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Erwin Rahakbauw
Abstrak :
ABSTRAK
Latar Belakang: Insiden kanker serviks di RSCM masih tinggi, sebagian besar datang pada stadium lanjut, dan angka harapan hidup yang masih rendah. Jika respon radiasi komplit dan eradikasi tumor lokoregional dapat tercapai pada pasien kanker serviks, diperkirakan dapat meningkatkan kesintasan. Oleh karena itu, kami bermaksud mengadakan penelitian terhadap respon terapi radiasi dan karakteristik klinis serta patologi yang berhubungan pada pasien kanker serviks di RSCM.Metode: Penelitian kohort ini dilakukan dengan menggunakan data sekunder terhadap 123 pasien kanker serviks stadium IIA-IIIB yang menjalani radiasi kuratif definitif sesuai protokol standard bulan Januari 2014-Des 2015 di RSUPN CiptoMangunkusumo. Dilakukan pencatatan karakteristik klinis dan patologis sebelum radiasi, Dicatat juga efek samping akut gastrointestinal, traktus genitourinaria, dan hematologis selama menjalani protokol radiasi sampai 3 bulan pasca radiasi. Data respon tiga bulan pasca radiasi lengkap berdasarkan klinis dan pemeriksaan ultrasonografi transrektal/transvaginal dicatat dan diklasifikasikan sesuai Response Evaluation Criteria in Solid Tumors RECIST .Hasil: Dari 123 kasus, 84 kasus 68,29 diperoleh respon komplit, 30 kasus 24,39 respon parsial, 6 kasus 4,88 respon stabil, dan 3 kasus 2,44 respon progresif. Berdasarkan efek samping akut gastrointestinal, tidak didapatkan efek samping derajat 0 pada 99 kasus 80,49 , derajat 1 pada 20 kasus 16,26 , derajat 2 pada 4 kasus 3,25 , derajat 3 pada 0 kasus 0 . Berdasarkan efek samping akut genitourinaria, tidak didapatkan efek samping derajat 0 pada 105 kasus 85,37 , derajat 1 pada 17 kasus 13,82 , derajat 2 pada 1 kasus 0,81 , dan derajat 3 pada 0 kasus 0 . Berdasarkan efek samping akut hematologis, tidak didapatkan efek samping derajat 0 pada 108 kasus 87,80 , derajat 1 pada 15 kasus 12,20 , derajat 2 pada 0 kasus 0 , dan derajat 3 pada 0 kasus 0 . Dengan membandingkan kelompok respon komplit dan tidak respon parsial, stabil, progresif didapatkan faktor usia dengan p=0,266 RR 0,87;IK95 0,67-1,12 , klasifikasi tekanan darah dengan p=0,882 RR 0,98; IK95 0,76-1,27 , Indeks Masa Tubuh dengan p= 0,397 RR 1,06;IK95 0,83-1,34 , kadar hemoglobin dengan p= 0,193 RR 0,71;IK95 0,40-1,27 , jumlah leukosit darah dengan p=0,969 RR=1,00; IK95 0,78-1,29 , kadar albumin darah dengan p= 0,198 RR 0,73;IK95 0,44-1,20 , stadium FIGO dengan p=0,526 RR 1,08; IK95 0,85-1,38 , diameter tumor terbesar dengan p=0,034 RR 1,30; IK95 1,03-1,63 , jenis histopatologis dengan p=0,159 RR 1,18;IK95 0,90-1,55 , dan derajat diferensiasi dengan p=0,469. Pada analisa multivariat, didapatkan hubungan bermakna antara diameter tumor p=0,036;RR 2,64; IK95 1,07-6,56 dengan respon radiasi komplit.Kesimpulan: Gambaran respon radiasi kuratif definitif pada kanker serviks stadium IIA-IIIB di RSCM adalah 68,29 respon komplit, 24,39 respon parsial, 4,88 respon stabil, dan 2,44 progresif. Efek samping akut gastrointestinal, genitourinaria, dan hematologis pada umumnya tidak terjadi selama dan sampai 3 bulan pasca radiasi, yaitu 80,49 tidak mengalami efek samping akut gastrointestinal, 85,37 tidak mengalami efek samping akut genitourinaria, dan 87,80 tidak terjadi efek samping akut hematologi. Sebagian besar efek samping akut yang terjadi berderajat rendah yaitu grade 1 dan 2 traktus gastrointestinal, masing-masing 16,26 dan 3,25 , grade 1 dan 2 traktus genitourinaria, yaitu masing-masing 13,82 dan 0,81 , dan grade 1 hematologi, yaitu 12,20 . Terdapat hubungan bermakna antara diameter tumor terbesar dengan respon komplit radiasi. Tidak terdapat hubungan bermakna antara usia, Indeks Masa Tubuh, kadar hemoglobin, jumlah leukosit darah, kadar albumin serum, stadium FIGO, jenis histopatologis, dan derajat diferensiasi dengan respon terapi radiasi. "hr>" "b>ABSTRACT
