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"Latar belakang: Insidensi dan faktor risiko karsinoma hepatoseluler (KSH) pada pasien hepatitis C virus (HCV) yang sudah mencapai sustained virological response (SVR) pasca terapi direct acting antiviral (DAA) belum banyak diketahui. Mengingat terdapat perbedaan jenis DAA, genotype virus, dan profil pasien di Indonesia, dilakukan studi untuk menilai insidensi dan faktor-faktor yang memengaruhi KSH pada pasien HCV pasca SVR post terapi DAA.Tujuan: Mengetahui insidensi dan faktor-faktor yang memengaruhi kejadian KSH pada pasien HCV yang mencapai SVR pasca pengobatan DAA.Metode: Desain penelitian kohort retrospektif di RSUPN Cipto Mangunkusumo, sampel pasien HCV yang SVR pasca DAA tahun 2017 – 2019, diikuti hingga 2024. Pasien dilakukan skrining USG abdomen, alpha-fetoprotein (AFP) dan CT Scan abdomen 3 fase apabila terdapat indikasi. Dilakukan analisis deskriptif, bivariat dengan Fisher’s exact, dan multivariat dengan regresi logistik bila terdapat faktor risiko di analisis bivariat (p <0,25).Hasil: Dari 180 subjek penelitian, insidensi dan rasio insidensi KSH pada seluruh populasi mencapai 4,4% (rasio insidens 0,91/100PY). Terdapat hubungan signifikan dari analisis bivariat variabel sirosis hepatis (RR 10,5; IK 95% (1,32 – 83,5); p =0,0073) dan DM tipe 2 (RR 8,47; IK 95% (2,3 – 31,1) p = 0,0048). Terdapat hubungan signifikan dari analisis multivariat variabel DM tipe 2 (aRR 3,1; IK 95% (0,86 – 3,83); p=0,002).Kesimpulan: Insidensi KSH mencapai 4,4% dari total populasi. DM tipe 2 memiliki hubungan yang signifikan terhadap kejadian KSH pada pasien HCV yang mencapai SVR pasca pengobatan DAA.

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Background: The incidence and risk factors for hepatocellular carcinoma (HCC) in hepatitis C (HCV) patients who have achieved sustained virological response (SVR) after direct-acting antiviral (DAA) therapy are not well established. Considering there are differences in DAA types, virus genotypes, and patient profiles in Indonesia, this study was conducted to assess the incidence and factors influencing HCC in HCV patients after SVR post DAA therapy.

Objective: To determine the incidence and factors influencing HCC in HCV patients achieving SVR after DAA treatment.

Method: Retrospective cohort study conducted at Cipto Mangunkusumo National General Hospital, sample of HCV patients had SVR after DAA therapy in 2017 – 2019, followed until 2024. Patients were screened for abdominal ultrasound, alpha-fetoprotein (AFP) and 3-phase abdominal CT scan, if indicated. Descriptive, bivariate analysis with Fisher's exact, and multivariate analysis with logistic regression were conducted.

Results: Among 180 subjects, the incidence and incidence ratio of HCC is 4.4% (0.91/100PY). Significant correlation in bivariate analysis from the variables liver cirrhosis (RR 10.5; CI 95% (1. 32 – 83.5); p = 0.0073) and type 2 DM (RR 8.47; CI 95% (2, 3 – 31.1) p = 0.0048). In multivariate analysis, there was significant correlation from type 2 DM variable (aRR 3.1; CI 95% (0.86 – 3.83); p=0.002).

Conclusion: The incidence of HCC reaches 4.4% of the total population. Type 2 DM has significant correlation with the incidence of HCC in HCV patients who achieve SVR after DAA treatment."

