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"[ABSTRAKOsteosarcoma adalah keganasan tulang tersering yang ditemukan pada usia muda. Terdapat beberapa faktor prognosis yang mempengaruhi, antara lain, staging, jenis kelamin dan usia. Pada osteosarcoma sel ganas menghasilkan alkaline fosphatase dan laktat dehidrogenase yang dihasilkan dari metabolisme sel kanker. Serum alkalin fosphatase (SAP) dan laktat dehidrogenase (LDH) dapat digunakan sebagai salah satu faktor prediktor prognosis.Tujuan dari studi ini adalah untuk mengetahui apakah SAP dan LDH dapat dijadikan faktor prediktor prognostik dan memperkirakan angka kesintasan pasien osteosarcoma.Penelitian ini dilakukan menggunakan metode potong-lintang untuk melihat hubungan antara usia, jenis kelamin, dan angka kesintasan 1 tahun dengan SAP dan LDH pada pasien osteosarcoma.Penelitian ini dilaksanakan di Departemen Orthopedi dan Traumatologi dan Departemen Patologi Anatomi FKUI/RSCM. Dari 303 pasien yang didiagnosis dengan osteosarcoma pada tahun 1995-2011, hanya 55 pasien yang memenuhi kriteria inklusi, terdiri atas 39 pasien laki-laki, 16 pasien perempuan dan umumnya berusia 20 tahun. Analisis dari penelitian ini menggunakan chi-square dan korelasi spearman. Dari hasil studi ini, tidak ditemukan asosiasi antara SAP dan LDH sebelum terapi dengan usia, jenis kelamin dan angka kesintasan 1 tahun.

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ABSTRACTOsteosarcoma is a bone malignancy that most commonly occurs in the young age. In this disease, there are many prognosis factor, hence, stage of the disease, gender and age.Alkaline phosphatase enzyme is produced by osteosarcoma cells and thus, increase in this malignancy. Whereas, LDH involve in cancer cell metabolism. Currently, the use of both Serum alkaline phosphatase (SAP) and lactate dehydrogenase (LDH) can be used as a prognostic factor.The research aims is to find out whether SAP and LDH, in addition to other prognostic factors, can be used to predict survivability of osteosarcoma patients. This research is a cross-sectional study and will discuss the association between age, gender, 1 year survival to the SAP and LDH in osteosarcoma patients.This study was conducted in the Department of Orthopaedic and Traumatology and Department of Pathology Anatomy FMUI/RSCM. There were 303 patients who are admitted to this hospital between the year 1995 to 2011, there were only 55 subjects included in this study that suit to the inclusion criteria. The analyses of this research was done using chi-square and spearman correlation.The sample were predominated by male (n=39), female (n=16) and the majority was the age of 20.In the results of this study, there were no association between pretreatment SAP and LDH with age, gender, and 1 year survival.;Osteosarcoma is a bone malignancy that most commonly occurs in the young age. In this disease, there are many prognosis factor, hence, stage of the disease, gender and age.Alkaline phosphatase enzyme is produced by osteosarcoma cells and thus, increase in this malignancy. Whereas, LDH involve in cancer cell metabolism. Currently, the use of both Serum alkaline phosphatase (SAP) and lactate dehydrogenase (LDH) can be used as a prognostic factor.The research aims is to find out whether SAP and LDH, in addition to other prognostic factors, can be used to predict survivability of osteosarcoma patients. This research is a cross-sectional study and will discuss the association between age, gender, 1 year survival to the SAP and LDH in osteosarcoma patients.This study was conducted in the Department of Orthopaedic and Traumatology and Department of Pathology Anatomy FMUI/RSCM. There were 303 patients who are admitted to this hospital between the year 1995 to 2011, there were only 55 subjects included in this study that suit to the inclusion criteria. The analyses of this research was done using chi-square and spearman correlation.The sample were predominated by male (n=39), female (n=16) and the majority was the age of 20.In the results of this study, there were no association between pretreatment SAP and LDH with age, gender, and 1 year survival.;Osteosarcoma is a bone malignancy that most commonly occurs in the young age. In this disease, there are many prognosis factor, hence, stage of the disease, gender and age.Alkaline phosphatase enzyme is produced by osteosarcoma cells and thus, increase in this malignancy. Whereas, LDH involve in cancer cell metabolism. Currently, the use of both Serum alkaline phosphatase (SAP) and lactate dehydrogenase (LDH) can be used as a prognostic factor.The research aims is to find out whether SAP and LDH, in addition to other prognostic factors, can be used to predict survivability of osteosarcoma patients. This research is a cross-sectional study and will discuss the association between age, gender, 1 year survival to the SAP and LDH in osteosarcoma patients.This study was conducted in the Department of Orthopaedic and Traumatology and Department of Pathology Anatomy FMUI/RSCM. There were 303 patients who are admitted to this hospital between the year 1995 to 2011, there were only 55 subjects included in this study that suit to the inclusion criteria. The analyses of this research was done using chi-square and spearman correlation.The sample were predominated by male (n=39), female (n=16) and the majority was the age of 20.In the results of this study, there were no association between pretreatment SAP and LDH with age, gender, and 1 year survival.;Osteosarcoma is a bone malignancy that most commonly occurs in the young age. In this disease, there are many prognosis factor, hence, stage of the disease, gender and age.Alkaline phosphatase enzyme is produced by osteosarcoma cells and thus, increase in this malignancy. Whereas, LDH involve in cancer cell metabolism. Currently, the use of both Serum alkaline phosphatase (SAP) and lactate dehydrogenase (LDH) can be used as a prognostic factor.The research aims is to find out whether SAP and LDH, in addition to other prognostic factors, can be used to predict survivability of osteosarcoma patients. This research is a cross-sectional study and will discuss the association between age, gender, 1 year survival to the SAP and LDH in osteosarcoma patients.This study was conducted in the Department of Orthopaedic and Traumatology and Department of Pathology Anatomy FMUI/RSCM. There were 303 patients who are admitted to this hospital between the year 1995 to 2011, there were only 55 subjects included in this study that suit to the inclusion criteria. The analyses of this research was done using chi-square and spearman correlation.The sample were predominated by male (n=39), female (n=16) and the majority was the age of 20.In the results of this study, there were no association between pretreatment SAP and LDH with age, gender, and 1 year survival.;Osteosarcoma is a bone malignancy that most commonly occurs in the young age. In this disease, there are many prognosis factor, hence, stage of the disease, gender and age.Alkaline phosphatase enzyme is produced by osteosarcoma cells and thus, increase in this malignancy. Whereas, LDH involve in cancer cell metabolism. Currently, the use of both Serum alkaline phosphatase (SAP) and lactate dehydrogenase (LDH) can be used as a prognostic factor.The research aims is to find out whether SAP and LDH, in addition to other prognostic factors, can be used to predict survivability of osteosarcoma patients. This research is a cross-sectional study and will discuss the association between age, gender, 1 year survival to the SAP and LDH in osteosarcoma patients.This study was conducted in the Department of Orthopaedic and Traumatology and Department of Pathology Anatomy FMUI/RSCM. There were 303 patients who are admitted to this hospital between the year 1995 to 2011, there were only 55 subjects included in this study that suit to the inclusion criteria. The analyses of this research was done using chi-square and spearman correlation.The sample were predominated by male (n=39), female (n=16) and the majority was the age of 20.In the results of this study, there were no association between pretreatment SAP and LDH with age, gender, and 1 year survival., Osteosarcoma is a bone malignancy that most commonly occurs in the young age. In this disease, there are many prognosis factor, hence, stage of the disease, gender and age.Alkaline phosphatase enzyme is produced by osteosarcoma cells and thus, increase in this malignancy. Whereas, LDH involve in cancer cell metabolism. Currently, the use of both Serum alkaline phosphatase (SAP) and lactate dehydrogenase (LDH) can be used as a prognostic factor.The research aims is to find out whether SAP and LDH, in addition to other prognostic factors, can be used to predict survivability of osteosarcoma patients. This research is a cross-sectional study and will discuss the association between age, gender, 1 year survival to the SAP and LDH in osteosarcoma patients.This study was conducted in the Department of Orthopaedic and Traumatology and Department of Pathology Anatomy FMUI/RSCM. There were 303 patients who are admitted to this hospital between the year 1995 to 2011, there were only 55 subjects included in this study that suit to the inclusion criteria. The analyses of this research was done using chi-square and spearman correlation.The sample were predominated by male (n=39), female (n=16) and the majority was the age of 20.In the results of this study, there were no association between pretreatment SAP and LDH with age, gender, and 1 year survival.]"