" Background The incidence of cervical cancer was still high in RSCM, whom most of them was found in advanced stage. The issue that still become a problem related to radiotherapy on those patients was non satisfying local tumor control, which range 20 50 . If we can reach complete response and eradication of locoregional tumor on cervical cancer patients, it is estimated that the survival rate will increase. Therefore, we conducted a research to find out response of radiotherapy and related clinic pathologic characterictics on cervical cancer patients in our hospital.Methods This cohort study used secondary data on 123 patients of cervical cancer stage IIA IIIB who had undergone radiation therapy based on standard protocol in our hospital, during Januari 2014 to Dec 2015. The clinical factors of those patients, such as age, Body Mass Index, blood pressure, hemoglobin level, blood leucocyte count, serum albumin, largest tumor diameter FIGO staging and pathologic characteristic, i.e histopathology and grading were recorded. During radiation protocol until 3 months post radiation, we also noted any side effects of gastrointestinal tract, genitourinary tract, and hematologic. Evaluation of radiotherapy response was based on Response Evaluation Criteria in Solid Tumors RECIST .Results Among 123 cases, 84 cases or 68.29 was complete response, 30 cases or 24.39 was partial response, 6 cases or 4.88 was stabile response, and 3 cases or 2.44 was progressive. Based on gastrointestinal side effect, there was no side effect or grade 0 on 99 cases 80.49 , grade 1 on 20 cases 16.26 , grade 2 on 4 cases 3.25 , grade 3 on 0 case 0 . Based on side effect of genitourinary, there was no side effect or grade 0 on 105 cases 85,37 , grade 1 on 17 cases 13.82 , grade 2 on 1 case 0.81 , grade 3 on 0 case 0 . Based on hematologic side effects, there was no side effect on 108 cases 87.80 , grade 1 on 15 cases 12.20 , grade 2 on 0 case 0 , grade 3 on 0 case 0 . On bivariate analysis, p of each factors were age p 0.266 RR 0.87 0.67 1.12 , Body Mass Index p 0.397 , blood pressure classification p 0.658 RR 0.98 0.76 1.27 , largest tumor diameter p 0.034 RR 1.30 1.03 1.63 , haemoglobin level p 0.193 RR 0.98 0.76 1.27 , blood leucocyte count p 0.969 RR 1.00 0.78 1.29 , FIGO staging II vs III p 0.526 RR 1.08 0.85 1.38 , histopathology result squamous cell carcinoma vs nonsquamous cell carcinoma p 0.159 RR 1.18 0.90 1.55 , and grading p 0.469 . on multivariate analysis, tumor diameter was statistically significant, with p 0.036 RR 2.64 1.07 6.56 .Conclusion Most of definitive curative radiotherapy response on cervical cancer stage IIA IIIB was complete 68.29 . Partial response was 24.49 , stable response was 4.88 , and progressive was 2.44 . The Acute side effect of gastrointestinal tract, genitourinary tract, and hematologic were commonly can be tolerable during and 3 months post radiation therapy. Clinico pathologic characteristic that significantly related to complete response of radiotherapy were largest tumor diameter.
