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"Tujuan: Mengetahui pengaruh mutasi patogenik BRCA1/2 tumor terhadap kesintasan pasien advanced stage-high grade serous epithelial ovarian cancer di RSUPN Dr. Cipto Mangunkusumo, RSUP Persahabatan, dan RS MRCCC Siloam Jakarta.Metode: Sejumlah 68 sampel dari 144 pasien diagnosis high-grade serous epithelial ovarian cancer (HGSOC) stadium FIGO IIB-IV, periode 1 Januari 2015 sampai 31 Maret 2021, di RSUPN Dr. Cipto Mangunkusumo, RSUP Persahabatan, dan RS MRCCC Siloam Jakarta, menjalani pemeriksaan NGS mutasi patogenik BRCA1/2 tumor, dilibatkan dalam penelitian kohort historikal ini. Kami membandingkan karakteristik klinikopatologis pasien, dan hasil luaran kesintasan, setelah pasien menjalani tatalaksana primer, berdasarkan status mutasi patogenik BRCA1/2 tumor. Faktor terkait tatalaksana, yang diperkirakan berpengaruh terhadap hasil luaran kesintasan pasien, juga turut dianalisis dalam penelitian ini.Hasil: Angka kejadian mutasi patogenik BRCA1/2 tumor diketahui sebesar 27,94% (19/68). Antara kelompok mutasi patogenik BRCA1/2 tumor, dengan kelompok tanpa mutasi patogenik, tidak terdapat perbedaan statistik signifikan berdasarkan usia, paritas, indeks massa tubuh (kg/m2), riwayat kanker payudara, stadium FIGO 2014, kadar CA125 serum pre operatif (U/mL), volume cairan ascites intra operatif (mL), lesi residual pasca laparotomi debulking, pemberian neoadjuvant chemotherapy (NACT), pemberian kemoterapi adjuvant. Riwayat kanker keluarga terkait HBOC, merupakan variabel paling berpengaruh terhadap mutasi patogenik BRCA1/2 tumor. Kelompok dengan riwayat kanker keluarga terkait HBOC, berisiko 5,212 kali lebih besar mengalami mutasi patogenik BRCA1/2 tumor, dibandingkan dengan kelompok tanpa riwayat kanker tersebut (RR adjusted 5,212; 95%CI 1,495-18,167; nilai p=0,010).Pada kelompok mutasi patogenik BRCA1/2 tumor, kemungkinan meninggal 86% lebih rendah (RR adjusted 0,149; 95%CI 0,046-0,475; nilai p=0,001), dan median survival yang lebih baik (median 46 bulan; 95%CI 34,009-57,991; nilai p=0,001), apabila dibandingkan dengan kelompok tanpa mutasi patogenik (median 23 bulan; 95%CI 15,657-30,343; nilai p=0,001). Analisis multivariat menunjukkan mutasi patogenik BRCA1/2 tumor merupakan faktor prognostik independen yang baik terhadap hasil luaran kesintasan (RR adjusted 0,149; 95%CI 0,046-0,475; nilai p=0,001).Kesimpulan: Pasien advanced stage-high grade serous epithelial ovarian cancer, dengan mutasi patogenik BRCA1/2 tumor, memiliki kesintasan lebih baik, dibandingkan pasien tanpa mutasi patogenik BRCA1/2 tumor.

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Objective: To evaluate the impact of pathogenic BRCA1/2 tumor mutational status on advanced stage- high grade serous epithelial ovarian cancer survival outcome at RSUPN Dr. Cipto Mangunkusumo, RSUP Persahabatan, and RS MRCCC Siloam Jakarta.

