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"Tujuan: Mengetahui bahwa indeks morfometrik USG merupakan metode yang baik dalam mendiagnosis keganasan ovarium tipe epitelial. Metode: Penelitian ini merupakan penelitian uji diagnostik yang dilakukan di Rumah Sakit Cipto Mangunkusumo dengan mengambil data retrospektif dari Januari 2016 hingga Desember 2017. Pasien poliklinik rawat jalan ginekologi dengan kecurigaan memiliki neoplasma ovarium kistik direkrut. Standar baku emas adalah temuan histologi dari massa adneksa yang dioperasi. Karakteristik gambaran pola morfometrik ultrasonografi meliputi bilateralitas, jumlah lokus, regularitas dinding dalam (inner wall), tonjolan papiler (papillary projection), bagian padat (solid part), asites, dan doppler blood flow.  Analisis ROC dilakukan untuk menentukan seberapa baik model ini digunakan sebagai metode diagnostik keganasan ovarium tipe epitelial. Analisis statistik dihitung, untuk mendapatkan nilai akurasi, sensitivitas, spesifisitas, nilai prediksi positif dan nilai prediksi negatif. Hasil: Penelitian ini melibatkan 178 pasien, sebanyak 101 kasus (56.74%) adalah k asusjinak dan 77 kasus (43.25%) adalah kasus ganas. Pola karakteristik USG, papillary projection (p-value = 0.000), solid part (p-value = 0.000), inner wall (p-value = 0.000), asites (p-value = 0.000) dan Doppler blood flow (p-value = 0.000) subjek penelitian memiliki hubungan yang bermakna dengan kejadian keganasan ovarium. Pola morfologi papillary projection memiliki nilai sensitifitas yang paling tinggi (83%), kemudian adanya asites (82%), dan iregularitas dinding (81%). Untuk kategori spesifisitas, didapatkan adanya bagian padat (solid part) memiliki nilai spesifisitas yang paling tinggi (93%).Analisis regresi multinomial digunakan untuk menilai gabungan pola karateristik yang bermakna untuk diagnostik keganasan ovarium tipe epitelial dengan AUC 89.40% (95%CI 84.70%-94.00%), Model ini akurat  secara statistik (p <0,05). Kesimpulan: Indeks morfometrik USG merupakan salah satu metode yang baik dalam memprediksi keganasan ovarium.

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Objective: To know whether the ultrasound morphometric index is a good method to diagnose epithelial ovarian malignancy.

Materials and methods: This study is a diagnostic test conducted at Cipto Mangunkusumo Hospital, Jakarta, Indonesia. All data were taken retrospectively from January 2016 to December 2017. Gynecological outpatient polyclinic patients with suspicion of having cystic ovarian neoplasms were recruited. Characteristics of ultrasound morphometric patterns include bilaterality, number of loci, inner wall regularity, papillary projection, solid part, ascites, and doppler blood flow.

Results: The study involved 178 patients, 101 cases (56.74%) were malignant and 77 cases (43.25%) were malignant cases. The characteristics of ultrasound, papillary projection, solid part, inner wall, ascites and Doppler blood flow patterns of the study subjects had a significant relationship with the incidence of ovarian malignancy. Multinomial regression analysis was used to assess the combined characteristic patterns for the diagnostic epithelial type ovarian malignancy with AUC 89.40% (95% CI 84.70% -94.00%), this model was statistically accurate (p <0.05).

Conclusion: Morphometric index of ultrasound is a good methods in predicting epithelial ovarian malignancy "