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2016
T58897
UI - Tesis Membership  Universitas Indonesia Library
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Wanita Idola
Abstrak :
[ABSTRAK
Tujuan: Menentukan hubungan obesitas dengan proporsi ukuran tumor, keterlibatan KGB aksila dan derajat histopatologi pada pasien kanker payudara stadium I – IIIA di RSUPNCM, serta membantu meningkatkan kualitas tatalaksana bagi klinisi. Metode: Analisa menggunakan data sekunder pada pasien kanker payudara stadium I – III A. Dikatan obesitas bila indeks massa tubuh ≥ 25 kg/m2 dan non obesitas < 25 kg/m2. Hasil ukuran tumor dikelompokkan menjadi < 2 cm, 2-5 cm dan > 5 cm berdasarkan sistem staging TNM AJCC. Ukuran tumor diperoleh melalui pencitraan ultrasonografi payudara yang tersimpan pada sistem PACS. Keterlibatan KGB aksila serta derajat histopatologi diperoleh dari hasil ekspertise patologi anatomi. Hasil: Jumlah subyek penelitian sebanyak 52 pasien kanker payudara stadium I– IIIA tahun 2012 - 2014 di RSUPNCM terdiri dari 26 pasien obesitas dan 26 pasien non obesitas. Tidak ada hubungan yang bermakna antara ukuran tumor berdasarkan staging dengan obesitas (P= 0,795 (uji chi square)). Tidak terdapat hubungan yang bermakna antara obesitas dengan derajat histopatologi (P=0,610, (uji mutlak fisher)). Tidak terdapat hubungan yang bermakna antara obesitas dan keterlibatan KGB aksila (P =0,404 (uji chi square)). Median ukuran tumor pada pasien obesitas 2,95 cm dan pasien non obesitas 2,73 cm. Dari 26 pasien obesitas, 25 diantaranya memiliki derajat tinggi. Dari 26 pasien non obesitas, 14 memiliki keterlibatan KGB aksila. Kesimpulan: Pasien kanker payudara yang obesitas tidak berhubungan dengan besarnya ukuran tumor, keterlibatan KGB aksila dan derajat histopatologi yang tinggi. Namun terdapat kecenderungan pasien kanker payudara yang obesitas memiliki ukuran tumor yang lebih besar dan tingginya derajat histopatologi. Sedangkan keterlibatan KGB aksila lebih cenderung pada pasien yang non obesitas.
ABSTRACT
Objective: Determine the relationship of obesity with tumor size proportion, axillary lymph node involvement and histopathological grading in breast cancer patients stage I-IIIA in Cipto Mangunkusomo hospital and to help improvement the quality of management by clinician. Methods: Analysis using secondary data of breast cancer patient stage I-IIIA. Obesity grouped if body mass index ≥ 25 kg/m2 and non obese < 25 kg/m2. The results of tumor size are grouped into 0-2 cm, 2-5 cm and > 5 cm based on the AJCC TNM staging system. Tumor size obtained through breast ultrasound imaging from PACS system. Axillary lymph node involvement and histopathological grading obtained from the anatomical pathology expertise. Results: The study subjects are 52 patients with stage I-IIIA breast cancer in 2012-2014 in Cipto Mangunkusumo consisted of 26 obese and 26 non-obese patients. There is no significant relationship between tumor size based on staging with obesity (P = 0.795 (chi square test)). There was no significant relationship between obesity and grading histopathology (P = 0.610, (absolute test fisher)). There was no significant relationship between obesity and the involvement of axillary lymph nodes (P = 0.404 (chi square test)). The median tumor size of 2.95 cm in obese patients and 2,73 cm in non-obese patients. From 26 obese patients, 25 of them had a high grading histopathology. From 26 non-obese patients, 14 of them had involvement of axillary lymph nodes. Conclusion: Breast cancer patients who are obese are not related to the larger tumor size , involvement of axillary lymph nodes and a high grading of histopathology. However, there is a tendency that breast cancer patients who are obese had larger tumor size and high grading of histopathology. Where as the involvement of axillary lymph nodes are more likely in non-obese patients., Objective: Determine the relationship of obesity with tumor size proportion, axillary lymph node involvement and histopathological grading in breast cancer patients stage I-IIIA in Cipto Mangunkusomo hospital and to help improvement the quality of management by clinician. Methods: Analysis using secondary data of breast cancer patient stage I-IIIA. Obesity grouped if body mass index ≥ 25 kg/m2 and non obese < 25 kg/m2. The results of tumor size are grouped into 0-2 cm, 2-5 cm and > 5 cm based on the AJCC TNM staging system. Tumor size obtained through breast ultrasound imaging from PACS system. Axillary lymph node involvement and histopathological grading obtained from the anatomical pathology expertise. Results: The study subjects are 52 patients with stage I-IIIA breast cancer in 2012-2014 in Cipto Mangunkusumo consisted of 26 obese and 26 non-obese patients. There is no significant relationship between tumor size based on staging with obesity (P = 0.795 (chi square test)). There was no significant relationship between obesity and grading histopathology (P = 0.610, (absolute test fisher)). There was no significant relationship between obesity and the involvement of axillary lymph nodes (P = 0.404 (chi square test)). The median tumor size of 2.95 cm in obese patients and 2,73 cm in non-obese patients. From 26 obese patients, 25 of them had a high grading histopathology. From 26 non-obese patients, 14 of them had involvement of axillary lymph nodes. Conclusion: Breast cancer patients who are obese are not related to the larger tumor size , involvement of axillary lymph nodes and a high grading of histopathology. However, there is a tendency that breast cancer patients who are obese had larger tumor size and high grading of histopathology. Where as the involvement of axillary lymph nodes are more likely in non-obese patients.]