"Latar belakang: Populasi usia lanjut dengan penyakit jantung koroner yang menjalani tindakan intervensi koroner perkutan (IKP) menunjukkan tren meningkat. Di sisi lain, kelompok usia lanjut juga dihadapkan dengan major adverse cardiac events pasca tindakan IKP. Identifikasi faktor prediktor yang mempengaruhi terjadinya MACE 30 hari diharapkan dapat menjadi sarana stratifikasi risiko pratindakan, meningkatkan luaran klinis serta menjadi pertimbangan pemilihan strategi intervensi pada pasien PJK usia lanjut.Tujuan: Mengetahui insidens MACE 30 hari, faktor prediktor MACE 30 hari pada pasien PJK usia lanjut yang menjalani tindakan IKP, dan pengembangan model prediksi MACE 30 hari.Metode: studi kohort retrospektif dengan menulusuri rekam medis pasien usia lanjut yang menjalani IKP di RSCM periode Januari 2017-Desember 2021. Dilakukan analisis bivariat chi-square antara faktor usia, jenis kelamin, hiperglikemia saat admisi, kreatinin serum, kelas Killip, status fungsional, status nutrisi, status frailty, dan jenis PJK dengan kejadian MACE 30 hari pascatindakan IKP. Analisis multivariat dan model prediksi dilakukan dengan metode regresi logistik.Hasil: Terdapat 616 subjek penelitian untuk diteliti. Insidens MACE 30 hari pada pasien PJK usia lanjut sebesar 5,4%. Hasil analisis bivariat menunjukkan adanya hubungan antara faktor hiperglikemia saat admisi, kelas Killip, status fungsional, status nutrisi, dan jenis PJK dengan kejadian MACE 30 hari (p<0,05). Hasil regresi logistik menunjukkan Kelas Killip dan jenis PJK merupakan faktor prediktor independen terjadinya MACE 30 hari dengan adjusted OR 8,841 (IK95% 3,339-23,410) untuk kelas Killip dan adjusted OR 3,774 (1,365-10,426) untuk PJK. Model prediksi MACE 30 hari memiliki nilai AUC 0,7995 (IK95% 0,712-0,886)Kesimpulan: MACE 30 hari pada pasien PJK usia lanjut yang menjalani IKP sebesar 5,4% dengan faktor prediktor independen kelas Killip dan jenis PJK.

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Background: The elderly with coronary heart disease undergoing percutaneous coronary intervention (PCI) shows an increasing trend. On the other hand, the elderly group is also faced with major adverse cardiac events after PCI. Identification of predictors that influence the occurrence of 30-day MACE is expected to be a means of preprocedural risk stratification, improve clinical outcomes and become a consideration for selecting intervention strategies in elderly CHD patients.

Objectives: To determine the incidence of 30-day MACE, the predictors of 30-day MACE in elderly CHD patients undergoing PCI, and the development of 30-day MACE prediction model.

Methods: Retrospective cohort study by reviewing medical records of elderly patients undergoing PCI at RSCM for the period January 2017-December 2021. Chi-square bivariate analysis was performed between predictors of age, sex, hyperglycemia at admission, serum creatinine, Killip class, functional status, nutritional status, frailty status, and type of CHD with MACE events 30 days after PCI. Multivariate analysis and prediction models were performed using the logistic regression.

Results: There were 616 research subjects to be studied. The incidence of 30-day MACE in elderly CHD patients was 5.4%. The results of bivariate analysis showed a relationship between hyperglycemia at admission, Killip class, functional status, nutritional status, and type of CHD with 30-day MACE (p<0.05). Logistic regression results showed Killip class and CHD type were independent predictors of 30-day MACE with adjusted OR 8.841 (95%CI 3.339-23.410) for Killip class and adjusted OR 3,774 (1.365-10.426) for type of CHD. The 30-day MACE prediction model has an AUC value of 0.7995 (95%CI 0.712-0.886)

Conclusion: Incidence of 30-day MACE in elderly with CHD undergoing PCI is 5.4% with Killip class and type of CHD as independent predictor factors."