Methods: A total 68 of 144 patients diagnosed with FIGO 2014 stage IIB-IV high grade serous epithelial ovarian cancer (HGSOC) between January 1st, 2015 until March 31st, 2021, at RSUPN Dr. Cipto Mangunkusumo, RSUP Persahabatan, and RS MRCCC Siloam Jakarta, underwent NGS tumor BRCA1/2 gene testing, and were included in this cohort hystorical study. We compared patients clinicopathological characteristics, and survival outcomes after primary treatment, according to pathogenic BRCA1/2 tumor mutational status. Treatment-related factors that might affect patients’ survival outcome were also investigated.

Results: The BRCA1/2 pathogenic tumor mutations prevalence was observed in this study 27.94% (19/68). There were no significant statistical differences in age, parity, body mass index (kg/m2), previous breast cancer history, FIGO 2014 staging, pre-operative serum CA 125 level (U/mL), intra operative ascites volume (mL), post cytoreductive surgery residual lesion, neoadjuvant chemotherapy (NACT), and adjuvant chemotherapy administration, between the pathogenic tumor BRCA1/2 mutation, and no pathogenic tumor BRCA1/2 mutation groups. The hereditary breast ovarian cancer family history (HBOC) variable has the strongest correlation with pathogenic tumor BRCA1/2 mutation. The group with a family history of HBOC-related cancer had a 5.212 times greater risk of developing pathogenic BRCA1/2 tumor mutations, compared with the group without a history of those cancer (RR adjusted 5.212; 95%CI 1.495-18.167; p value=0.010).

The pathogenic BRCA1/2 tumor mutation group displayed better survival outcome. In the pathogenic BRCA1/2 tumor mutation group, the likelihood of dying was 86% lower (RR adjusted 0.149; 95%CI 0.046-0.475; p-value=0.001), and the median survival was better (median 46 months; 95%CI 34.009- 57.991; p value=0.001), than without pathogenic BRCA1/2 tumor mutations group (median 23 months; 95%CI 15.657-30.343; p value=0.001). The multivariate analyses identified pathogenic BRCA1/2 tumor mutation as an independent favorable prognostic factor for survival outcome (RR adjusted 0.149; 95%CI 0.046-0.475; p-value=0.001).

Conclusions: In advanced stage-HGSOC, patients with pathogenic BRCA1/2 tumor mutations have a better prognosis with longer survival outcome than those without pathogenic BRCA1/2 tumor mutations."