"Latar belakang: Interpretasi cairan peritoneum yang tepat secara sitopatologi sangat mempengaruhi tatalaksana dan prognosis pasien, padahal pemeriksaan sitopatologi cairan peritoneum masih memiliki nilai negatif palsu dan positif palsu yang cukup tinggi, dan hingga saat ini penelitian tentang arsitektur sitopatologi maupun penanda sitomorfologi yang mengarahkan pada adanya sel neoplasma di cairan peritoneum masih menunjukkan hasil yang beragam. Bahan dan cara kerja: Penelitian potong lintang dengan data sekunder berupa slaid dan formulir sediaan sitopatologi cairan peritoneum yang memiliki data berpasangan dengan diagnosis histopatologi. Diagnosis klinis berupa neoplasma epitelial ovarium. Slaid dan formulir diambil dari arsip Departemen Patologi Anatomik FKUI/RSCM tahun 2011 - 2012, dilakukan pembacaan ulang semua slaid sitopatologi dengan diagnosis akhir dikategorikan sebagai positif atau negatif, peneliti membaca pula sediaan histopatologi untuk mengetahui morfologi sel pada lesi, kemudiaan dilakukan penilaian terhadap arsitektur sitopatologi berupa: selularitas, sel berkelompok, struktur papiler, intercelular windows, group contours, jisim psamoma, dan penanda sitomorfologi berupa: atipia inti, inti bertumpuk, anak inti, rasio inti:sitoplasma, ukuran inti, dan ukuran sel.Hasil penelitian: Sampel penelitian sejumlah 47 sediaan sitopatologi dengan diagnosis sitopatologi akhir 34 kasus (72.3%) negatif, 13 kasus (27.7%) positif. Terdapat perbedaan bermakna arsitektur sitopatologi berupa: selularitas (p = 0.017), sel berkelompok (p = 0.001), intercellular windows (p = 0.00), group contours (p = 0.00), dan gambaran sitomorfologi berupa: atipia inti (p = 0.00), inti bertumpuk (p = 0.001), anak inti (p = 0.001), rasio inti:sitoplasma (p = 0.00), ukuran inti (p = 0.00), ukuran sel (p = 0.00) antara cairan peritoneum positif dan negatif. Melalui uji multivariat didapatkan penanda yang paling berpengaruh terhadap diagnosis sitopatologi positif atau negatif yaitu: intercellular windows, atipia inti, dan selularitas.Kesimpulan: Terdapat tiga penanda yang paling berpengaruh terhadap diagnosis positif ditemukannya sel neoplasma ganas dalam cairan peritoneum pada kasus dengan lesi ovarium, secara berturut - turut yaitu: tidak ditemukannya intercellular windows pada kelompokan sel, sel memiliki atipia inti sedang hingga berat, dan selularitas lebih dari 20 kelompok dari keseluruhan sediaan apus.

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Background : Peritoneal fluid cytopathology interpretation profoundly influences patients management and prognosis, however this practice still has high false positive and false negative value, and until now research concerning the architectural and cytomorphology features for detecting malignant cells in peritoneal fluid still has various result.Materials and Methods : Cross sectional study using secondary data of peritoneal fluid cytopathology and histopathology slides and form, from patients with clinical diagnosis of ovarian epithelial neoplasm. The data was taken from the archive of Anatomical Pathology Department Cipto Mangunkusumo Hospital 2011 - 2012. The researchers examined the cytopathology slides and also examined the histopatology slide for morphology comparison, and then make a final cytopathological diagnosis of positive peritoneal fluid containing neoplastic cells or negative. Architectural features including: cellularity, cells grouping, papillary structure, intercellular windows, group contours, psamoma bodies, and cytomorphology features including: nuclear atypia, overlapping nuclei, nucleoli, nuclei : cytoplasm ratio, the dimension of the nuclei and cells were also examined.Result : There were 47 samples with final cytopathology diagnosis: 34 cases (72.3%) negative for neoplastic cells in the peritoneal fluid and 13 cases (27.7%) positive. There were significant differences in cytopathology architectural including cellularity (p = 0.017), cells grouping (p = 0.001), intercellular windows (p = 0.00), group contours (p = 0.00) and cytomorphology features including nuclear atypia (p = 0.00), overlapping nuclei (p = 0.001), nucleoli (p =0.001), nuclei : cytoplasm ratio (p = 0.00), the dimension of nuclei (p = 0.00), the dimension of cell (p = 0.00) between the positive and negative peritoneal fluid cytopathology. Using multivariate analysis there were 3 cytological features that have the strongest association with positive or negative peritoneal cytopathology diagnosis, they were: intercellular windows, nuclear atypia, and cellularity.Conclusion: In peritoneal fluid cytopathology for examining ovarian lesion there were 3 cytological features that have the strongest association with finding neoplastic cells in peritoneal fluid, they were: the absent of intercellular windows, moderate to severe cytological atypia, and cellularity more than 20 groups in all smear preparation."