"Latar belakang : Osteosarkoma merupakan tumor ganas primer tulang yang paling banyak ditemukan pada anak dan dewasa muda. Patogenesisnya melibatkan berbagai perubahan gen yang kompleks. Jalur utama yang berperan dalam patogenesis antara lain jalur protein Retinoblastoma (Rb). p16 bekerja sebagai tumor suppressor pada jalur Rb dalam menghambat pembelahan sel tumor. Salah satu faktor prognosis osteosarkoma adalah respon kemoterapi yang dinilai melalui pemeriksaan histopatologik berdasarkan luasnya nekrosis tumor. Obat kemoterapi dan p16 keduanya bekerja sama didalam menghambat pembelahan sel dan memicu apoptosis. Beberapa penelitian menyebutkan hilangnya fungsi p16 berkaitan dengan tingginya progresivitas sel tumor dan respon terapi yang buruk. Tujuan penelitian ini adalah mencari hubungan antara ekspresi p16 dengan respon histologik kemoterapi neoadjuvan pada penderita osteosarkoma konvensional.Metode: Penelitian menggunakan metode potong lintang. Sampel terdiri atas 33 kasus di Departemen Patologi Anatomik FKUI/RSCM tahun 2013 sampai 2018, 8 kasus (24,2%) memiliki respon histologik baik (nekrosis >90%) dan 25 kasus (75,8%) memiliki respon buruk (nekrosis <90%). Dilakukan pulasan imunohistokimia p16 pada setiap kasus biopsi yang belum diberi kemoterapi neoadjuvan, dihitung persentase sel tumor yang positif. Ekspresi p16 positif ditentukan berdasarkan inti sel tumor terpulas sedang atau kuat pada > 30% sel tumor. Hasil perhitungan dikelompokkan menjadi ekspresi positif  dan negatif kemudian dikorelasikan dengan luas nekrosis dari reseksi tumor setelah kemoterapi neoadjuvan.Hasil : Ekspresi positif ditemukan sebanyak 10 kasus (30,3%) dan ekspresi negatif 23 kasus (69,7%). Pada ekspresi positif, 6 dari 10 kasus memiliki respon kemoterapi baik dan pada ekspresi negatif, 21 dari 23 kasus memiliki respon kemoterapi buruk.  Hasil penelitian menunjukkan ekspresi imunohistokimia p16 berhubungan signifikan dengan respon histologik baik kemoterapi neoadjuvan (p=0,004) dengan prevalence ratio 6,90 (95% confidence interval, 1,672-28,480;  p = .004)Kesimpulan : Ekspresi p16 positif berhubungan dengan respon histologik baik kemoterapi neoadjuvan pada osteosarkoma konvensional.

