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Abstrak :
Tujuan : Penelitian ini ditujukan untuk mengevaluasi sensitivitas dan spesifisitas dari beberapa metode penapisan keganasan pada tumor ovarium jenis epitelial dengan membandingkan Skor Gatot dan Risk Malignancy Index, serta mengajukan modifikasi Skor Gatot. Metode : Empat ratus satu pasien dengan kecurigaan keganasan ovarium tipe epithelial dimasukkan sebagai subjek penelitian, dilakukan prosedur anamnesis, pemeriksaan fisik, laboratoris dan ultrasonografi. Dari data tersebut, diambil variabel-variabel yang sesuai dengan Skor Gatot dan Risk Malignancy Index. Dilakukan analisa statistik berupa perhitungan sensitivitas dan spesifisitas serta ROC dan titik potong optimal. Hasil : Dari 401 subjek penelitian, didapatkan bahwa Skor Gatot memiliki sensitivitas 73.7% dan spesifitas 45.6% (p = 0.000; LR 28.830) sedangkan RMI memiliki nilai sensitivitas 72.4%, spesifisitas 35.94% (p = 0.02, LR 9.588) untuk RMI 1 dan nilai sensitivitas 76%, spesifisitas 30.9% (p = 0.05; LR 7.984) untuk RMI 2. Dilakukan modifikasi pada Skor Gatot dengan pembobotan ulang pada tiap variabel, didapatkan hasil Modifikasi Skor Gatot 1 memiliki titik potong pada nilai 28.5 dengan sensitivitas sebesar 60.4% dan spesifisitas sebesar 61.4% (p= 0.000, LR 44.228) dan Modifikasi Skor Gatot 2 memiliki nilai potong pada titik 5.75 dengan kisaran nilai sensitivitas 49.3 – 69.6% dan sensitivitas 51.6-65.2% ( p = 0.000; LR 36.806). Kesimpulan : Skor Gatot dan RMI memberikan hasil yang kurang memuaskan dalam melakukan prediksi keganasan ovarium. Dengan melakukan pembobotan ulang pada tiap variabel pada Skor Gatot, sensitivitas dan, terutama, spesifisitas dapat ditingkatkan dalam mendeteksi adanya keganasan ovarium tipe epitelial. Hal ini ditujukan agar dapat meningkatkan prediksi keganasan pada pasien dalam usia reproduksi.

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Objective : The study was designed to evaluate the sensitivity and specificity of several methods in detecting ovarian epithelial malignancy by comparing Gatot Score and Risk Malignancy Index, and also proposing the modification of Gatot Score. Method : Four hundred and one subjects with suspected epithelial ovarian malignancy entered the study and performed anamnesis, physical examinations, laboratories studies and ultrasonography. From the data, we took the variables according to Gatot Score and Risk Malignancy Index. We performed statistic analysis in term of sensitivity, specificity, ROC and optimal cut-off-point. Results : From 401 observation subjects, revealed that Gatot Score possess the sensitivity of 73.7% and specificity of 45.6% (p = 0.000; LR 28.830), while RMI possess the sensitivity of 72.4% and specificity of 35.94% (p = 0.02, LR 9.588) for RMI 1, and the sensitivity of 76% and specificity of 30.9% (p = 0.05; LR 7.984) for RMI 2. Modification to Gatot Score was performed by re-weighting to its all variables, which resulted in Gatot Score Modification 1 with cut-off point of 28.5, sensitivity of 60.4% and specificity of 35.94% (p= 0.000, LR 44.228) and Gatot Score Modification 2 with cut-off point of 5.75, sensitivity range between 49.3 – 69.6% and specificity range between 51.6-65.2% ( p = 0.000; LR 36.806). Summary : Both Gatot Score and RMI resulted in unsatisfactory output in predicting the malignancy of ovary. By reassigning the weighting of all variables in Gatot Score, especially the specificity was improved in detecting the malignancy of epithelial type ovary. This measure was directed for patients in reproductive ages, thus increasing the possibility of true malignancy.