"[ABSTRAKLatar belakang: Interpretasi cairan peritoneum yang tepat secara sitopatologi sangatmempengaruhi tatalaksana dan prognosis pasien, padahal pemeriksaan sitopatologi cairanperitoneum masih memiliki nilai negatif palsu dan positif palsu yang cukup tinggi, danhingga saat ini penelitian tentang arsitektur sitopatologi maupun penanda sitomorfologi yangmengarahkan pada adanya sel neoplasma di cairan peritoneum masih menunjukkan hasilyang beragam.Bahan dan cara kerja: Penelitian potong lintang dengan data sekunder berupa slaiddan formulir sediaan sitopatologi cairan peritoneum yang memiliki data berpasangan dengandiagnosis histopatologi. Diagnosis klinis berupa neoplasma epitelial ovarium. Slaid danformulir diambil dari arsip Departemen Patologi Anatomik FKUI/RSCM tahun 2011 ? 2012,dilakukan pembacaan ulang semua slaid sitopatologi dengan diagnosis akhir dikategorikansebagai positif atau negatif, peneliti membaca pula sediaan histopatologi untuk mengetahuimorfologi sel pada lesi, kemudiaan dilakukan penilaian terhadap arsitektur sitopatologiberupa: selularitas, sel berkelompok, struktur papiler, intercelular windows, group contours,jisim psamoma, dan penanda sitomorfologi berupa: atipia inti, inti bertumpuk, anak inti,rasio inti:sitoplasma, ukuran inti, dan ukuran sel.Hasil penelitian: Sampel penelitian sejumlah 47 sediaan sitopatologi dengandiagnosis sitopatologi akhir 34 kasus (72.3%) negatif, 13 kasus (27.7%) positif. Terdapatperbedaan bermakna arsitektur sitopatologi berupa: selularitas (p = 0.017), sel berkelompok(p = 0.001), intercellular windows (p = 0.00), group contours (p = 0.00), dan gambaransitomorfologi berupa: atipia inti (p = 0.00), inti bertumpuk (p = 0.001), anak inti (p = 0.001),rasio inti:sitoplasma (p = 0.00), ukuran inti (p = 0.00), ukuran sel (p = 0.00) antara cairanperitoneum positif dan negatif. Melalui uji multivariat didapatkan penanda yang palingberpengaruh terhadap diagnosis sitopatologi positif atau negatif yaitu: intercellular windows,atipia inti, dan selularitas.Kesimpulan: Terdapat tiga penanda yang paling berpengaruh terhadap diagnosispositif ditemukannya sel neoplasma ganas dalam cairan peritoneum pada kasus dengan lesiovarium, secara berturut - turut yaitu: tidak ditemukannya intercellular windows padakelompokan sel, sel memiliki atipia inti sedang hingga berat, dan selularitas lebih dari 20kelompok dari keseluruhan sediaan apus.