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Background : Osteosarcoma is the most common primary malignant bone tumor in children and young adult. Its pathogenesis has been linked to alterations in several genes. The high percentage is found involving Retinoblatoma (RB) pathway.  p16 plays as a tumor suppressor in RB pathway to controll proliferation of the tumor cell. The degree of neoadjuvan chemotherapy histological necrosis response is related to prognosis of patients with osteosarcoma. Chemotherapy and p16 both synergic in inhibit the cell tumor proliferation and support apoptotic. Loss of p16 function is related to progressiveness of the tumor.Methods : The aim of this study was to investigate the relationship of p16 expression in pretreatment osteosarcoma to pathologic necrotic histological response after neoadjuvan chomotherapy. This is a cross sectional study. p16 stainning was done  and count the positive expression tumor cell in percentage. Positive was defined as strong and medium nuclear stainning in 30% or greater. The samples is catagorized into positive and negative expression then it is correlated into tumor necrotic area based on grade of Huvos.Results : Samples consist of 33 cases. Positive stainning was found in 10 cases (30,3%), 6 of 10 cases had good chemotherapy response. Negative stainning was found in 23 cases and 21 of 23 cases had poor chemotherapy response. A significant association was noted between p16 expression and histological necrotic response to neoadjuvan chemotherapy (p=0,004) with prevalence ratio 6,90 (95% confidence interval, 1,672-28,480; p = .004)Conclusion : The result showed that p16 expression associate significantly with histological necrotic response to neoadjuvan chemotherapy in conventional osteosarcoma (p=0,004)."

"Walaupun masih kontroversial, jenis kelamin dan umur diduga sebagai faktor prognostik yang mempengaruhi angka kesintasan osteosarkoma (suatu keganasan tulang yang umum terjadi pada anak-anak dan dewasa muda). Oleh karena itu, penelitian ini bertujuan untuk mengetahui angka kesintasan pasien osteosarkoma di RSCM selama periode waktu enam tahun (2006-2011) dan mengaitkannya dengan umur dan jenis kelamin. Studi potong-lintang ini menggunakan rekam medis 167 pasien osteosarkoma di Departemen Ortopedi dan Traumatologi Rumah Sakit Cipto Mangunkusumo (RSCM). Studi ini menunjukkan bahwa usia lebih muda saat didiagnosis berkaitan dengan respon yang lebih baik terhadap kemoterapi (p=0,028). Jenis kelamin perempuan berkaitan secara signifikan dengan stadium penyakit yang lebih rendah (p=0,04), respon yang lebih baik terhadap kemoterapi (p=0,016), dan berkurangnya risiko metastasis (p=0,008). Median waktu kesintasan pada studi ini adalah 12 bulan, yang disebabkan oleh pendeknya masa pemantauan pasien. Walaupun terdapat keterbatasan, angka kesintasan pasien perempuan lebih baik secara signifikan daripada pasien laki-laki. Angka kesintasan pada golongan usia yang lebih muda menunjukkan kecenderungan lebih baik, walau tidak signifikan secara statistik. Hasil uji multivariate tidak menunjukkan bukti tentang adanya keterkaitan stadium penyakit, respon kemoterapi, dan metastasis terhadap kesintasan. Sebagai kesimpulan, jenis kelamin perempuan berkaitan dengan tumor yang lebih favourable dan angka kesintasan yang lebih tinggi.

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In order to improve the plateaued average 70% survival of osteosarcoma patients, prognostic factors has to be identified to improve adjustment according to patient's characteristics. Female gender and younger age at diagnosis have been suggested as good prognostic factors though inconclusive. Therefore, this study aims to determine the survival rate of osteosarcoma patients admitted to Cipto Mangunkusumo Hospital from 2006 to 2011 and correlate it with age and gender. This cross-sectional study used the medical records of osteosarcoma patients admitted in the department of Orthopedics and Traumatology Cipto Mangunkusumo Hospital. Records of 167 patients were retrieved for this study.

This study shown that younger age was associated with better chemotherapeutic response (p=0,028). Meanwhile, female gender was associated with less advanced disease at presentation (p=0,04), better chemotherapeutic response (p=0,016), and less risk for metastasis (p=0,008). The median survival in this study was 12 months, an underestimation due to short followup duration. Still, female patients survived longer than males. We showed a trend of better survival for younger patients, however the result was not significant. Multivariate analysis failed to show any correlation between various tumor-related variables with survival."