Abstrak :
ABSTRAK Latar Belakang: Sekitar 9-33% pasien penyakit trofoblas maligna (PTM) yang diobati dengan kemoterapi agen tunggal akan membutuhkan terapi multi agen karena adanya resistensi terhadap obat lini pertama, termasuk metotreksat (MTX), atau efek samping toksisitas. Hingga saat ini, resistensi terapi lini pertama masih menjadi masalah akibat tingkat identifikasi yang masih rendah. Sebelumnya, belum pernah dilakukan penelitian mengenai kadar Beta-HCG sebagai prediktor resistensi pada pasien PTM risiko rendah. Tujuan: Mengetahui nilai prediktif kadar Beta-HCG untuk risiko resistensi metotreksat pada PTM risiko rendah. Metode: Penelitian ini adalah studi analitik potong lintang menggunakan data rekam medis dari 58 subjek. Subjek adalah semua pasien yang terdiagnosis dengan PTM risiko rendah dan diberikan terapi MTX pada bulan Januari 2011 hingga Desember 2016 di RSUPN Dr. Cipto Mangunkusumo. Pengambilan subjek dilakukan secara konsekutif. Subjek dengan data yang tidak lengkap atau adanya riwayat PTM sebelumnya dieksklusi dari penelitian ini. Hasil: Prevalensi resistensi MTX yaitu 32,8%. Tidak ditemukan asosiasi bermakna antara karakteristik demografik (usia, paritas, pekerjaan, dan pendidikan) ataupun karakteristik klinis (riwayat kehamilan, interval antara kehamilan terakhir dan awal kemoterapi, ukuran tumor, riwayat gagal kemoterapi, lokasi dan jumlah metastasis) dengan resistensi MTX. Ditemukan perbedaan bermakna pada kadar Beta-HCG antara kelompok resistensi dan tidak resistensi pada siklus 4 (p<0,001), 6 (p<0,001), dan 8 (p<0,001). Perbedaan bermakna juga ditemukan pada perubahan kadar Beta-HCG dari awal hingga minggu kedua (p<0,001, AUC 0,8). Cut-off penurunan Beta-HCG sebesar 23% memiliki sensitivitas sebesar 78,9% dan spesifisitas sebesar 74,4% untuk memprediksi resistensi MTX.

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ABSTRACT Background: Approximately 9-33% patients with gestational trophoblastic neoplasia (GTN) treated with single agent chemotherapy would need multi agent chemotherapy, whtether due to resistance to first-line therapy, including methotrexate (MTX), or toxic side effect. Currently, resistance to first-line therapy is still a problem due to low identification rate. To this date, there are no studies regarding Beta-HCG level as a MTX resistance predictor for low risk GTN. Purpose: Identify the predictive value of Beta-HCG level for the risk of MTX resistance in low risk GTN. Methods: This was an analytical cross-sectional study using medical records of 58 subjects. Subjects were all patients diagnosed with low risk GTN and given MTX therapy during the period of January 2011 to December 2016 at Cipto Mangunkusumo Hospital. Consecutive sampling was done. Subjects with incomplete data or history of previous GTN were excluded from this study. Results: The prevalence of MTX resistance was 32,8%. No significant association was found between demographic characteristics (age, parity, job, and education) or clinical characteristics (gestational history, interval between last pregnancy and the start of chemotherapy, tumor size, history of chemotherapy failure, location and number of metastasis) and MTX resistance. A significant difference in the level of Beta-HCG between resistance and non-resistance groups were found on cycle 4 (p<0,001), 6 (p<0,001), and 8 (p<0,001). A significant difference was also found in the change of Beta-HCG from the start to the second week of therapy (p<0,001, AUC 0,8). Beta-HCG decrease cut-off of 23% had the sensitivity of 78,9% and specificity of 74,4% to predict MTX resistance. Conclusions: The prevalence of MTX resistance was 32,8% in this study. The decrease in Beta-hCG level from the start to the second week of therapy could be used as a MTX resistance predictor in low risk GTN patients.