"Latar Belakang: Kanker ovarium merupakan kanker kedelapan tersering, terhitung hampir 4% dari semua kanker pada perempuan di dunia. Kanker ovarium memiliki prognosis yang buruk dan angka kematian tertinggi. Setiap tahunnya terdapat 225.000 perempuan yang terdiagnosis kanker ovarium dan 140.000 perempuan meninggal disebabkan oleh penyakit ini. Berdasarkan jumlah tersebut, 90% kasus merupakan kanker ovarium epitelial. Bila berdasarkan stadium, lebih banyak pasien datang terdiagnosis dengan kanker ovarium stadium lanjut dibandingkan dengan stadium dini. Hal ini dikarenakan kanker ovarium bersifat asimtomatik, onset gejala yang terlambat dan belum adanya skrining yang terbukti efektif untuk kanker ovarium. Tujuan utama pengobatan kanker stadium lanjut adalah memperpanjang waktu untuk bertahan hidup dengan kualitas hidup yang baik dan tata laksana standarnya adalah operasi sitoreduksi. Di RSCM, evaluasi kesintasan dari pasien kanker ovarium epitelial stadium lanjut yang menjalani operasi sitoreduksi belum dianalisis.Tujuan: Mengetahui kesintasan pasien kanker ovarium stadium lanjut yang menjalani operasi sitoreduksi di RSCM dan juga mengetahui kesintasannya berdasarkan hasil histopatologi dan pemberian kemoterapi ajuvan.Metode: Penelitian ini merupakan penelitian kohort retrospektif dengan menggunakan data dari rekam medis. Pengambilan sampel dilakukan dengan cara consecutive sampling. Subjek penelitian adalah semua pasien kanker ovarium epitelial stadium lanjut yang menjalani operasi sitoreduksi pada bulan Januari 2013-Januari 2015 di RSCM.Hasil: Dari 48 subjek yang diteliti, didapatkan sebanyak 23 (48%) subjek menjalani operasi sitoreduksi optimal dan 25 (52%) subjek menjalani operasi sitoreduksi suboptimal. Didapatkan kesintasan 5 tahun pada pasien yang menjalani operasi sitoreduksi optimal sebesar 43,5%, sedangkan untuk sitoreduksi suboptimal sebesar 32%. Pada pasien yang menjalani operasi sitoreduksi optimal, yang diberikan kemoterapi ajuvan didapatkan kesintasan 5 tahun sebesar 40%, sedangkan pada pasien yang tidak diberikan sebesar 46,2%. Pada pasien yang menjalani operasi sitoreduksi suboptimal, yang diberikan kemoterapi ajuvan didapatkan kesintasan 5 tahun sebesar 40%, sedangkan pada pasien yang tidak diberikan sebesar 20%. Pada pasien dengan hasil histopatologi seromusinosum didapatkan kesintasan 5 tahun sebesar 100%, sedangkan untuk serosa, musinosa, endometrioid dan sel jernih berturut-turut sebesar 50%, 33,3%, 25%, dan 21,4%.Kesimpulan: Operasi sitoreduksi optimal memiliki kesintasan 5 tahun yang lebih baik dibandingkan dengan operasi sitoreduksi suboptimal. Operasi sitoreduksi suboptimal dan tidak dilanjutkan dengan pemberian kemoterapi ajuvan memiliki kesintasan yang buruk. Jenis histopatologi seromusinosum memiliki kesintasan yang lebih baik dibandingkan dengan jenis serosum, musinosum, endometrioid dan sel jernih.

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Background: Ovarian cancer is the eighth most common cancer, almost 4% of all cancers in women in the world. Ovarian cancer has a poor prognosis and the highest mortality rate. Every year 225,000 women are diagnosed with ovarian cancer and 140,000 women die from this disease. Based on this number, 90% of cases are epithelial ovarian cancer. Based on stadium, more patients diagnosed with advanced-stage ovarian cancer compared with early stage, because ovarian cancer is asymptomatic, delayed onset and there is no screening that has proven effective for ovarian cancer. The standard management for advanced stage ovarian cancer is debulking surgery. At RSCM, evaluation of survival of advanced stage epithelial ovarian cancer patients who were performed debulking surgery has not been analyzed.

Objective: Knowing the survival of patients with advanced-stage ovarian cancer who underwent debulking surgery at RSCM and also knowing their survival based on histopathological results and adjuvant chemotherapy.

Methods: This was a retrospective cohort study using data from medical records. Sampling was done by consecutive sampling. The subjects of this study were all patients with advanced-stage epithelial ovarian cancer patients who were performed debulking surgery in January 2013-January 2015 at RSCM.

Results: From the 48 subjects, 23 (48%) subjects were performed optimal debulking surgery and 25 (52%) subjects were performed suboptimal debulking surgery. Overall survival in patients undergoing optimal debulking surgery is 43.5% with a median survival rate of 39 months, while for suboptimal debulking surgery is 32% with a median survival rate of 29 months. In patients who underwent optimal cytoreduction surgery, those given adjuvant chemotherapy obtained a overall survival is 40%, whereas in patients who were not given is 46.2%. In patients who underwent suboptimal cytoreduction surgery, those who were given adjuvant chemotherapy found a overall survival rate of 40%, whereas in patients who were not given is 20%. In patients with histopathological results seromucinous obtained 5-year survival by 100%, while for serous, mucous, endometrioid and clear cells simultaneously were 50%, 33.3%, 25%, and 21.4%.

Conclusion: Optimal debulking surgery has a better 5-year survival compared to suboptimal debulking surgery. Suboptimal cytoreduction surgery and not followed by adjuvant chemotherapy has poor survival. The histopathological type of seromucinous has better survival compared with the types of serous, mucinous, endometrioid and clear cells."