"Latar Belakang/Tujuan. Angka kematian dan kejadian metastasis kanker payudara cukup tinggi. Faktor metabolik termasuk resistensi insulin mempunyai peranan terhadap progresivitas kanker payudara namun terdapat hanya sedikit penelitian yang menilai hubungan resistensi insulin dengan kejadian metastasis kanker payudara. Terdapat hubungan yang erat antara beberapa variabel dalam kelompok pasca-menopause terhadap kejadian metastasis, pemberian terapi hormonal aromatase inhibitor dan kemoterapi terhadap nilai HOMA-IR. Mengetahui hubungan resistensi insulin yang dinilai menggunakan nilai homeostatic model assessment for insulin resistance (HOMA-IR) dengan kejadian metastasis kanker payudara.Metode. Studi potong lintang yang meneliti 150 pasien kanker payudara di Rumah Sakit Cipto Mangunkusumo (RSCM) dan Rumah Sakit Siloam Mochtar Riady Comprehensive Cancer Centre (MRCCC) Jakarta dalam rentang waktu agustus 2019-april 2020. Terdapat 150 subjek penelitian, nilai titik potong HOMA-IR ditentukan dengan kurva receiver operating curve (ROC). Dilakukan analisis subgrup kelompok pasca menopause terhadap metastasis, terapi hormonal dan kemoterapi terhadap HOMA-IR.Hasil. Tidak didapatkan nilai titik potong optimal HOMA-IR terhadap kejadian metastasis (Area under curve (AUC) 0,50, P : >0,05, interval kepercayaan (IK) 95% : 0,406-0,593). Tidak terdapat hubungan bermakna variabel pasca-menopause dengan kejadian metastasis dan kemoterapi terhadap nilai HOMA-IR. Terdapat hubungan bermakna pemberian terapi hormonal aromatase inhibitor terhadap peningkatan nilai HOMA-IR, P : <0,01Simpulan. Tidak terdapat hubungan yang bermakna antara resistensi insulin dengan kejadian metastasis pada pasien kanker payudara.

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Background/Purpose. Mortality and incidence rate of metastatic breast cancer is quite high.

Metabolic factors including insulin resistance have a role in the progression of breast cancer,

but there are only a few studies that assess the relationship of insulin resistance with the incidence of breast cancer metastases. There is a close relationship between variables in the postmenopausal group for the occurrence of metastases, administration of hormonal aromatase inhibitors and chemotherapy to the value of HOMA-IR. Knowing the relationship of insulin resistance which was assessed using the value of

the homeostatic model assessment for insulin resistance (HOMA-IR) with the incidence of metastatic breast cancer.

Method. A cross-sectional study examining 150 breast cancer patients at Cipto Mangunkusumo General Hospital and Siloam Hospital Mochtar Riady Comprehensive Cancer Center Jakarta in August 2019-April 2020. There are 150 subjects research, the HOMA-IR cutoff value is determined by the receiver operating curve (ROC) curve. Postmenopausal subgroups were analyzed for metastases, hormonal therapy and chemotherapy for HOMA-IR.

Results. There was no optimal HOMA-IR cut off value for metastatic events (Area under curve (AUC) 0.50,

P:> 0.05, 95% confidence interval (IK): 0.406-0.593). There was no significant relationship between postmenopausal variables with the incidence of metastasis and chemotherapy on the value of HOMA-IR. There was a significant

relationship between the administration of hormonal aromatase inhibitor therapy to the increase of HOMA-IR value, P: <0.01"