Abstrak :
ASBTRAK
Latar Belakang: Kanker serviks merupakan kanker dengan jumlah kasus baru terbanyak urutan kedua di Indonesia (Globocan 2018). Penyebab kanker serviks yaitu Infeksi Human Papilloma Virus (HPV). Inspeksi visual dengan asam asetat (IVA) merupakan salah satu metode deteksi dini yang dipilih menjadi program nasional di Indonesia. Namun kurang efektifnya pelaksanaan program penapisan kanker serviks ini masih menjadi masalah di Indonesia. Berkembangnya teknologi untuk mengambil gambaran foto serviks menggunakan kamera telepon seluler menjadi suatu gagasan metode penapisan alternatif berupa dokumentasi hasil temuan IVA DoVIA yang dapat disebut sebagai mini colposcopy. Tujuan: Untuk mengetahui hasil kesesuaian temuan dokumentasi IVA (Documentation of Visual Inspection with Acetic Acid / DoVIA) terhadap hasil temuan kolposkopi sebagai metode skrining kanker serviks. Metode : Penelitian ini merupakan penelitian deskriptif, menggunakan desain potong lintang yang dilaksanakan pada April tahun 2017 - Maret 2019 dengan mengikutsertakan 182 sampel foto dokumentasi yang diambil oleh peneliti, menggunakan kamera dengan ketajaman minimal 13 megapixel, memiliki autofokus dan aplikasi pencahayaan assistive light atau lampu sorot, analisis penilaian yang dilakukan 3 penilai yang telah ditentukan yaitu; konsulen onkologi ginekologi, residen obstetri ginekologi dan dokter umum yang telah mendapatkan pembekalan dan pengetahuan mengenai DoVIA dan kolposkopi, dengan kategori penilaian yang dilakukan menilai hasil kesesuaian dengan kappa test adalah ketajaman gambar foto serviks, tampilan sambungan skuamo kolumnar (SSK), kejelasan tampilan white epitel pada serviks. Hasil : Hasil yang didapat pada Dokumentasi IVA DoVIA terhadap kolposkopi, nilai kappa 0.717 (baik), kemudian dilakukan uji inter-rater untuk melihat konsistensi terhadap Dokumentasi IVA, nilai kesesuaian 0.764 (baik) pada penilai konsulen dan residen, nilai 0.703 (baik) pada penilaian konsulen dan dokter umum. Kesimpulan: Nilai kesesuaian Dokumentasi IVA DoVIA terhadap kolposkopi dengan Kappa baik, sehingga dapat melengkapi pemeriksaan IVA sebagai alternatif skrining kanker serviks.

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ABSTRACT
Abstract: Cervical cancer has the second highest number of new cases in Indonesia (Globocan 2018). Human papilloma virus (HPV) infection has been known as the etiology of cervical cancer so that the disease course and early detection methods has been studied. Visual inspection with acetic acid (VIA) is one of the early detection methods chosen as the national program in Indonesia. However, lack of efectiveness in executing cervical cancer screening program is still our biggest problem. Taking photograph of the cervix using mobile phone may become an alternative idea to document VIA results or DoVIA that can be termed as mini colposcopy. Aim : To find out the suitability of Documentation of Visual Inspection with Acetic Acid DoVIA result compare to colposcopy result as a method of cervical cancer screening. Method: This is a descriptive study using cross sectional design that took place from April 2017 until March 2019. One hundred eighty two sampels of documentation photographs taken by the researcher were included, using minimized 13 mepapixel, and the best lighting method such autofocus, and assistive light application. The photographs were reviewed by the 3 selected reviewers: oncology and gynecology consultant, obstetric and gynecology resident, and general practitioner that were trained about DoVIA and colposcopy. The review was based on kappa test which assessed the sharpness, squamo-columnar junction and white epitel visualization on the cervix. Results: Kappa score on DoVIA versus colposcopy was 0,717 (good). Inter-rater test was performed to assess consistency and the result was 0,764 (good) between consultant and resident, 0,703 (good) between consultant and general practitioner. Conclusion: Kappa test of IVA documentation DoVIA gives a good kappa value, so that it is expected to be an alternative screening for cervical cancer.

Abstrak :
ABSTRAK
Tujuan: Penelitian ini bertujuan untuk mengetahui kesintasan hidup pasien kanker serviks dan faktor-faktor yang mempengaruhinya.

Metode: Penelitian ini menggunakan desain kohort retrospektif dengan analisis kesintasan. Pasien kanker serviks yang didiagnosis di Rumah Sakit Cipto Mangunkusumo pada 1 Januari 2005 sampai 31 Desember 2006 dimasukkan dalam penelitian ini. Dilakukan pendataan tanggal dan umur saat diagnosis, tingkat pendidikan, stadium, jenis histopatologi, diferensiasi tumor, invasi limfovaskuler, jenis terapi, dan lengkapnya terapi. Jika pasien menjalani operasi, dinilai pula adanya tumor pada kelenjar getah bening(KGB) atau batas sayatan. Selanjutnya pasien diamati sampai minimal 5 tahun apakah pasien masih hidup. Kemudian dilakukan analisis kesintasan dengan metode Kaplan Meier. Faktor-faktor yang mempengaruhi kesintasan dinilai dengan analisis Cox regression.

Hasil: Diperoleh 447 pasien kanker serviks dalam kajian ini. Didapatkan median survival keseluruhan pasien kanker serviks 1916 hari (63 bulan) dengan kesintasan hidup 5 tahun 52%. Faktor umur, pendidikan, jenis pembiayaan, ukuran tumor, dan adanya invasi limfovaskuler tidak menunjukkan adanya perbedaan kesintasan. Stadium III dan IV memiliki kesintasan hidup yang lebih rendah dengan Hazard Ratio 3.27 dan 6.44. Diferensiasi buruk dan terapi tidak lengkap memiliki kesintasan yang lebih rendah dengan HR 2.26 dan 2.22. Jenis histopatologi lain-lain memiliki kesintasan yang lebih rendah dengan HR 2.85, namun tidak menunjukkan perbedaan bermakna pada uji multivariat. Pada pasien yang menjalani operasi disertai adanya tumor pada KGB menunjukkan kesintasan yang lebih rendah dengan HR 12.01, sedangkan adanya tumor pada batas sayatan tidak menunjukkan perbedaan kesintasan yang bermakna. Jenis terapi pada stadium awal ataupun sradium lanjut tidak menunjukkan perbedaan pada uji multivariat.