"Latar Belakang Pada tahun 2020, ditemukan total kasus kanker serviks mencapai 36.633 kasus dengan 21.003 di antaranya adlaah kasus kematian di Indonesia. Pasien kanker serviks stadium awal diberikan pilihan tatalaksana pembedahan umumnya berupa histerektomi. Pilihan terapi ajuvan juga diberikan guna mengurangi risiko terjadinya kekambuhan. Dengan tingginya kasus kematian kanker serviks di Indonesia, diperlukan penelitian lebih lanjut terkait angka kesintasan pasien kanekr serviks yang dilakukan histerektomi radikal di Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo pada tahun 2010-2018 dengan memerhatikan dilakukan atau tidaknya terapi ajuvan dan ada tidaknya kekambuhan yang terjadi pada pasien. Metode Penelitian ini adalah penelitian deskriptif analitik dengan desain penelitian kohort retrospektif. Data diambil dari rekam medik dan dianalisis kesintasannya dengan metode Kaplan-Meier. Hasil Didapat sebanyak 9,1% (7 orang) pasien mengalami kematian (event) dan 90,9% (70 orang) pasien bertahan hidup dalam kurun waktu tiga tahun dari tanggal tatalaksana histerektomi radikal dilakukan. Pada analisis bivariat antara variabel usia, stadium, terapi ajuvan, dan kekambuhan terhadap kesintasan tidak ditemukan adanya P Value < 0,05 sehingga tidak ada perbedaan ataupun hubungan yang bermakna. Kesimpulan Kesintasan tiga tahun pasien kanker serviks yang dilakukan histerektomi radikal di Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo pada tahun 2010-2018 sebesar 90,9%.

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Introduction In 2020, the total number of cervical cancer cases was found to reach 36,633 cases with 21,003 of them being deaths in Indonesia. Patients with early stage cervical cancer are given surgical treatment options, generally in the form of hysterectomy. Adjuvant therapy options are also given to reduce the risk of recurrence. With the high number of cervical cancer deaths in Indonesia, further research is needed regarding the survival rate of cervical cancer patients who undergo radical hysterectomy in National Referral Hospital Cipto Mangunkusumo in 2010-2018 by paying attention to whether or not adjuvant therapy was carried out and whether or not there was a recurrence. Method This research is a descriptive analytical study and using a retrospective cohort design. Data were taken from medical records and analyzed for survival using the Kaplan-Meier method. Results It is found that 9.1% (7 people) of patients experienced death (event) and 90.9% (70 people) of patients survived within three years from the date the radical hysterectomy was carried out. In the bivariate analysis between the variables such as age, stage, adjuvant therapy, and recurrence, there is no P value < 0.05 was found (no significant difference). Conclusion Three-year survival of cervical cancer patients who undergo radical hysterectomy in National Referral Hospital Cipto Mangunkusumo in 2010-2018 was 90.9%."