"Latar Belakang. Kesintasan 3 tahun pasien KNF stadium lokal lanjut di Indonesia lebih rendah dibandingkan luar negeri. Prediktor alternatif dari rasio hemoglobin-trombosit (RHT) lebih sederhana, murah, dan stabil nilainya dibanding rasio dari komponen sel leukosit, namun belum ada studi yang meneliti perannya dalam memrediksi mortalitas tiga tahun pasien KNF stadium ini.Tujuan. Mengetahui peran RHT sebelum terapi dalam memrediksi kesintasan tiga tahun pasien KNF stadium lokal lanjut.Metode. Studi kohort retrospektif yang meneliti 289 pasien KNF stadium lokal lanjut yang diterapi di Rumah Sakit Cipto Mangunkusumo (RSCM) dalam rentang waktu Januari 2012 - Oktober 2016. Nilai RHT optimal didapatkan menggunakan receiver operating curve (ROC). Subjek penelitian dibagi menjadi 2 kelompok, di bawah dan di atas titik potong. Kurva Kaplan-Meier digunakan untuk menilai kesintasan tiga tahun dan dilakukan uji regresi Cox sebagai uji multivariat terhadap variabel perancu (usia > 60 tahun, stadium, jenis kelamin, dan indeks massa tubuh) untuk mendapatkan nilai adjusted hazard ratio (HR).Hasil. Nilai titik potong RHT optimal adalah 0,362 (AUC 0,6228, interval kepercayaan (IK) 95% : 0,56-0,69, sensitivitas 61,27%, spesifisitas 60,34%). 48,44% pasien memiliki nilai RHT <0,362 dan memiliki mortalitas tiga tahun lebih besar dibandingkan kelompok lainnya (50%vs31,54%). RHT < 0,362 secara signifikan memrediksi kesintasan tiga tahun (p = 0,003; HR 1,75; IK 95% 1,2-2,55). Pada analisis multivariat, RHT < 0,362 sebelum terapi merupakan faktor independen dalam memrediksi kesintasan tiga tahun pada pasien KNF stadium lokal lanjut (adjusted HR 1,82; IK 95% 1,25-2,65).Simpulan. RHT < 0,362 sebelum terapi dapat memrediksi kesintasan tiga tahun pasien KNF stadium lokal lanjut

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Background. The 3-year survival of locally advanced nasopharyngeal cancer (NPC) patients in Indonesia is lower than in foreign countries. Alternative predictors from the hemoglobin-platelet ratio (HPR) are easier, cheaper, and stable in value than the ratio of leukocyte cell components, but there are no study conducted to know its potential in predicting three-year survival in locally advanced

nasopharyngeal cancer.

Objective. To determine the role of pre-treatment hemoglobin to platelet ratio in predicting three-year survival of locally advanced nasopharyngeal cancer patients.

Method. Retrospective cohort study that examined 289 locally advanced NPC patients who underwent therapy at the National Government General Hospital-Cipto Mangunkusumo from January 2012 to October 2016. HPR cut-off was determined using ROC, and then subjects were divided into two groups according to its HPR value. The Kaplan-Meier curve was used to determine the three-year survival of the patients and cox regression test used as multivariate analysis with confounding variables in order to get adjusted hazard ratio (HR).

Results. The optimal cut-off for HPR was 0,362 (AUC 0,6228, 95% CI: 0,56-0,69, sensitivity 61,27%, specificity 60,34%). Patients with HPR < 0,362 occurred in 48, 44% and had higher three-year mortality (50% vs. 31, 54%). HPR <0.362 significantly predicted the three years of survival (p = 0,003; HR 1, 75; IK 95% 1, 2-2, 55). In multivariate analysis,

it was concluded that pre-treatment HPR < 0,362 was an independent factor in predicting three-year

survival in locally advanced NPC patients (adjusted HR 1, 82; IK 95% 1, 25-2, 65).

Conclusion. Pre-treatment HPR < 0, 362 could predict the three-year survival of locally advanced nasopharyngeal cancer patients."