Kesimpulan: Median survival pasien kanker serviks adalah 63 bulan. Faktor-faktor yang berpengaruh secara independen terhadap kesintasan pasien kanker serviks adalah stadium, diferensiasi tumor, kelengkapan terapi, dan adanya tumor pada kelenjar getah bening.

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ABSTRACT
Objective: To find out of the probability of 5 years survival rate on cervical cancer patients and to identify the influencing factors.

Methods: This is a retrospective cohort study. Cervical cancer patients treated at Cipto Mangunkusumo Hospital in 2005-2006 were selected. Demographic and clinical data were collected. Demographic data collected were diagnosis time, age, and education level. Clinical data collected were stage, histopathology, differentiation, lymphovascular invasion, and therapy. The appearance of the tumor on the specimen margin and lymphnodes was also noted in the patient underwent surgery. All the patients were followed up for minimal 5 years to know whether the patient was alive. Kaplan Meier methods was used to determine the survival rate probability and Cox regression analysis was used to assessed the factors influencing the cervical cancer survival

Result: A total of 447 cervical cancer patients was enrolled to this study. Median survival of these patients was 63 months and the overall 5-years survival probability was 52%. Age, education level, funding source, tumor size, and lymph-vascular invasion showed no significant differences on cervical cancer survival. Stage III and IV had lower survival probability (Hazard Ratio 3.27 and 6.44). Poor differentiated tumor and uncompleted therapy also had lower survival probability (HR 2.26 and 2.22). Histopathology of others had lower survival probability(HR 2.85), but wasn't significant on multivariate analysis. The presence of tumor on the cervical cancer specimen during operation showed worse survival probability (HR 12.01), otherwise the presence of tumor on specimen margin didn't show difference survival. Therapy types didn't showed any differences, either on early and advanced stage.

Conclusion: Cervical cancer median survival was 63 months. Independent influencing factors in this study were cancer’s stage, tumor differentiation, therapy completeness, and the presence of the tumor on the pelvic lymph nodes specimen during operation.

Abstrak :
ABSTRAK

Tujuan: Untuk mengetahui gambaran transposisi ovarium sebagai upaya proteksi fungsi ovarium pada pasien kanker serviks yang menjalani radioterapi

Metode: Penelitian ini merupakan penelitian cohort, before–after study pada pasien-pasien kanker serviks dan kanker vagina stadium IB, IIA, IIB, IIIA, dan IIIB yang akan menjalankan radioterapi dan dilakukan transposisi ovarium. Penelitian dilakukan di Rumah Sakit Cipto Mangunkusumo (RSCM) dan Rumah Sakit Umum Persahabatan (RSUP) sejak 1 Januari 2011 sampai 31 Maret 2014. Luaran yang diukur adalah perubahan kadar Anti Mullerian Hormone (AMH), Follicle Stimulating Hormone (FSH), dan skor keluhan hidup terkait menopause.

Hasil: Terdapat 16 subyek penelitian, namun hanya 12 orang subyek yang dilakukan transposisi ovarium dan menyelesaikan radioterapi. Efek proteksi transposisi ovarium sangat rendah (8,3%) dimana hanya satu dari 12 orang yang tidak mengalami penurunan kadar AMH setelah radioterapi. Sisanya mengalami penurunan kadar AMH setelah radioterapi yang bermakna (T-test berpasangan p=0,037). Kadar FSH meningkat sesudah radioterapi (T-test berpasangan p= 0,015). Skor keluhan hidup meningkat setelah dilakukan radioterapi (T-test berpasangan p<0,001). Faktor penyebab efek proteksi transposisi ovarium yang rendah karena sebagian besar subyek memiliki kadar awal AMH yang rendah. Rekomendasi penelitian ini adalah memperketat proses seleksi transposisi ovarium, yaitu usia ≤ 35 tahun, kadar AMH > 0,3 ng/ml, dan kadar FSH≤ 12 mIU/ml.

Kesimpulan: Transposisi ovarium memiliki efek proteksi fungsi ovarium yang rendah (8,3%). Hal itu dapat disebabkan karena sebagian besar subyek memiliki kadar AMH yang rendah sebelum terapi.