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ABSTRACTBackground : Peritoneal fluid cytopathology interpretation profoundly influences patientsmanagement and prognosis, however this practice still has high false positive and falsenegative value, and until now research concerning the architectural and cytomorphologyfeatures for detecting malignant cells in peritoneal fluid still has various result.Materials and Methods : Cross sectional study using secondary data of peritoneal fluidcytopathology and histopathology slides and form, from patients with clinical diagnosis ofovarian epithelial neoplasm. The data was taken from the archive of Anatomical PathologyDepartment Cipto Mangunkusumo Hospital 2011 ? 2012. The researchers examined thecytopathology slides and also examined the histopatology slide for morphology comparison,and then make a final cytopathological diagnosis of positive peritoneal fluid containingneoplastic cells or negative. Architectural features including: cellularity, cells grouping,papillary structure, intercellular windows, group contours, psamoma bodies, andcytomorphology features including: nuclear atypia, overlapping nuclei, nucleoli, nuclei :cytoplasm ratio, the dimension of the nuclei and cells were also examined.Result : There were 47 samples with final cytopathology diagnosis: 34 cases (72.3%)negative for neoplastic cells in the peritoneal fluid and 13 cases (27.7%) positive. There weresignificant differences in cytopathology architectural including cellularity (p = 0.017), cellsgrouping (p = 0.001), intercellular windows (p = 0.00), group contours (p = 0.00) andcytomorphology features including nuclear atypia (p = 0.00), overlapping nuclei (p = 0.001),nucleoli (p =0.001), nuclei : cytoplasm ratio (p = 0.00), the dimension of nuclei (p = 0.00),the dimension of cell (p = 0.00) between the positive and negative peritoneal fluidcytopathology. Using multivariate analysis there were 3 cytological features that have thestrongest association with positive or negative peritoneal cytopathology diagnosis, they were:intercellular windows, nuclear atypia, and cellularity.Conclusion: In peritoneal fluid cytopathology for examining ovarian lesion there were 3cytological features that have the strongest association with finding neoplastic cells inperitoneal fluid, they were: the absent of intercellular windows, moderate to severecytological atypia, and cellularity more than 20 groups in all smear preparation, Background : Peritoneal fluid cytopathology interpretation profoundly influences patientsmanagement and prognosis, however this practice still has high false positive and falsenegative value, and until now research concerning the architectural and cytomorphologyfeatures for detecting malignant cells in peritoneal fluid still has various result.Materials and Methods : Cross sectional study using secondary data of peritoneal fluidcytopathology and histopathology slides and form, from patients with clinical diagnosis ofovarian epithelial neoplasm. The data was taken from the archive of Anatomical PathologyDepartment Cipto Mangunkusumo Hospital 2011 – 2012. The researchers examined thecytopathology slides and also examined the histopatology slide for morphology comparison,and then make a final cytopathological diagnosis of positive peritoneal fluid containingneoplastic cells or negative. Architectural features including: cellularity, cells grouping,papillary structure, intercellular windows, group contours, psamoma bodies, andcytomorphology features including: nuclear atypia, overlapping nuclei, nucleoli, nuclei :cytoplasm ratio, the dimension of the nuclei and cells were also examined.Result : There were 47 samples with final cytopathology diagnosis: 34 cases (72.3%)negative for neoplastic cells in the peritoneal fluid and 13 cases (27.7%) positive. There weresignificant differences in cytopathology architectural including cellularity (p = 0.017), cellsgrouping (p = 0.001), intercellular windows (p = 0.00), group contours (p = 0.00) andcytomorphology features including nuclear atypia (p = 0.00), overlapping nuclei (p = 0.001),nucleoli (p =0.001), nuclei : cytoplasm ratio (p = 0.00), the dimension of nuclei (p = 0.00),the dimension of cell (p = 0.00) between the positive and negative peritoneal fluidcytopathology. Using multivariate analysis there were 3 cytological features that have thestrongest association with positive or negative peritoneal cytopathology diagnosis, they were:intercellular windows, nuclear atypia, and cellularity.Conclusion: In peritoneal fluid cytopathology for examining ovarian lesion there were 3cytological features that have the strongest association with finding neoplastic cells inperitoneal fluid, they were: the absent of intercellular windows, moderate to severecytological atypia, and cellularity more than 20 groups in all smear preparation]"

"Penelitian ini membahas perbandingan performa diagnostik sistem skoring International Ovarian Tumor Analysis (IOTA) dengan Risk of Malignancy Index-4 (RMI-4) dan indeks morfologi Sassone dalam memprediksi keganasan ovarium prabedah. Dilakukan uji diagnostik potong-lintang secara retrospektif dengan pasien neoplasma ovarium di RSUPN Dr. Cipto Mangunkusumo dari Januari hingga Desember 2013. Nilai diagnostik dari keempat metode skoring dihitung dengan luaran: sensitivitas, spesifisitas, nilai prediksi positif, nilai prediksi negatif, akurasi dan nilai AUC. Penelitian ini menyimpulkan IOTA simple-rules memiliki performa diagnostik lebih baik dibandingkan IOTA subgroup, RMI-4 dan indeks morfologi Sassone.

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This study compared diagnostic performance of scoring system of International Ovarian Tumor Analysis (IOTA) with Risk of Malignancy Index-4 (RMI-4) and Sassone morphology index to predict ovarian malignancy preoperatively. A retrospective study was done involving subject with ovarian neoplasm at National General Hospital Dr. Cipto Mangunkusumo on January to December 2013. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and AUC value were calculated. This study concluded that diagnostic performance of IOTA simple-rules were significantly better than IOTA subgroup, RMI-4 and Sassone morphology index."

"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.

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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."