"ABSTRAKatar Belakang. Kanker kepala dan leher (KKL) merupakan kanker peringkat ke 6 di Dunia. Mayoritas pasien KKL datang ke Rumah Sakit pada stadium lokal lanjut. Progression Free Survival (PFS) merupakan luaran yang baik untuk mengevaluasi keberhasilan suatu terapi pada kasus tumor padat. Peneliti memilih PFS 2 tahun pada kanker kepala dan leher untuk diteliti karena kurun waktu 2 tahun merupakan waktu biologis untuk suatu tumor padat dapat berkembang kembali. Penelitian dilakukan karena perbedaan jenis kanker kepala leher di Indonesia dibandingkan dengan negara Eropa dan Amerika.Tujuan. Mengetahui mortalitas 2 tahun pasien KKL serta PFS 2 tahun pasien KKL serta faktor-faktor yang Memengaruhi.Metode Studi dengan desain kohort retrospektif yang meneliti 216 pasien KKL stadium lokal lanjut yang menjalani kemoradiasi di Rumah Sakit Cipto Mangunkusumo dalam rentang waktu Januari 2015 sampai Desember 2017. Data diambil melalui rekam medis. Data laboratorium yang diambil memiliki rentang waktu 2-4 minggu sebelum dan 2-4 minggu setelah kemoradiasi. Jika ada data yang kurang seperti durasi ikan asin dan riwayat merokok dikonfirmasi melalui media telepon. Pada penelitian ini tidak melihat proses pembuatan ikan asin dan jumlah ikan asin yang dikonsumsi. Penelitian ini tidak meneliti HPV maupun EBV. Pengamatan PFS dimulai dari hari pertama kemoradiasi sampai terjadinya event berupa progresi atau kematian dalam kurun waktu 2 tahun. Data PFS dicatat dalam 2 kelompok PFS ≤ 2 tahun dan >2 tahun. Analisis bivariat menggunakan uji Kai Kuadrat, variabel-variabel yang bermakna akan diuji lebih lanjut dengan menggunakan uji regresi logistik.Hasil. Penelitian ini mendapatkan 216 pasien yang menjalani kemoradiasi pertama kali di RSCM. Terdapat 103 (47,69%) pasien yang meninggal dalam 2 tahun pasca pengobatan. Sedangkan terdapat 108 (50%) pasien yang mengalami PFS 2 tahun. Berdasarkan hasil analisis multivariat didapatkan bahwa merokok (p=0,024), kadar hemoglobin < 12 g/dl (p=0,008), ECOG (p=0,017), serta respons terapi (p=0,006) memengaruhi PFS 2 tahun pasien KKL.Kesimpulan. Proporsi kematian dalam 2 tahun di RSCM masih cukup tinggi (47,69%), dengan PFS 2 tahun mencapai 50%. Kebiasaan merokok, kadar hemoglobin, ECOG serta respons terapi memengaruhi PFS 2 tahun pasien KKL.

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ABSTRACTBackground. Head and neck cancer (HNC) is the 6th cancer in the world. The majority of HNC patients come to the hospital at the locally advanced stage. Progression Free Survival (PFS) is a good outcome for evaluating the success of therapy in solid tumor cases. Researchers chose a 2-year PFS in head and neck cancer to study because within 2-year period is the biological time for a solid tumor to progress again. The study was conducted because of differences in the types of head and neck cancer in Indonesia compared to European and American countries.Aim. Knowing the mortality of HNC patients and 2 years PFS of HNC patients as well as the factors that influenced.Method. A retrospective cohort study design that examined 216 locally advanced HNC patients who underwent chemoradiation at Cipto Mangunkusumo Hospital in the period of January 2015 to December 2017. Data retrieved through medical records. Laboratory data taken 2-4 weeks prior and 2-4 weeks after chemoradiation. If there is insufficient data such as the duration of salted fish and smoking history it is confirmed through telephone. this study did not see the process of making salted fish and the amount of salted fish consumed. This study did not examine HPV or EBV. PFS observation starts from the first day of chemoradiation until the event occurs in the form of a progression or death within 2 years. PFS data are recorded in 2 PFS groups ≤ 2 years and> 2 years. Bivariate analysis using the Chi Square test, if these requirements are not met, the researcher uses the Fischer-exact test. Variables will be further tested using multivariat logistic regression tests.Results. This study found 216 patients who underwent chemoradiation for the first time at RSCM. There were 103 (47.69%) patients who died within 2 years after treatment. Whereas there were 108 (50%) patients who had PFS 2 years. Based on the results of multivariate analysis, it was found that smoking (p = 0.024), hemoglobin level <12 g / dl (p = 0.008), ECOG (p = 0.017), and therapeutic response (p = 0.006) affected PFS 2 years.Conclusion. The proportion of mortality within 2 years in RSCM is still quite high (47.69%), with a 2-years PFS reaching 50%. Smoking, hemoglobin levels, ECOG and therapeutic response affect the 2-year PFS of patients."