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ABSTRAK

Objective: To know the effect of ovarian transposition in protecting ovarian function in cervical cancer patients undergoing radiotherapy

Methodology: This cohort study was before–after study in patients who had cervical or vaginal cancer stage IB, IIA, IIB, IIIA, and IIIB who underwent ovarian transposition before radiotherapy. This study was done in Cipto Mangunkusumo Hospital and Persahabatan satellite hospital since 1 January 2011 until 31 March 2014. The level of Anti Mullerian Hormone (AMH), Follicle Stimulating Hormone (FSH), and menopause symptom score were evaluated before and after radiotherapy.

Result: There were 16 patients who underwent ovarian transposition but only 12 patients completed radiotherapy. The protective effect of ovarian transposition was low, only one among 12 subjects (8.3%) did not experience decreased level of AMH. Ten subjects had significantly decreased AMH level after radiotherapy (paired T-test, p=0.037). FSH level was significantly increased after radiotherapy (paired T-test p=0.015). Menopause symptoms scores were increased after radiotherapy (paired T-test p<0.001). This study recommended the tighter selection criteria for patients undergoing ovarian transposition such as, age younger than 35 years old, AMH level > 0,3 ng/ml, and FSH level≤ 12 mIU/ml.

Conclusion: Ovarian transposition had low protective effect (8.3%) and it might be caused by the low level of AMH in most subjects before radiotherapy

Abstrak :
Latar belakang: Angka ketahanan hidup 5 tahun pasien keganasan ovarium rendah, karena >70% kasus terlambat didiagnosis. Skor Gatot Purwoto merupakan metode prediksi keganasan ovarium pra-bedah. Terdapat rentang yang berbeda cukup jauh antara nilai diagnostik Gatot Purnomo dari beberapa penelitian. Pada aplikasinya penderita tumor ovarium curiga ganas dengan skor prediksi Gatot Purwoto (GP) < 4 (rendah) masih terdapat kecurigaan adanya keganasan ovarium sehingga masih dilakukan prosedur potong beku sebagai alat diagnostik intrabedah. Tujuan: Untuk mengetahui sensitivitas, spesifisitas, nilai duga positif dan nilai duga negatif prosedur potong beku yang dilakukan pada penderita tumor ovarium curiga ganas dengan skor prediksi Gatot Purwoto ≤ 4 dan untuk mengetahui peningkatan nilai diagnostik antara prosedur potong beku dibandingkan dengan skor gatot purwoto pada penderita tumor ovarium curiga ganas dengan skor prediksi Gatot Purwoto ≤ 4 Metode: Uji ini adalah uji diagnostik dengan desain potong lintang. Pasien tumor ovarium curiga ganas dengan skor prediksi Gatot Purwoto (GP) < 4 yang dilakukan prosedur potong beku di RSCM selama periode Juli 2008 – Juli 2013 diikutsertakan dalam penelitian ini. Data diambil secara konsekutif dari rekam medik, kemudian dianalisis secara manual dengan menggunakan tabel 2x2 dan rumus parameter diagnostik. Kami menganalisis nilai diagnostik potong beku dibandingkan dengan baku emas yaitu blok parafin. Kemudian kami melihat adakah peningkatan nilai diagnostik prediksi keganasan ovarium jika hanya dilakukan skor GP saja dan jika dilakukan skor GP disertai dengan potong beku Hasil: Dari 160 orang subyek penelitian didapatkan prosedur potong beku memiliki akurasi yang cukup baik dalam mendiagnosis keganasan ovarium yaitu 78,5%. Sensitivitas, spesifisitas, nilai duga positif, nilai duga negatif dan akurasi prosedur potong beku pada penelitian ini berturut turut adalah 84,3%, 92,9%, 75%, 95,9% dan 85,5%. Selain itu prosedur potong beku pada penderita tumor ovarium curiga ganas dengan skor prediksi GP ≤4 secara bermakna memberikan manfaat dalam mendiagnosis keganasan ovarium yaitu meningkatkan nilai diagnostik sebesar 15,9% dibandingkan hanya menggunakan skor GP saja tanpa potong beku. Kesimpulan: Prosedur potong beku memiliki nilai diagnostik yang baik dan masih memberikan manfaat dalam mendiagnosis tumor ovarium curiga ganas dengan skor prediksi GP < 4. Skor prediksi GP memberikan nilai diagnostik yang cukup rendah untuk memprediksi keganasan ovarium, sehingga perlu dilakukan perbaikan sistem penilaian prediksi keganasan ovarium. ......Background: The 5-year survival rate of patients with ovarian cancer is low, because over 70% of cases are diagnosed in a late stage. Gatot Purwoto score is a method to predict ovarian malignancy prior to surgery. There is a variabel range on the diagnostic values of Gatot Purwoto (GP) score from several studies. In its application, patients with GP prediction score < 4 (low) still has a suspicion for ovarian malignancy, therefore frozen section is still performed as an intraoperative diagnostik tool. Aim: To obtain the sensitivity, specificity, positive predictive value, and negative predictive value of frozen section performed in patients with suspected malignant ovarian tumors with GP score ≤ 4 and to discover the increase of diagnotic value of frozen section compared to GP score in patients with suspected malignant ovarian tumors with GP score ≤ 4. Methods: This is a diagnostic study with cross sectional design. Patients with suspected malignant ovarian tumors with GP score ≤ 4 who underwent frozen section in RSCM from July 2008 – July 2013 were included in this study. Data were obtained consecutively from medical records, then analyzed manually with 2x2 tables and diagnostik parameter formula. We analyzed frozen section compared to the gold standard (paraffin block). Then we observed if there was an increase of diagnostic value of predicting ovarian malignancy with GP score alone or GP score combined with frozen section. Result: We obtained 160 subjects. Frozen section had an overall good accuracy in predicting ovarian malignancy (78.5). The sensitivity, specificity, positive predictive value, and negative predictive value of frozen section are 84,3%, 92,9%, 75%, 95,9% and 85,5%, respectively. Frozen section also increased the diagnostic value as much as 15,9% compared to GP score alone without frozen section. Conclusion: Frozen section had a good diagnostic value and is still useful in diagnosing suspected malignant ovarian tumors with GP score ≤ 4. GP prediction score has a quite low diagnostic value in predicting ovarian malignancy, therefore an improved system to predict ovarian malignancy is needed.