"Latar Belakang: Osteosarkoma merupakan jenis tumor tulang ganas paling sering pada anak dan remaja. Sejumlah faktor prognostik telah diketahui mempengaruhi luaran pada osteosarkoma pediatrik, termasuk lokasi dan ukuran tumor primer, adanya metastasis, resektabilitas, keadaan remisi, serta respons kemoterapi yang diperiksa dengan derajat nekrosis tumor. Penelitian ini bertujuan untuk mengetahui luaran osteosarkoma pada anak dan faktor-faktor yang mempengaruhinya.Metode: Penelitian ini merupakan studi observasional dengan desain cross sectional. Penelitian dilakukan di poliklinik Onkologi Orthopaedi Rumah Sakit Cipto Mangunkusumo, Jakarta pada bulan Januari 2020-Juni 2021. Pengambilan subjek penelitian dilakukan berdasarkan metode consecutive sampling. Data klinis, radiologis dan laboratorium diambil dari rekam medis, sementara skor MSTS diukur melalui wawancara terhadap subjek baik secara langsung atau pun melalui telepon. Data pasien dimasukkan ke dalam CRF (Case Report Form) untuk osteosarkoma dari Departemen Orthopaedi dan Traumatologi. Seluruh data dianalisis dan ditabulasikan ke dalam tabel.Hasil dan pembahasan: Pada penelitian ini, angka kesintasan keseluruhnan kasus osteosarkoma adalah 31,8%, dan rekurensi lokal terjadi pada 18,2% kasus pasien osteosarkoma anak. Metastasis terjadi pada 65,9% kasus dan sebagain besar metastasis ditemukan pada paru. Didapatkan jenis kelamin berhubungan dengan kesintasan pada pasien osteosarkoma (P<0,05). Hubungan kesintasan dengan usia sampel tidak bermakna, namun terdapat hubungan signifikan antara kesintasan dengan alkalin fosfatase, jenis biopsi, lokasi tumor, dan tipe HUVOS. Terdapat hubungan signifikan antara rekurensi lokal dengan nilai serum alkaline fosfatase, namun tidak terdapat hubungan signifikan antara rekurensi lokal jenis kelamin dan usia, jenis biopsi, tipe HUVOS, dan lokasi tumor. Rata-rata skor MSTS dari 14 subjek penelitian adalah 20,93 ± 3,63. Tidak terdapat perbedaan signifikan antara metastasis dengan jenis kelamin, usia, alkalin fosfatase, jenis biopsi, tipe HUVOS, dan lokasi tumor. Terdapat hubungan signifikan antara rekurensi lokal dan alkaline fosfatase (P < 0,05). Kesintasan dan metastasis memiliki perbedaan yang signifikan (P < 0,001).Kesimpulan: Terdapat hubungan yang bermakna antara kadar alkaline fosfatase terhadap rekurensi lokal pada anak dengan osteosarkoma. Terdapat hubungan yang bermakna antara metastasis dengan kesintasan 5 tahun pada anak dengan osteosarkoma. Hal ini menandakan bahwa angka kesintasan tinggi pada pasien yang tidak mengalami metastasis.

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Background: Osteosarcoma is the most frequent malignant bone tumor in children and adolescents. A number of prognostic factors have been known to affect the outcomes of pediatric osteosarcoma, including the location and size of the primary tumor, the presence of metastasis, resectability, remissions, and the chemotherapy response examined by the degree of tumor necrosis. This study aims to determine the outcomes of osteosaroma in children and the factors that influence it.

Methods: This was an observational analytic study with a retrospective cross sectional design. The study was conducted at the Orthopedic Oncology Polyclinic Cipto Mangunkusumo Hospital, Jakarta in January 2020 – June 2021. The research sampling was carried out based on the consecutive random sampling method. Clinical, radiological and laboratory data were documented from medical records, while the MSTS score was measured through interviews on the subject both directly or by telephone. Patient data was inserted into the CRF (Case Report Form) for osteosarcoma from the orthopedic and traumatology department. All data were analysed and tabulated into the table.

Results and Discussion: In this study, the overall 5 years survival rate of osteosarcoma was 31.8%, and the local recurrence is 18.2% of pediatric osteosarcoma patients. Metastases occurred in 65.9% of cases and most of the metastases were found in the lung. It was found that gender was significanced with survival in osteosarcoma patients (P<0.05). The relationship between survival and age was not significant, but there was a significant relationship between survival and alkaline phosphatase, type of biopsy, tumor location, and type of HUVOS. There was a significant relationship between local recurrence and serum alkaline phosphatase, but there was no significant relationship between local recurrence, gender and age, type of biopsy, HUVOS type, and tumor location. The mean of MSTS score of the 14 study subjects was 20.93 ± 3.63. There was no significant difference between metastases by sex, age, alkaline phosphatase, type of biopsy, type of HUVOS, and tumor location. There was a significant relationship between local recurrence and alkaline phosphatase (P < 0.05). There was a significant difference between survival and metastasis (P < 0.001).

Conclusion: There was a significant relationship between alkaline phosphatase level and local recurrence in children with osteosarcoma. There was a significant association between metastasis and a 5-year mortality in children with osteosarcoma"