"Latar Belakang : Sampai saat ini kanker ovarium masih menjadi salah satu kanker dengan angka mortalitas yang tinggi pada wanita dikarenakan tidak dijumpainya gejala yang khas sehingga lebih banyak kasus terdiagnosis pada stadium lanjut. Belum adanya metode skrining menjadikan pentingnya metode diagnostik yang mempunyai sensitivitas dan spesifisitas yang tinggi. Evaluasi biomarker yang baru diperlukan untuk dapat mendeteksi tumor ovarium ganas pada stadium awal.Objektif : Penelitian ini dilakukan untuk menilai ekspresi Immediate Early Response Gene X-1 (IEX-1) saliva sebagai prediktor keganasan pada tumor ovarium epitelial.Metode : Merupakan penelitian uji diagnostik pada pasien tumor ovarium yang direncanakan operasi elektif dengan mengambil 3-5 ml saliva pasien sebelum tindakan operasi. Subjek penelitian yang memenuhi kriteria inklusi dan eksklusi dibagi menjadi dua kelompok berdasarkan hasil histopatologi yaitu tumor ovarium epitelial jinak dan ganas. Dilakukan pemeriksaan ekspresi IEX-1 saliva dengan metode Real Time qPCR.Hasil : Hasil penelitian ini didapat dari 47 subjek, 22 subjek tumor ovarium epitelial ganas dan 25 subjek merupakan tumor ovarium epitelial jinak. Rerata ekspresi IEX-1 saliva lebih tinggi pada tumor ovarium epitelial jinak (1,976) dibandingkan ganas (0,554) (p<0,001). Didapatkan nilai AUC ekspresi IEX-1 0,949 (IK95% 0,894-1,000), nilai cut off point IEX-1 saliva ≥ 0.9115 dengan sensitivitas 84%, spesifisitas 86,4%, nilai duga positif 82,6% dan nilai duga negatif 87,5%. Terdapat hubungan yang signifikan antara ekspresi IEX-1 saliva dengan kejadian tumor ovarium epitelial ganas (OR 5,031, IK95% 2,039-12,41; p<0,001).Kesimpulan : Terdapat hubungan yang bermakna antara penurunan ekspresi IEX-1 saliva dengan kejadian tumor ovarium epitelial ganas dengan sensitivitas dan spesifisitas yang cukup baik.

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Backgound: Ovarian cancer is still one of the cancers with a high mortality rate in women because there are no typical symptoms so that more cases are diagnosed at an advanced stage. The absence of a screening method makes the importance of a diagnostic method that has high sensitivity and specificity. Evaluation of new biomarkers is needed to detect malignant ovarian tumors at an early stage.

Objectives: This study was conducted to assess the expression of salivary Immediate Early Response Gene X-1 (IEX-1) as a predictor of malignancy in epithelial ovarian tumors.

Methods: This is a diagnostic test study in ovarian tumor patients who are planned for elective surgery by taking 3-5 ml of patient's saliva before surgery. Research subjects who met the inclusion and exclusion criteria were divided into two groups based on the histopathological results, benign and malignant epithelial ovarian tumors. The salivary IEX-1 expression was examined using the Real Time qPCR method.

Results: The results of this study were obtained from 47 epithelial ovarian tumors subjects, 22 malignant tumors and 27 benign tumors. The mean salivary IEX-1 expression was higher in benign epithelial ovarian tumors (1.976) than in malignant (0.554) (p<0.001). The AUC expression value of IEX-1 was 0.949 (95% CI 0.894-1,000), salivary IEX-1 cut off point value was 0.9115 with sensitivity 84%, specificity 86.4%, positive predictive value 82.6% and negative predictive value 87, 5%. There was a significant relationship between salivary IEX-1 expression and the event of malignant epithelial ovarian tumors (OR 5.031, 95% CI 2.039-12.41; p<0.001).

Conclusions: There is a significant correlation between decreased salivary IEX-1 expression and the event of malignant epithelial ovarian tumors with a good sensitivity and specificity."