2015
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UI - Tesis Membership  Universitas Indonesia Library
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Novita Sari
Abstrak :
Adenoma hipofisis merupakan salah satu tumor primer intrakranial tersering yang sebagian dapat bersifat agresif dengan risiko rekurensi/regrowth yang lebih tinggi sehingga berdampak buruk pada kualitas hidup pasien. Identifikasi awal adenoma hipofisis yang agresif dapat membantu menentukan strategi tatalaksana dan follow-up untuk mencegah terjadinya rekurensi/regrowth. Penilaian aktivitas proliferasi dengan ekspresi Ki-67 pada adenoma hipofisis diharapkan dapat memprediksi terjadinya rekurensi/regrowth. Penelitian ini bertujuan untuk menilai ekspresi Ki-67 pada adenoma hipofisis yang mengalami rekurensi/regrowth dan yang tidak mengalami rekurensi/regrowth. Penelitian ini merupakan penelitian retrospektif analitik dengan desain potong lintang. Sampel berupa kasus adenoma hipofisis di Departemen Patologi Anatomik FKUI/RSCM tahun 2016-2020. Dilakukan pemeriksaan imunohistokimia Ki-67 dan penilaian persentase sel tumor yang terpulas positif. Analisis statistik dilakukan dengan uji komparatif numerik di antara dua kelompok tersebut. Nilai titik potong untuk prediksi rekurensi/regrowth ditentukan dengan analisis kurva receiving operator characteristic. Didapatkan 46 kasus adenoma hipofisis yang terdiri atas 23 kasus dengan rekurensi/regrowth dan 23 kasus tanpa rekurensi/regrowth. Rerata ekspresi Ki-67 pada kelompok yang mengalami rekurensi/regrowth lebih tinggi dibandingkan dengan kelompok yang tidak mengalami rekurensi/regrowth. (1,58% vs 0,88%, p=0,003). Nilai titik potong untuk yang direkomendasikan untuk prediksi rekurensi/regrowth sebesar 1,37%. Ekspresi Ki-67 yang lebih tinggi berhubungan dengan rekurensi/regrowth pada adenoma hipofisis. ......Pituitary adenoma is one of the most common primary intracranial tumor that some can behave aggresively with higher reccurrence/regrowth risk and have bad impact to patient’s quality of life. Early identification of aggressive pituitary adenoma can help for deciding aggressive treatment strategies and strict follow-up to prevent recurrence/regrowth. Proliferation assesment using Ki-67 expression is expected to be one of the predictor of tumor recurrence/regrowth. This study aims to evaluate Ki-67 expression in pituitary adenoma with recurrence/regrowth and without recurrence/regrowth. This is an analytic retrospective study with cross sectional study design including specimens diagnosed as pituitary adenoma recorded in archives of Anatomical Pathology Departement FMUI/CMH from 2016-2020. Ki-67 immunostaining was conducted and Ki-67 expression in percentage was evaluated. Data was analyzed statistically to evaluate Ki-67 expression. Cut-off point to predict recurrence/regrowth was determined using receiving operator charasteristic curve analysis. Forty-six cases were selected, consisted of 23 cases with recurrence/regrowth and 23 cases without recurrence/regrowth. There was higher expression of Ki-67 in adenoma with recurrence/regrowth than adenoma without recurrence/regrowth (1,58% vs 0,88%, p=0,03). Recommended cut off value to predict recurrence/regrowth in this study was 1,37%. Higher Ki-67 expression was associated with recurrence/regrowth in pituitary adenoma.