"[ABSTRAKPendahuluan Osteosarkoma adalah tumor ganas tulang paling sering ditemukan di RS Cipto Mangunkusumo (RSCM). Penatalaksanaan osteosarkoma dengan limb-salvage surgery (LSS) makin berkembang disamping tindakan amputasi. Penelitian ini bertujuan untuk mengetahui perbandingan luaran hasil LSS dan amputasi pada pasien osteosarkoma di RSCM.Metode Studi ini menggunakan desain kohort retrospektif pada pasien osteosarkoma periode tahun 1995-2014 di RSCM. Dilakukan evaluasi angka kesintasan, rekurensi lokal, metastasis, komplikasi, skor fungsional menurut Musculoskeletal Tumor Society Scoring system (MSTS) pada pasien yang dilakukan LSS dan amputasi. Metode Kaplan-Meier digunakan untuk mendeskripsikan kesintasan, sintasan bebas rekurensi lokal antara LSS dan amputasi. Hubungan karakteristik pasien dianalisis dengan uji log rank. Uji Kai kuadrat, Eksak Fischer dan Mann-Whitney U digunakan untuk menganalisis hubungan antara skor MSTS dan karakteristik pasien, angka rekurensi, metastasis serta komplikasi. Untuk melihat pengaruh katakteristik terhadap sintasan dilakukan analisis regresi Cox dan uji Wald serta analisis multivariat backward stepwise.Temuan Penelitian dan Diskusi Kesintasan 5 tahun pasien osteosarkoma 14,6%. Kesintasan 5 tahun LSS 34,8%, kesintasan 5 tahun amputasi 15,9%. Kesintasan bebas rekurensi lokal 5 tahun untuk LSS 96,2% dan untuk amputasi 86,5%. Kesintasan dipengaruhi metastasis, tipe operasi dan ukuran tumor. Metastasis merupakan faktor paling berpengaruh berdasarkan analisis multivariat. Metastasis terbanyak ditemukan di paru. Gejala awal dan staging Enneking mempengaruhi metastasis (p=0,02 dan 0,007). Infeksi adalah komplikasi tersering. Tipe biopsi FNAB memberi komplikasi yang paling sedikit. LSS memberi skor fungsional yang lebih tinggi (83,3%) daripada amputasi (61,7%). Pasien dengan rekurensi lokal cenderung mempunyai skor fungsional buruk (p=0,023).Kesimpulan Kesintasan paling tinggi pada pasien osteosarkoma RSCM yang dilakukan LSS. Luaran fungsional dengan skor MSTS baik (83,3%) didapatkan pada pasien yang dilakukan LSS dan bebas rekurensi lokal. Skor MSTS buruk dijumpai pada pasien amputasi dengan rekurensi lokal, komplikasi dan metastasis.

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ABSTRACTIntroduction Osteosarcoma is the most common malignant bone tumor seen in Cipto Mangunkusumo Hospital (CMH). Treatment for osteosarcoma includes limb-salvage surgery (LSS), and it is increasingly more frequently performed compared to amputation. This study aims to analyze the outcome of LSS compared to amputation for osteosarcoma patients in CMH.Methods This is a retrospective cohort study to review osteosarcoma patients during 1995-2014 period in CMH. Analysis was performed on survival rate, local recurrence, metastasis, complication, and functional score according to Musculoskeletal Tumor Scoring System (MSTS) for patients underwent LSS or amputation. Kaplan-Meier method was used to determine survival rate, and disease-free survival rate between LSS and amputation. Log-rank analysis was used to determine relationship between patients characteristic. Chi-Square, Exact-Fischer, and Mann-Whitney U tests were used to analyze the correlation between MSTS score and patient characteristics, rate of recurrence, metastasis, and complication. To determine the influence of patient characteristics to survival, Cox regression analysis, Wald Test and backward stepwise multivariate analysis were performed.Results and discussion 5-year survival rate osteosarcoma patients was 14.6%, 5-year survival rate for LSS was 34.8% compared to 15.9% for amputation. Disease-free survival for LSS was 96,2%, while amputation was 86,5%. Survival were influenced by metastasis, type of surgical intervention, and tumor size. According to multivariate analysis, survival was most influenced by metastasis. Metastasis were found predominantly in lungs. Initial symptoms and Enneking stage were correlated to metastasis (p=0.02 and 0.007, respectively). Infection was the most common complication. FNAB gave the least complication compared to other types of biopsy. LSS gave the highest functional score (83.3%) compared to amputation (61.7%). Patients with local recurrence tend to have poor functional score (p=0.023).Conclusion The highest survival rate for osteosarcoma patients in CMH was found on patients who underwent LSS. Good functional outcome according to MSTS score (83.3%) were found on patients who underwent LSS and free of local recurrence. Poor MSTS score were seen on patients undergone amputation, patients who had had local recurrence, complication and metastasis, Introduction Osteosarcoma is the most common malignant bone tumor seen in Cipto Mangunkusumo Hospital (CMH). Treatment for osteosarcoma includes limb-salvage surgery (LSS), and it is increasingly more frequently performed compared to amputation. This study aims to analyze the outcome of LSS compared to amputation for osteosarcoma patients in CMH.Methods This is a retrospective cohort study to review osteosarcoma patients during 1995-2014 period in CMH. Analysis was performed on survival rate, local recurrence, metastasis, complication, and functional score according to Musculoskeletal Tumor Scoring System (MSTS) for patients underwent LSS or amputation. Kaplan-Meier method was used to determine survival rate, and disease-free survival rate between LSS and amputation. Log-rank analysis was used to determine relationship between patients characteristic. Chi-Square, Exact-Fischer, and Mann-Whitney U tests were used to analyze the correlation between MSTS score and patient characteristics, rate of recurrence, metastasis, and complication. To determine the influence of patient characteristics to survival, Cox regression analysis, Wald Test and backward stepwise multivariate analysis were performed.Results and discussion 5-year survival rate osteosarcoma patients was 14.6%, 5-year survival rate for LSS was 34.8% compared to 15.9% for amputation. Disease-free survival for LSS was 96,2%, while amputation was 86,5%. Survival were influenced by metastasis, type of surgical intervention, and tumor size. According to multivariate analysis, survival was most influenced by metastasis. Metastasis were found predominantly in lungs. Initial symptoms and Enneking stage were correlated to metastasis (p=0.02 and 0.007, respectively). Infection was the most common complication. FNAB gave the least complication compared to other types of biopsy. LSS gave the highest functional score (83.3%) compared to amputation (61.7%). Patients with local recurrence tend to have poor functional score (p=0.023).Conclusion The highest survival rate for osteosarcoma patients in CMH was found on patients who underwent LSS. Good functional outcome according to MSTS score (83.3%) were found on patients who underwent LSS and free of local recurrence. Poor MSTS score were seen on patients undergone amputation, patients who had had local recurrence, complication and metastasis]"

