odds Ratio value with a 95% confidence interval. The therapy response outcome prediction model was carried out using the logistic regression analysis method. The limit of statistical significance used is alpha 5%. Results: There was a significant relationship between the pre-treatment ADC value and tumor volume with the therapeutic response outcome with a p value of 0.000. The optimal ADC cut-off value is 0.801 x 10-3 mm2/s with a sensitivity of 87.5% and a specificity of 88.2%. Patients with ADC values ​​≥ 0.801 x 10-3 mm2/s have a 52.5 times higher risk of experiencing a poor response to therapy than patients with ADC values < 0.801 x 10-3 mm2/s. The optimal tumor volume cut-off value of 45.7 cm3 with a sensitivity of 93.8% and a specificity of 75% was also obtained. Patients with a tumor volume ≥ 45.7 cm3 have a 36 times higher risk of having a poor response to therapy than patients with a tumor volume < 45.7 cm3. Conclusion: Pre-treatment ADC value and tumor volume can be used as an outcome prediction for nasopharyngeal carcinoma therapy response. Further research is needed with a larger number of subjects to reduce the 95% confidence interval of odds ratio and strengthen the results obtained.}