"ABSTRAKNama :Nugraha Utama PelupessyProgram Studi :S3 Ilmu KedokteranJudul :Marker Cancer Stem Cells CD133, CD44, dan ALDH1A1 Sebagai Faktor Prognostik pada Kanker Ovarium Tipe Epitelial Kanker ovarium merupakan penyakit yang bersifat heterogen dan kebanyakan pasien datang dengan stadium lanjut. Kanker ovarium epitelial tipe II mempunyai sifat pertumbuhan tumor yang cepat dan secara genetik labil dibandingkan tipe I. Keberadaan cancer stem cells CSC dianggap sebagai salah satu faktor prognostik terjadinya kemoresisten dan kesintasan hidup yang rendah.Penelitian ini bertujuan untuk membuktikan CSC sebagai faktor prognostik dengan menggunakan marker CD133, CD44, dan ALDH1A1 pada kanker ovarium tipe epitelial.Marker CD133, CD44, dan ALDH1A1 diperiksa dengan imunohistokimia dan flowcytometry. Hasil ekspresi marker CSC pasien kanker ovarium tipe I dan tipe II dimasukkan kedalam suatu tabel yang dihubungkan dengan respons kemoterapi dan kesintasan hidup. Analisis data dilakukan dengan program computer STATA 14. Analisis kesintasan dilakukan dengan analisis Kaplan-Meier dan uji asumsi cox proportional hazard. Analisis multivariat dipakai untuk model prognosis selama 10 bulan. Sistem skoring dibuat dengan menggunakan receiver operating characteristic ROC curve analyses.Data demografi kelompok terbanyak adalah usia ge; 45 tahun; 40 sampel 72,7 , stadium I, 23 sampel 41,8 , diferensiasi buruk 30 sampel 54,5 , dan tipe II 16 sampel 29,1 . Perbedaan yang bermakna antara tipe histopatologi dengan marker CSC hanya terlihat pada marker CD44. Skor Prediksi Kemoresisten SPKr 10 bulan yang dihubungkan dengan 4 variabel yaitu usia ge; 45 tahun, tipe II, stadium III minus;IV, dan CD44 tinggi dengan ROC 72,47 dan probabilitas post test 82,5 . Kurva ROC berdasarkan kombinasi marker CSC dan faktor klinikopatologi yaitu stadium III minus;IV, usia ge; 45 tahun, diferensiasi buruk, tipe II, CD133 negatif, CD44 tinggi, dan ALDH1A1 tinggi adalah 0,841. Skor Prediksi Kematian SPKm 10 bulan yang dihubungkan dengan 3 variabel yaitu stadium III minus;IV, tipe II, dan CD44 tinggi dengan AUC 80,44 dan probabilitas post test 78,7 . Kurva ROC berdasarkan kombinasi marker CSC dan faktor klinikopatologi yaitu stadium III minus;IV, usia ge; 45 tahun, diferensiasi buruk, tipe II, CD133 positif, CD44 tinggi, dan ALDH1A1 tinggi adalah 0,841.Simpulan: Marker CD44 terbukti berperan pada kanker ovarium tipe II. Skor Prediksi Kemoresisten dan Skor Prediksi Kematian dapat ditentukan selain dengan faktor klinikopatologi, juga dengan memakai marker CSC. Kata kunci: ALDH1A1, CD44, CD133, CSC, kanker ovarium epitelial, kesintasan hidup, respons kemoterapi.

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ABSTRACTName : Nugraha Utama PelupessyStudy Program : Doctoral Program Medical SciencesTitle :Cancer Stem Cell CD133, CD44 andALDH1A1 Markers As Prognostic Factors on Epithelial Ovarian Cancer. Ovarian cancer is a heterogeneous disease and most of the patients came with an advanced stage. Epithelial ovarian cancer type II has the characteristic of rapid tumor growth and genetically more labile than that of type I. The presence of cancer stem cells CSC is considered as one of the prognostic factors of low mortality and survival.The aims of this study was to prove CSC as prognostic factors using CD133, CD44, and ALDH1A1 markers on epithelial ovarian cancer.Clinicopathology and demographic data were collected from medical records. CD133, CD44, and ALDH1A1 markers were examined with flowcytometry and immunohistochemistry. CSC marker expression of the patients with ovarian cancer type I and II was connected with chemotherapy and survival response. Data analysis was done by using STATA 14 software. Survival analysis was done by using Kaplan-Meier analysis and Cox proportional hazard test. Multivariate analysis is used for prognosis model for ten months. Receiver Operating Characteristic ROC curve analyses was used as the system scoring. The highest group demographic data were age ge; 45 years; 40 samples 72.7 , stage I, 23 samples 41.8 , poor differentiation 30 samples 54.5 , and type II 16 samples 29.1 . A significant difference between the histopathologic type and the CSC marker was seen only in CD44 marker. Chemoresistance Prediction Score in 10 months was associated with 4 variables ie age ge; 45 years, type II, stage III minus;IV, and CD44 high with ROC 72.47 and posttest probability 82.5 . The highest chemoresitency scoring ROC curve based on the combination of CSC marker and clinicopathology factors; stage III minus;IV, age ge; 45 years, poor differentiation, type II, negative CD133, high CD44, and high ALDH1A1, was 0.841. Mortality Prediction Score in 10 months was associated with 3 variables is stage III minus;IV, type II, and CD44 high with AUC 80.44 and posttest probability 78.7 . The highest mortality scoring ROC curve based on the combination of CSC marker and clinicopathology factors; stage III minus;IV, age ge; 45 years, poor differentiation, type II, positive CD133, high CD44, and high ALDH1A1, was 0.841. Conclusion: The CD44 marker has a role in type II ovarian epithelial cancer. Chemoresistance Prediction Score and Mortality Prediction Score can be determined from clinicopathological factors and using CSC marker. Keywords: ALDH1A1, CD44, CD133, chemotherapy response, CSC, Epithelial Ovarian Cancer, survival"