"Pendahuluan: Osteosarkoma adalah tumor tulang ganas primer pada anak-anak dan remaja. Penelitian ini bertujuan untuk membandingkan hasil dan kelangsungan hidup pada pasien osteosarkoma pasca operasi di RSCM Jakarta dari tahun 2010 hingga 2022 dan faktor-faktor yang mempengaruhinya.Metode: Penelitian ini merupakan penelitian kohort retrospektif dilakukan di Rumah Sakit Cipto Mangunkusumo (RSCM). Subjek adalah pasien osteosarkoma femoralis distal yang menjalani disartikulasi pinggul atau amputasi transfemoral pada 2010-2020. Data yang dikumpulkan dan dianalisis meliputi karakteristik pasien, kelangsungan hidup, metastasis dan skor MSTS.Hasil: Jumlah subjek penelitian adalah 42. Subjek amputasi transfemoral lebih tua dibandingkan disartikulasi pinggul (p=0,048). Insiden metastasis lebih banyak pada amputasi dibandingkan dengan disartikulasi pinggul (p=0,001). Subjek disartikulasi pinggul memiliki diameter tumor yang jauh lebih besar daripada subjek amputasi transfemoral (p=0,031).Pembahasan: Hubungan yang signifikan antara diameter tumor dan kelangsungan hidup terjadi karena diameter tumor terkait dengan kejadian metastasis  dan kejadian metastasis terkait dengan kelangsungan hidup. Tidak ada perbedaan yang signifikan antara skor MSTS dan jenis amputasi karena kedua kelompok subjek menggunakan kruk, faktor sosial ekonomi untuk membuat prostesis, dan kesulitan dalam mencapai ukuran tunggul yang ideal dalam kasus tumor.Kesimpulan: Ada hubungan yang signifikan antara diameter tumor dan metastasis dengan kelangsungan hidup dan diameter tumor dengan metastasis.

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Pendahuluan: Osteosarkoma adalah tumor tulang ganas primer pada anak-anak dan remaja. Penelitian ini bertujuan untuk membandingkan hasil dan kelangsungan hidup pada pasien osteosarkoma pasca operasi di RSCM Jakarta dari tahun 2010 hingga 2022 dan faktor-faktor yang mempengaruhinya.

Metode: Penelitian ini merupakan penelitian kohort retrospektif dilakukan di Rumah Sakit Cipto Mangunkusumo (RSCM). Subjek adalah pasien osteosarkoma femoralis distal yang menjalani disartikulasi pinggul atau amputasi transfemoral pada 2010-2020. Data yang dikumpulkan dan dianalisis meliputi karakteristik pasien, kelangsungan hidup, metastasis dan skor MSTS.

Hasil: Jumlah subjek penelitian adalah 42. Subjek amputasi transfemoral lebih tua dibandingkan disartikulasi pinggul (p=0,048). Insiden metastasis lebih banyak pada amputasi dibandingkan dengan disartikulasi pinggul (p=0,001). Subjek disartikulasi pinggul memiliki diameter tumor yang jauh lebih besar daripada subjek amputasi transfemoral (p=0,031).

Pembahasan: Hubungan yang signifikan antara diameter tumor dan kelangsungan hidup terjadi karena diameter tumor terkait dengan kejadian metastasis dan kejadian metastasis terkait dengan kelangsungan hidup. Tidak ada perbedaan yang signifikan antara skor MSTS dan jenis amputasi karena kedua kelompok subjek menggunakan kruk, faktor sosial ekonomi untuk membuat prostesis, dan kesulitan dalam mencapai ukuran tunggul yang ideal dalam kasus tumor.

Kesimpulan: Ada hubungan yang signifikan antara diameter tumor dan metastasis dengan kelangsungan hidup dan diameter tumor dengan metastasis."

"Insiden osteosarkoma di seluruh dunia mencapai 3,4 kasus per satu juta penduduk per tahun. Sebanyak 10%-20% pasien osteosarkoma ditemukan telah mengalami metastasis. Kemampuan metastasis yang tinggi pada osteosarkoma ini didukung dengan karakteristik populasi selnya yang memiliki tingkat proliferasi yang tinggi, serta peran cancer stem cells (CSC) dalam proses tumorigenesis dan metastasis osteosarkoma. Salah satu metode untuk mendeteksi CSC adalah dengan mendeteksi marker permukaan dan ekspresi stem-like gene, antara lain CD133 dan CXCR4. Tujuan penelitian ini untuk mengetahui hubungan kadar CD133 dan CXCR4 dengan kejadian metastasis pada pasien osteosarkoma. Penelitian ini menggunakan pendekatan cross sectional, dengan sampel serum darah pasien yang didiagnosis osteosarkoma berdasarkan hasil histopatologi di RSCM dan RSUP Prof. Dr. I.G.N.G. Ngoerah. Pemeriksaan kadar CD133 dan CXCR4 menggunakan KIT ELISA Reed Biotech dengan menilai absorbansi secara kuantitatif. Data metastasis diperoleh dari rekam medik. Hubungan kadar CD133 dan CXCR4 dengan kejadian metastasis pada osteosarkoma dianalisis dengan uji chi-square dengan tingkat kemaknaan p<0,05 dianggap signifikan. Penelitian ini melibatkan 40 orang dengan 80% diantaranya berusia <40 tahun. Rerata kadar CD133 yang diperolah sebesar 0.23±0.02 pg/ml, sedangkan rerata kadar CXCR4 yang diperoleh sebesar 6015.82±2345.55 pg/ml. Dari penelitian ini didapatkan adanya hubungan yang signifikan antara kadar CD133 dan CXCR4 dengan kejadian metastasis.