Abstrak :
[ABSTRAK
Penelitian ini bertujuan untuk mengetahui gambaran umum kanker ovarium di Rumah Sakit Ciptomangunkusumo (RSCM) 5 tahun terakhir beserta faktor-faktor yang berhubungan dengan kanker ovarium. Penelitan ini mengambil data pasien kanker ovarium selain tipe borderline yang terdapat di Cancer Registry divisi Ginekologi Onkologi dan masih memiliki rekam medis di RSCM pada periode Januari 2010 – Desember 2014, dilakukan follow up untuk mengetahui kesintasan hidup selama 4 tahun. Kami mendapatkan 98 subyek penelitian. Pada penelitian ini didapatkan insidensi kanker ovarium terbanyak pada usia 45-54 tahun (33,6%), insidensi kanker ovarium menurun dengan bertambahnya jumlah anak, sebagian besar kanker ovarium merupakan tipe epitelial (76,5%) dan sebagian besar pasien didiagnosa pada stadium lanjut (55.1%). Kesintasan hidup 4 pasien kanker ovarium tipe epitelial 77%; tipe germinal 83.3%; tipe stroma 100%. Kesintasan hidup 4 tahun dengan terapi pembedahan 84.1%; pembedahan disertai kemoterapi adjuvan 83.3%; kemoterapi neoadjuvan sebelum pembedahan 68.4%. Terdapat 63% respon komplit pada kelompok kemoterapi adjuvan; dan 41.2% pada kelompok kemoterapi neoadjuvan.