"Latar Belakang: Kanker ovarium menduduki peringkat ke-3 sebagai kanker tersering pada perempuan di Indonesia. Keganasan ovarium dianggap sebagai silent killer karena tidak memiliki gejala yang signifikan pada stadium awal sehingga hampir 50% pasien datang sudah pada stadium lanjut. Oleh karena itu, diperlukan alat skrining di pelayanan primer untuk mendeteksi keganasan ovarium dan salah satu modalitas pemeriksaan adalah ultrasonografi sederhana.Tujuan: Mengetahui nilai diagnostik pemeriksaan ultrasonografi sederhana dalam menilai keganasan tumor ovarium dibandingkan hasil histopatologi pascaoperasi.Metode: Penelitian ini merupakan studi potong lintang pada pasien tumor ovarium di polikinik Ginekologi RSCM Jakarta yang dilakukan operasi pada bulan Maret hingga Juli 2015. Sampel penelitian diambil dengan metode consecutive sampling. Analisis menggunakan uji Chi-square dan regresi logistik untuk mencari hubungan antara pola morfologi ultrasonografi dengan hasil histopatologi dimana terdapat hubungan bermakna apabila nilai p<0,05. Selain itu, dibuat model persamaan dari regresi logistik untuk menghitung probabilitasHasil: Terdapat 80 subjek penelitian dimana 58 subjek (72,5%) dengan tumor jinak dan 22 subjek (27,5%) dengan tumor ganas. Hasil ultrasonografi dengan pola morfologi ≥2 menunjukkan hasil ganas pada 53,8% subjek dengan nilai diagnostik sensitivitas 100%, spesifisitas 82,8%, nilai duga positif 68,8%, dan nilai duga negatif 100%. Pola morfologi yang paling berpengaruh terhadap keganasan tumor ovarium adalah permukaan dalam dinding kista ireguler, multilokular, terdapat penonjolan papiler, dan ada bagian padat dalam tumor. Probabilitas subjek mendapat tumor ganas apabila memiliki pola morfologi ≥3 adalah lebih dari 88,9%,Kesimpulan: Pemeriksaan ultrasonografi sederhana dapat digunakan untuk mendeteksi keganasan tumor ovarium.

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Background: Ovarian cancer ranked 3rd most common cancer in Indonesian women. Ovarian malignancy is considered as silent killer because there is no significant symptom in early stage therefore almost 50% patients came in late stage. Thus, screening tool is needed in primary health care to detect ovarian malignancy and one of recommended modality is simple ultrasound examination.

Aim: To know diagnostic values of simple ultrasound examination to detect ovarian malignancy compared with post operative histopathologic findings.

Method: This study used cross-sectional design in Cipto Mangunkusumo Hospital gynecologic outpatients with ovarian tumor undergone operation between March to July 2015. Samples were taken using consecutive sampling. Analysis was done using Chi-square test and logistic regression to find the relationship between ultrasound morphologic patterns with histopathologic findings where there is a significant relationship when p value < 0.05. Furthermore, a model derived from logistic regression was made to calculate the probability having ovarian malignancy.

Result: There were 80 subjects which 58 subjects (72.5%) have benign tumor and 22 subjects (27.5%) have malignant tumor. Ultrasound examination result using ≥2 morphologic patterns gave malignant result in 53.8% subjects with diagnostic values of sensitivity of 100%, specificity 82.8%, positive predictive value of 68.8%, and negative predictive value of 100%. The most important patterns were irreguler internal cyst wall, multilocular, presence of pappilary projection, and presence of solid component. The probability of subject having ovarian malignancy if there were ≥3 morphologic patterns was more than 88.9%.

Conclusion: Simple ultrasound examination can be used to detect ovarian malignancy."