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The incidence of osteosarcoma worldwide reaches 3.4 cases per million population per year. As many as 10%- 20% of osteosarcoma patients are found to have experienced metastasis. The high metastatic ability in osteosarcoma is supported by the characteristics of its cell population which has a high proliferation rate, as well as the role of cancer stem cells (CSC) in the process of tumorigenesis and metastasis of osteosarcoma. One method to detect CSC is to detect surface markers and stem-like gene expression, including CD133 and CXCR4. The purpose of this study was to determine the relationship between CD133 and CXCR4 levels and the incidence of metastasis in osteosarcoma patients. This study used a cross-sectional approach, with blood serum samples from patients diagnosed with osteosarcoma based on histopathology results at RSCM and Prof. Dr. I.G.N.G. Ngoerah Hospital. Examination of CD133 and CXCR4 levels using the Reed Biotech ELISA KIT by assessing absorbance quantitatively. Metastasis data were obtained from medical records. The relationship between CD133 and CXCR4 levels with the incidence of metastasis in osteosarcoma was analyzed using the chi-square test with a significance level of p<0.05 considered significant. This study involved 40 people with 80% of them aged <40 years. The average CD133 level obtained was 0.23±0.02 pg/ml, while the average CXCR4 level obtained was 6015.82±2345.55 pg/ml. From this study, a significant relationship was found between CD133 and CXCR4 levels with the incidence of metastasis."

"Periosteal osteosarkoma merupakan tumor ganas tulang yang jarang didapat, dibentuk dari sarkoma tulang dengan didominasi komponen tulang rawan yang berdiferensiasi dan tumbuh pada permukaan tulang. Penelusuran kepustakaan tidak banyak menyebutkan mengenai kasus ini. Laporan kasus ini terakhir dilaporkan oleh Klinik Mayo tahun 1999. Kami laporkan satu kasus periosteal osteosarkoma pada penderita laki-laki berusia 17 tahun. Penderita menjalani tindakan pembedahan berupa prosedur ?limb salvage?, dengan pra dan pasca bedah penderita mendapat kemoterapi (neo-ajuvan dan ajuvan). Tidak ditemukan rekurensi lokal dan metastasis di paru, pada follow up sampai dengan 14 bulan pasca bedah. (Med J Indones 2003; 12: 166-70)

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Periosteal osteosarcoma is a rare type of malignant bone neoplasm, with predominantly cartilaginous component and arising on the bone surface. Reports of the case in the literature were rare. Last case was reported by Mayo Clinic in 1999. We report a case of periosteal osteosarcoma in a 17-year-old male, who was treated surgically with a limb salvage procedure, neoadjuvant and adjuvant chemotherapy were also given to the patient. There was no local recurrence and lung metastases up to 14 months after surgery. (Med J Indones 2003; 12: 166-70)"

"Latar belakang: Teknik radiasi ekstrakorporeal merupakan alternatif tindakan pembedahan penyelamatan ekstremitas pada kasus osteosarkoma khususnya di pusat layanan dengan keterbatasan endoprostesis dan alograf. Penelitian ini bertujuan untuk mengevaluasi hasil tindakan pembedahan penyelamatan ekstremitas dengan otograf yang diradiasi secara ekstrakorporeal pada pasien-pasien osteosarkoma yang datang ke RSCM.Metode: Studi ini menggunakan desain kohort retrospektif yang dilakukan pada 20 pasien osteosarkoma stadium IIB yang diterapi dengan pembedahan penyelamatan ekstremitas dengan otograf yang diradiasi secara ektrakorporeal selama periode 1995-2008. Dilakukan evaluasi terhadap angka kesintasan, rekurensi lokal, metastasis, komplikasi, lamanya unifi kasi, dan skor fungsional menurut sistem skor Musculoskeletal Tumor Society Scoring System (MSTS). Metode Kaplan-Meier digunakan untuk mendeskripsikan kesintasan, angka rekurensi lokal, kesintasan bebas tumor, dan kesintasan bebas metastasis. Hubungan variabel-variabel seperti usia, jenis kelamin, lokasi tumor, ukuran tumor, tipe osteosarkoma, kadar alkali fosfatase serum, jenis biopsi, dan klasifi kasi Huvos dianalisis dengan uji log rank. Uji chi-square digunakan untuk menganalisis hubungan antara skor MSTS dan karakteristik pasien, angka rekurensi, metastasis, serta komplikasi.Hasil: Kesintasan 5 tahun 54,97 ± 9,8%, kesintasan bebas rekurensi lokal 5 tahun 66,5 ± 7,6%, dan kesintasan bebas metastasis 5 tahun 57,13 ± 10,04%. Enam pasien meninggal dunia, lima disebabkan oleh metastasis ke paru dan satu karena toksisitas kemoterapi. Tiga pasien menjalani konversi amputasi karena rekurensi lokal. Kurva Kaplan-Meier menunjukkan Huvos (III,IV) selalu memberikan angka kesintasan, kesintasan bebas rekurensi lokal, dan kesintasan bebas metastasis yang lebih baik daripada Huvos (I, II). Kadar alkali fosfatase serum yang normal selalu memberikan kesintasan bebas rekurensi lokal yang lebih baik dibandingkan dengan kadar alkali fosfatase serum yang meningkat. Angka unifi kasi rata-rata 8,13 bulan. Skor MSTS dengan hasil baik (70,63%) dijumpai pada pasien yang bebas osteosarkoma pasca terapi, tetapi skor MSTS dengan hasil buruk dijumpai pada pasien dengan rekurensi lokal (p=0,025), metastasis (p=0,01), pasien dengan komplikasi (p=0,03), dan kombinasi ketiganya (p=0,001).Kesimpulan: Luaran fungsional dengan skor MSTS baik (70,63%) didapatkan pada pasien yang bebas osteosarkoma pasca terapi, skor MSTS buruk dijumpai pada pasien dengan rekurensi lokal, metastasis, pasien dengan komplikasi, dan kombinasi ketiganya. (Med J Indones 2011; 20:131-7).