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ABSTRACT
The aim of this research is to describe the incidence of ovarian cancer and its characteristic in Ciptomangunkusumo Hospital in the last 5 year. The data was collected from Gynecology Oncology Division’s Cancer Registry and RSCM’s medical record from Januari 2010 – December 2014, follow up was performed to know the survival. There was 98 subject in this research. The result was : majority incidence of ovarian cancer was in the age 45-54 years old (33,6%); ovarian cancer incidence decrease in parity’s group; the majority histotype was epithelial (76.5%); and most of them were diagnosed on advanced stage (55.1%). The 4 year survival rate for epithelial was 77%; germinal was 83,3%; and stromal was 100%. Based on therapy the 4 year survival rate was 84.1%; 83.3% in adjuvant chemotherapy group; and 68.4% in neoadjuvan chemotherapy. In the group of adjuvant chemotherapy there was 63% complete respon and 41.2% in neoadjuvan chemotherapy.;The aim of this research is to describe the incidence of ovarian cancer and its characteristic in Ciptomangunkusumo Hospital in the last 5 year. The data was collected from Gynecology Oncology Division’s Cancer Registry and RSCM’s medical record from Januari 2010 – December 2014, follow up was performed to know the survival. There was 98 subject in this research. The result was : majority incidence of ovarian cancer was in the age 45-54 years old (33,6%); ovarian cancer incidence decrease in parity’s group; the majority histotype was epithelial (76.5%); and most of them were diagnosed on advanced stage (55.1%). The 4 year survival rate for epithelial was 77%; germinal was 83,3%; and stromal was 100%. Based on therapy the 4 year survival rate was 84.1%; 83.3% in adjuvant chemotherapy group; and 68.4% in neoadjuvan chemotherapy. In the group of adjuvant chemotherapy there was 63% complete respon and 41.2% in neoadjuvan chemotherapy.;The aim of this research is to describe the incidence of ovarian cancer and its characteristic in Ciptomangunkusumo Hospital in the last 5 year. The data was collected from Gynecology Oncology Division’s Cancer Registry and RSCM’s medical record from Januari 2010 – December 2014, follow up was performed to know the survival. There was 98 subject in this research. The result was : majority incidence of ovarian cancer was in the age 45-54 years old (33,6%); ovarian cancer incidence decrease in parity’s group; the majority histotype was epithelial (76.5%); and most of them were diagnosed on advanced stage (55.1%). The 4 year survival rate for epithelial was 77%; germinal was 83,3%; and stromal was 100%. Based on therapy the 4 year survival rate was 84.1%; 83.3% in adjuvant chemotherapy group; and 68.4% in neoadjuvan chemotherapy. In the group of adjuvant chemotherapy there was 63% complete respon and 41.2% in neoadjuvan chemotherapy., The aim of this research is to describe the incidence of ovarian cancer and its characteristic in Ciptomangunkusumo Hospital in the last 5 year. The data was collected from Gynecology Oncology Division’s Cancer Registry and RSCM’s medical record from Januari 2010 – December 2014, follow up was performed to know the survival. There was 98 subject in this research. The result was : majority incidence of ovarian cancer was in the age 45-54 years old (33,6%); ovarian cancer incidence decrease in parity’s group; the majority histotype was epithelial (76.5%); and most of them were diagnosed on advanced stage (55.1%). The 4 year survival rate for epithelial was 77%; germinal was 83,3%; and stromal was 100%. Based on therapy the 4 year survival rate was 84.1%; 83.3% in adjuvant chemotherapy group; and 68.4% in neoadjuvan chemotherapy. In the group of adjuvant chemotherapy there was 63% complete respon and 41.2% in neoadjuvan chemotherapy.]

Abstrak :
Penelitian ini bertujuan untuk membandingkan ROMA dengan RMI dalam memprediksi keganasan tumor ovarium epitelial di RS dr. Cipto Mangunkusumo (RSUPNCM). Penelitian ini merupakan uji diagnostik dengan desain potong lintang yang dilakukan di Departemen Obstetri dan Ginekologi, RSUPNCM. Pada penelitian ini, dari 213 subjek diperoleh sensitivitas dan spesifisitas RMI 85.3%, dan 66.3%, Nilai Duga Positif dan Negatif RMI 79.7%, dan 74.3%, Rasio Kemungkinan Positif dan Negatif RMI 2.53, dan 0.22; dan sensitivas dan spesifisitas ROMA 95.4%, dan 32.5%, Nilai Duga Positif dan Negatif 68.9%, dan 81.8%, Rasio Kemungkinan Positif dan Negatif 1.41, dan 0.14. AUC ROMA lebih baik daripada RMI, tetapi tidak bermakna secara statistik (seluruh kelompok: AUC 69.56%>67.49%, perbedaan AUC 0.0207, p 0.526; kelompok pascamenopause: AUC 91.47%>88.97%, perbedaan AUC 0.0250, p 0.0571; kelompok premenopause: AUC 86.20%>78.16%, perbedaan AUC 0.0804, p 0.0571). Pada titik potong ideal (RMI 330, ROMA premenopause 30,4; dan pascamenopause 53.1), ROMA mempunyai sensitivitas dan spesifitas yang lebih baik dibandingkan RMI (sensitivitas 82.31% vs 74.62%; spesifisitas 78.31% vs 75.9%). Dapat disimpulkan bahwa tidak terdapat perbedaan antara ROMA dengan RMI, tetapi sensitivitas dan spesifisitas ROMA lebih baik daripada RMI pada titik potong ideal. ......The purpose of this research is to compare ROMA with RMI to predict malignancy of ovarian tumor, epithelial type in Indonesia, especially at the Cipto Mangunkusumo hospital. It was a cross sectional study with a diagnostic design, which was performed in the Oncology Gyneology division. From 213 sampels, the RMI showed a sensitivity of 85.3%, a specificity of 66.3%, a PPV of 79.7%, a NPV of 74.3%, a LR+ of 2.53, LR- 0.22 and an accuracy of 0.77; while ROMA has a sensitivity of 95.4%, a specificity of 32.5%,a PPV 68.9% of, a NPV of 81.8%, a LR+ 1.41, LR- 0.14 and an accuracy of 0.71. Overall AUC ROMA indicated better results compared to those results using the RMI diagnostic method, (all groups: AUC 69.56%>67.49%, p 0.526; as with the postmenopause group: the AUC was 91.47%>88.97%, p 0.0571; and the premenopause group: the AUC 86.20%>78.16%, p 0.0571). At ideal the cut-off point (RMI 330, ROMA premenopause 30,4; and postmenopause 53.1), ROMA has shown better sensitivity and specificity than RMI (sensitivity 82.31% vs 74.62%; specificity 78.31% vs 75.9%). It can be concluded that there is no significantly different between ROMA and RMI, but at ideal cut off, sensitivity and specificity ROMA better than RMI.