"Latar Belakang: Limfadenektomi memainkan peranan penting dalam operasi surgical staging kanker ovarium. Limfadenektomi merupakan prosedur yang kompleks dan berpotensi menyebabkan berbagai komplikasi intra- dan pascaoperasi. Beberapa penelitian menunjukkan bahwa subtipe histologi dan derajat histopatologi kanker ovarium yang berbeda memiliki kejadian metastasis kelenjar limfe yang berbeda pula, sehingga dapat mempengaruhi pengambilan keputusan klinis.Tujuan: Mengetahui prevalensi metastasis kelenjar limfe pada pasien kanker ovarium tipe epitel stadium klinis 1 pada berbagai subtipe histologi dan derajat histopatologi.Metode: Penelitian menggunakan metode potong lintang pada pasien kanker ovarium tipe epitel stadium klinis 1 yang menjalani limfadenektomi di RSUPN Dr. Cipto Mangunkusumo, Jakarta, pada tahun 2014-2023. Data yang dikumpulkan mencakup karakteristik demografi, subtipe histologi, derajat histopatologi, dan status metastasis kelenjar limfe. Hubungan antar variabel dianalisis menggunakan uji chi-square atau uji Fisher's exact.Hasil: Terdapat 106 subjek yang memenuhi kriteria inklusi. Peningkatan stadium akibat metastasis kelenjar limfe ditemukan pada 6.6% subjek. Metastasis kelenjar limfe paling banyak ditemukan pada subtipe histologi serosum derajat tinggi (15.4%) dan derajat diferensiasi buruk (10.6%). Hubungan yang signifikan secara statistik ditemukan antara kejadian metastasis kelenjar limfe dengan derajat diferensiasi (P=0.043), namun tidak dengan subtipe histologi. Tidak terdapat subjek dengan derajat diferensiasi baik-sedang yang mengalami metastasis kelenjar limfe.Kesimpulan: Keputusan untuk melakukan limfadenektomi perlu dipertimbangkan kembali saat melakukan operasi surgical staging pada kanker ovarium tipe epitel stadium klinis 1 dengan derajat diferensiasi baik-sedang. Penelitian lanjutan dengan jumlah sampel yang lebih besar dibutuhkan untuk kesimpulan yang lebih kuat.

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Background: Lymphadenectomy plays an integral role in the surgical staging of ovarian cancer. However, it is a complex procedure that is potentially associated with intra- and post-operative complication. Some studies showed that distinct histologic subtype and grade have different frequencies of lymph node metastases and these might have potential implication for clinical decision making.

Objective: To evaluate the prevalence of lymph node metastasis in patients with clinically stage 1 epithelial ovarian cancer of various histologic subtype and grade.

Methods: This was a cross sectional study including clinically stage 1 epithelial ovarian cancer patient who underwent lymphadenectomy at Dr. Cipto Mangunkusumo Hospital, Jakarta, during the period of 2014-2023. Demographics, histologic subtype, tumor grade, and lymph node status were collected. Comparisons were made with Chi square or Fisher's exact test.

Results: A total of 106 subjects were included in the study. Upstaging due to lymph node metastases were found in 6.6% of subjects. Lymph node metastases were most common in high-grade serous histology (15.4%) and poorly differentiated tumor grade (10.6%). However, a significant association with lymph node metastases rate was found only on tumor grade (P=0.043) and not histologic subtype. Furthermore, no subjects with well-to-moderately differentiated tumor had lymph node metastases.

Conclusions: The decision to perform lymphadenectomy should be reconsidered when performing surgical staging in patients with well-to-moderately differentiated clinically stage 1 epithelial ovarian carcinoma. Additional studies with larger samples are needed for exact conclusion."

"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."