"Latar belakang: Kanker ovarium khususnya jenis epitelial merupakan salah satu kanker tersering yang diderita oleh perempuan dengan angka mortalitas dan morbiditas yang tinggi. Hingga saat ini, beberapa penelitian telah meneliti berbagai faktor prognostik pada kanker ovarium, khususnya trombosit yang secara patofisiologi memiliki hubungan dengan berbagai marker inflamasi pada kanker. Tujuan: (1) Membuktikan bahwa trombositosis sebagai faktor prognosis pada pasien kanker ovarium jenis epitelial (2) Membuktikan angka OS selama 3 tahun pada pasien kanker ovarium jenis epitelial dengan trombositosis lebih buruk dibandingkan tanpa trombositosis. Metode: Penelitian ini menggunakan studi kohort retrospektif menggunakan data rekam medis pasien kanker ovarium epitelial yang terdaftar pada cancer registry Departemen Obstetri dan Ginekologi Divisi Onkologi Rumah Sakit Cipto Mangunkusumo pada tahun Januari 2014- Juli 2016. Pengamatan dilakukan saat subjek pertama kali didiagnosis kanker ovarium hingga terjadi peristiwa hidup, meninggal, atau hilang dari pengamatan dalam waktu 3 tahun. Hasil: Didapatkan 220 subjek penelitian yang merupakan populasi terjangkau dan memenuhi kriteria inklusi dan eksklusi. Dari 220 subjek penelitian, 132 (60%) dari 220 subjek penelitian merupakan pasien dengan kanker ovarium stadium lanjut (Stadium II/III/IV). Trombositosis didapatkan pada 94 orang subjek penelitian (42,7%). Pasien dengan kanker stadium lanjut memiliki risiko trombositosis yang lebih tinggi dibandingkan subjek pada stadium awal (p=0,005;OR=2,329). Meski begitu, ada atau tidaknya trombositosis secara statistik tidak bermakna pada OS selama 3 tahun (p=0,555). Terdapat mean time survival yang lebih rendah pada pasien dengan trombositosis tetapi tidak ada perbedaan hazard ratio yang bermakna antara subjek dengan atau tanpa trombositosis (p=0,399). Pada penelitian ini, didapatkan faktor prognostik yang bermakna pada OS selama 3 tahun antara lain adalah ada tidaknya asites (HR=3,425; p=0,025), stadium (HR=9,523; p=0,029) dan residu tumor ≥ 1 cm (HR=4,137; p=0,015) dengan stadium kanker ovarium merupakan faktor independen (HR=9,162; p=0,033). Sensitivitas dan spesifisitas trombositosis terhadap kanker ovarium stadium lanjut didapatkan sebesar 50,75% dan 69,32%. Kesimpulan: Trombositosis sebagai faktor prognostik pada pasien kanker ovarium jenis epitelial tidak dapat dibuktikan dan angka OS selama 3 tahun pada pasien dengan trombositosis dibandingkan dengan pasien tanpa trombositosis tidak bermakna secara statistik.

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Background: Ovarian cancer, especially, epithelial ovarian cancer is one of the most common cancer in women with high rate of mortality and morbidity. Some studies have found that some biological factors that can be used as a prognostic factor for epithelial ovarian cancer, particularly, thrombocytes which pathophysiologically correlates with inflammation markers in cancer. Aim: (1) To determine thrombocytosis as a prognostic factor for epithelial ovarian cancer. (2) To determine that 3-year overall survival in epithelial ovarian cancer with thrombocytosis is significantly shorter than patients without thrombocytosis. Method: This study is a retrospective cohort study using medical record of patients with epithelial ovarian cancer which are registed in the cancer registry of Oncology Division in Obstetric and Gynecology Department, Cipto Mangunkusumo Hospital from January 2014 until July 2016. Datas were collected when subjects were first diagnosed with epithelial ovarian cancer until diseases outcomes (survive, death, or loss to follow up) were identified in 3 years. Result: Out of 220 subjects, 132 (60%) were patients with advanced stage epithelial ovarian cancer (stage II/III/IV). 94 (42,7%) subjects had thrombocytosis. Patients with advanced stage of disease had higher risk of having thrombocytosis than the ones with earlier stage (p=0,005;OR=2,329). Correlation between thrombocytosis and 3-year overall survival was known to be insignificant (p=0,555). There was shorter mean time survival between patients with thrombocytosis and the ones without but the there was no significant difference in hazard ratio between the two groups. In this study, several prognostic factors of epithelial ovarian cancer were identifed such as ascites (HR=3,425; p=0,025), stage of disease (HR=9,523; p=0,029), and post-operative residual tumor ≥ 1 cm (HR=4,137; p=0,015) with stage of disease being the independent prognostic factor (HR=9,162; p=0,033). Sensitivity and specificity of thrombocytosis to advance stage of epithelial ovarian cancer were found to be 50,75% and 69,32%, respectively. Conclusion: Thrombocytosis as a prognostic factor in patients with epithelial ovarian cancer cannot be proven statistically. There is also no significant difference of 3-year overall survival between patients with or without thrombocytosis."

"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."