Depok: Fakultas Kedokteran Universitas Indonesia, 2022
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UI - Tesis Membership  Universitas Indonesia Library
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Starleen Ellexia
Abstrak :
Latar Belakang Tumor otak adalah neoplasma intrakranial di dalam otak atau di kanal tulang belakang pusat. Tumor otak ganas primer mempengaruhi sekitar 200.000 orang di seluruh dunia setiap tahun. Tumor otak disebabkan oleh pembelahan sel yang abnormal dan tidak terkontrol. Penanganan tumor otak di Indonesia masih belum terintegrasi baik dari segi promotif, preventif, maupun kuratif. Tumor otak sendiri dapat menyebabkan berbagai komplikasi sampai kematian. Oleh karena itu, pada penelitian kali ini dilakukan studi mengenai keterkaitan jenis, letak, dan ukuran tumor dengan skor fungsional berupa skor KPS yang didapatkan pasien pre dan post tindakan serta hubungannya dengan tingkat resektabilitas tumor pasien saat dilakukan operasi. Skor KPS dapat berfungsi sebagai salah satu faktor prognosis kualitas hidup pasien. Metode Penelitian ini akan menggunakan metode kohort retrospektif dengan melihat rekam medis pasien tumor otak dari tahun 2021 sampai 2022 yang ditatalaksana di RSCM. Rekam medis akan diambil secara consecutive sampling. Hasil Terdapat hubungan antara jenis tumor dengan skor KPS pre operasi dimana nilai median untuk semua jenis adalah 80 namun, adenoma mendapatkan mean skor KPS tertinggi (84,59) dan jenis tumor lain mendapatkan mean skor KPS terendah (73,73). Ukuran tumor dan skor KPS pre operasi tidak didapatkan hubungan korelasi yang kuat yaitu hanya sebesar -0,194 (CI 95% -0,313 - -0,069). Letak tumor dengan skor KPS pre operasi didapatkan ada hubungannya dengan hasil tumor supratentorium memiliki median skor KPS pre operasi lebih tinggi dibandingkan tumor infratentorium. Hasil ini berbeda dengan studi-studi lainnya sehingga diperlukan penelitian lebih lanjut. Demikian juga dengan tingkat resektabilitas dengan skor KPS post operasi dimana didapatkan hasil signifikansi sebesar p=0,107 sehingga hubungannya tidak signifikan. Namun jika dilihat mediannya, (Gross Total Resection) GTR memiliki skor KPS post operasi yang lebih baik dibandingkan dengan (SubTotal Resection) STR yaitu 85 dan 80 secara berurut. Kesimpulan Perbedaan jenis tumor mempengaruhi skor KPS pre operasi. Semakin besar ukuran tumor yang dialami pasien, maka semakin rendah skor KPS pre operasi yang didapatkan. Selain itu, skor KPS pre operasi juga berhubungan dengan letak tumor yang dialami pasien. Sedangkan, skor KPS post operasi pada penelitian ini tidak menunjukkan hubungan yang signifikan dengan tingkat resektabilitas tumor pada pasien yang dioperasi. ......Introduction Brain tumors are intracranial neoplasms within the brain or in the central spinal canal. Primary malignant brain tumors affect around 200,000 people worldwide each year. Brain tumors are caused by abnormal and uncontrolled cell division. Management of brain tumors in Indonesia is still not integrated in terms of promotive, preventive and curative. Brain tumors themselves can cause various complications up to death. Therefore, In this study, an investigation was carried out to explore the correlation between the type, location, and size of the tumor and its impact on the functional score, measured by the KPS score, obtained from patients before and after surgery. Additionally, the study examined the association between the level of resectability and the type of tumor. KPS score can be used as one prognostic factor for patient quality of life. Method This study will use a retrospective cohort method by looking at the medical records of brain tumor patients from 2021 to 2022 who were treated at RSCM. Medical records will be taken by consecutive sampling. Results A correlation exists between tumor types and preoperative KPS scores, with a median value of 80 for all types. Adenomas achieve the highest mean KPS score (84.59), while other tumor types have the lowest mean KPS score (73.73). A weak correlation is observed between tumor size and preoperative KPS scores, with a coefficient of only - 0.194 (95% CI -0.313 to -0.069). There is a relationship between tumor location and preoperative KPS scores, as supratentorial tumors have a higher median preoperative KPS score compared to infratentorial tumors. These findings differ from other studies, suggesting the need for further research. Similarly, the level of resectability and postoperative KPS scores show a non-significant relationship with a p-value of 0.107. However, when looking at the medians, Gross Total Resection (GTR) is associated with a higher postoperative KPS score compared to Subtotal Resection (STR), namely 85 and 80, respectively. Conclusion The type of tumor affects preoperative KPS scores. The larger the tumor size, the lower the preoperative KPS score. Additionally, preoperative KPS scores are also associated with tumor location. However, postoperative KPS scores in this study do not show a significant relationship with the resectability of tumors in operated patients.
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023
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UI - Skripsi Membership  Universitas Indonesia Library