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.

Abstrak :
ABSTRAK
TUJUAN : Mengetahui jumlah sel NK dan fungsinya menghasilkan IFN-? pada serviks normal, infeksi subklinis HPV-RT, lesi prakanker dan kanker serviks terkait perjalanan alami kanker serviks.METODE : Penelitian ini merupakan sebuah studu deskripsi komparasi numeric lebih dari 2 grup dengan total subjek 40 perempuan yang memenuhi kriteria inklusi dan eksklusi. Sampel diambil dari swab serviks dengan cytobrush dan diproses di laboratorium untuk menghitung jumlah sel NK dan fungsinya menghasilkan interferon gamma dengan metode flowsitometri. Data dianalisis dengan uji Kruskall Wallis dan analisis post-hoc unutuk menentukan perbedaan antara grup.HASIL : Rerata jumlah sel NK pada kelompok serviks normal, infeksi subklinis HPV-RT, lesi prakanker, dan kanker serviks berturut-turut adalah 2.6 , 11.6 , 12 , dan 7.4 . Rerata jumlah sel NK memproduksi IFN-? pada kelompok serviks normal, infeksi subklinis HPV-RT, lesi praknaker, dan kanker serviks berturut-turut adalah 8.1 , 3.3 , 1.1 , dan 1.8 Terdapat perbedaan jumlah sel NK pada pada jaringan serviks normal, infeksi subklinis HPV-RT, lesi prakanker dan kanker serviks p=0.001 . Tidak terdapat perbedaan jumlah sel NK yang menghasilkan IFN-? pada pada jaringan serviks normal, infeksi subklinis HPV-RT, lesi prakanker dan kanker serviks p=0.577 .KESIMPULAN : Jumlah sel NK pada serviks normal secara bermakna lebih rendah dibanding kelompok lainnya. Namun tidak ada perbedaan jumlah sel NK yang memproduksi IFN-? antar kelompok. Aktivitas sel NK sebagai imunomodulator dapat berkaitan dengan aktivitas sitotoksiknya, meskipun mempunyai jalur aktivasi yang berbeda. Diperlukan penelitian lanjutan untuk menilai aktifitas sel NK memproduksi sitokin. Selain itu fungsi sitotoksik sel NK juga perlu dipelajari untuk mengetahui peranan seutuhnya sel NK terkait perjalanan alami kanker serviks.

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ABSTRACT
Objective To know NK cell count and its function to produce IFN on normal cervix, subclinical high risk HPV hr HPV infection, precancerous lesion, and cervical cancer in order to understand the natural history of uterine cervical cancer.Methods This is a descriptive comparative numerical study with more than two unpaired group with total subjects of 40 females who met the inclusion and exclusion criteria. Samples were gathered from cervical tissue using cytobrush and were processed in the laboratory to calculate NK cell count using flowcytometry. Data was analyzed using Kruskal Wallis and post hoc analysis was done to determine the difference between groups.Results The mean NK cell count on normal cervix, subclinical hr HPV infection, precancerous lesion, and cervical cancer were 2.6 , 11.6 , 12 , and 7.4 . The mean NK cell producing IFN on normal cervix, subclinical hr HPV infection, precancerous lesion, and cervical cancer were 8.1 , 3.3 , 1.1 , and 1.8 . There is significant difference of NK cell count between 4 groups p 0.001 but there is no significant difference of NK cellproducing IFN p 0.577 .Conclusion NK cell count in normal cervix was significantly lower than other group. However, there wasn rsquo t any difference on IFN production between groups. NK cells activity as an immunomodulator can be associated to its cytotoxic activities, although from different pathway. Further study is needed to understand NK cell activity in cytokine production and its role in cervical cancer natural history.