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Background: Extracorporeally irradiated (ECI) technique is an alternative of limb salvage procedure in treating osteosarcoma regarding limitation of endoprosthesis and allograft. This study evaluated the outcomes of limb salvage surgery using extracorporeally irradiated (ECI) autograft and its correlation with patientâ??s characteristics.

Methods: Retrospective cohort design was performed to study 20 patients with stage IIB osteosarcoma treated by ECI autograft from 1995 to 2008. Survival, local recurrence, metastases, complications, union time and functional score based on Musculoskeletal Tumor Society scoring system-(MSTS) were evaluated. Kaplan-Meier method was used to describe survival, local recurrence free survival, and metastases free survival. The correlation among patientâ??s characteristics that were age, gender, duration, site of tumor size, type of osteosarcoma, SAP (serum alkaline phosphatase) level, type of biopsy, and type of Huvos were analyzed by Log rank test. Chi-square test was used to analyze the correlation between MSTS score and patientâ??s characteristics, local recurrence, metastases, complications.

Results: Five-year survival was 54.97 ± 9.8 %, fi ve-year local recurrence free survival was 66.5 ± 7.6%, and fi ve year metastasis-free survival was 57.13 ± 10.04%. Six patients died, fi ve were due to lung metastases and one due to complication of chemotherapy. Three underwent amputation after local recurrence. Kaplan-Meier curve showed that a good type of Huvos (III, IV) always gave better survival, local recurrence free survival, and metastases free survival than poor type of Huvos (I,II). Normal SAP level gave better local recurrence free survival compare to increased level of SAP. Mean of union rate was 8.13 months. MSTS mean score was good (70.63%) in patients with no evidence of disease. MSTS score was poor in patients with local recurrence (p=0.025), metastases (p=0.01), complications (p=0.03), and the combined of those three outcomes (p=0.001).

Conclusions: Functional outcome was poor in patients with local recurrence, metastases, and complications. SAP level and type of Huvos could be studied further as predictive factors for the outcomes (survival, local recurrence, metastases). (Med J Indones 2011; 20:131-7)."

"PENDAHULUANMakalah ini dibuat untuk meninjau lebih jauh kepustakaan yang ada sampai saat ini, di mana dibicarakan mengenai terapi amputasi, limb salvage dan ajuvan terapi yang diberikan sebelum atau sesudah terapi bedah, di mana semua hal tersebut ditujukan untuk meningkatan survival rate pada penderita osteosarkoma. Seperti kita ketahui, amputasi sampai saat ini merupakan pilihan utama dalam terapi bedah. Beberapa penulis mengemukakan bahwa sejak dua dekade terakhir ini reseksi menjadi populer. Kemudian W. F. Enneking pada tahun 1980 mengajukan staging untuk neoplasms muskulo skeletal, di mana penyusunan staging tersebut mempunyai maksud untuk menggolongkan faktor-faktor prognosa yang berarti penyusunan implikasi spesifik untuk terapi pembedahan, dan petunjuk untuk melengkapi terapi tambahan. Makalah ini juga berisi ilustrasi penderita-penderita yang berobat di Bagian Bedah RSCM, periode Januari 1980 s/d Desember 1981, yang mempunyai masalah lain di samping masalah diatas. Bahan Dan Cara, Dikumpulkan status penderita osteo sarkoma yang berobat 1981 semuanya berjumlah delapan orang. Dikumpulkan kepustakaan yang ada, dan kemudian mencoba membandingkannya. Kepustakaan, Osteosarkoma merupakan tumor tulang primer, menurut klasifikasi AEGERTER (1968) digolongkan dalam " True neoplasma of bone ", jenis " Osteogenic sarcoma ". Neoplasma ini berasal dari sel mesensimal primitif, serf osteoblastik, di daerah metafisis tulang panjang. Etiologi neoplasma ini belum dapat dijelaskan secara pasti, akan tetapi ditemukan oleh pengarang-pengarang, bahwa neoplasma ini dapat terjadi pada satu keluarga, setelah radiasi, bersama neoplasma lain, timbul dari neoplasma lain, setelah trauma , dan oleh virus. Neoplasma ini umumnya menyerang penderita usia antara deka de 1-2 pada metafisis tulang panjang, dan penderita lakilaki lebih banyak dari pada wanita. Insidens di Amerika Serikat 1 : 100.000, dan di Inggris 1: 75.000. Di dalam deretan tumor tulang primer, menempati urutan kedua setelah plasma sel yeloma. Diagnosis ditegakkan dengan pemeriksaan klinis, radiologis dan patologi anatomis. "