"Pendahuluan: Rabdomiosarkoma adalah high grade malignancy sekaligus sarkoma jaringan lunak tersering pada anak dan remaja. Limb salvage surgery LSS semakin luas dianut dan dipraktekkan sebagai prioritas oleh karena kemajuan kemoterapi dan radioterapi. Data demografi dan evaluasi tatalaksana itu beserta kaitannya dengan analisis kesintasan belum pernah ada di Indonesia. Metode: Desain penelitian ini adalah kohort retrospektif, yang dilakukan di Departemen Orthopaedi, Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo, Jakarta, Indonesia. Pada Januari 2005-Desember 2016, 43 pasien rabdomiosarkoma ekstrimitas dan pelvis dianalisis secara demografi. Dari jumlah tersebut, 28 pasien menjalani tatalaksana dan dianalisis kesintasannya terkait berbagai faktor. Dari jumlah itu, 15 pasien dibagi menjadi dua kelompok salvage atau ablasi dan dianalisis luaran fungsionalnya setelah satu tahun pasca operasi dengan skor MSTS. Hasil: Distribusi umur menunjukkan kemaknaan terhadap jenis pleomorfik, yang hanya ditemukan pada dewasa p=0,035. Luaran fungsional kelompok salvage rerata = 13,4 secara bermakna p=0,005 lebih baik dibandingkan ablasi rerata = 22,23. Insiden metastasis secara bermakna menurunkan kesintasan p=0,034. Angka kesintasan adalah 3,53 dan median kesintasan adalah 14 bulan. Distribusi umur berupa kurva bimodal dengan insiden dekade awal dibentuk oleh tipe embrional dan diatas 45 tahun oleh tipe plemorfik. Simpulan: Fungsi ekstrimitas pasca salvage menunjang fungsi sehari-hari dan tidak terpengaruh morbiditas pasca operasi, serta tidak berpengaruh pada kesintasan juga rekurensi. Karenanya, prosedur itu menjadi prioritas dibanding ablasi. Pengananan awal agresif pada pencegahan metastasis dapat meningkatkan kesintasan. Modalitas kemoterapi multiagen, radioterapi, dan bedah memberikan kecenderungan hasil terbaik.

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Introduction Introduction Rhabdomyosarcoma, classified as high grade sarcoma, comprises the most common soft tissue sarcoma in children and adolescent, in which the treatment has been advancing. Limb salvage surgery has been acknowledged and performed widely as the priority on local control of pelvic and extremity rhabdomyosarcoma, due to the advancement on radiotherapy and chemotherapy. The established data on patients demography and current treatments evaluation in Indonesia, are not available yet, especially in the concern of survival.

Method: The study design is retrospective cohort, which was performed in Orthopaedics and Traumatology Department, Cipto Mangunkusumo National Primary Referral Hospital, Jakarta, Indonesia. From January 2005 to December 2016, 43 patients, diagnosed as extremity or pelvic rhabdomyosarcoma, were analyzed for demography. 28 patients of them, underwent treatment, and were analyzed for survival analysis. Subsequently, 15 patients of them were divided into two groups ablation and salvage , and analyzed for one year postoperative functional outcome in Musculoskeletal Tumour Society score.

Result: Age distribution has association on pleomorphic type, which is only found on adults p 0,035. Functional outcome on salvage group mean 22.23 has better outcome p 0,005 result ablation group mean 13.4. Of all oncologic parameters, metastasis has association with worsening 5 years survival p 0,034. The 5 years survival rate is 3.53 and median survival is 14 months. Age distribution shows bimodal curve on incidence, which comprised from embryonal type on first decade and pleomorphic type after fourth decade.

Conclusion: The extremity function after salvage procedure reassure daily life and had not influenced by postoperative morbidity, also has no association with survival and recurrence. Therefore, salvage procedure has become priority comparing to ablation. Early aggressive management on metastatic prevention may increase survival. Combination on multiagent chemotherapy, radiotherapy, and wide excision has the most favorable survival."

"Latar Belakang: USG payudara dan mamografi secara luas digunakan sebagai modalitas diagnostik yang efektif untuk mengevaluasi kelainan payudara. Derajat keganasan histopatologis berperan penting dalammanajemen karsinoma payudara. Ketersediaan pemeriksaan histopatologis yang terbatas dan sebaran pemeriksaan USG dan mamografi yang lebih luas diharapkan dapat membantu klinisi dalam menentukan penatalaksanaan karsinoma payudara lebih dini. Tujuan penelitian ini adalah meningkatkan nilaimamografi serta USG payudara dengan mengetahui keterkaitan temuan morfologis lesi berdasarkan USG payudara dan mamogram yang dapat mengidentifikasi derajat keganasan histopatologis karsinoma payudara. Metode: Studi retrospektif ini melibatkan subyek dengan karsinoma payudara primer yangmenjalani USG dan mamografi serta belum menjalani prosedur apapun. Temuan USG dan mamogram dianalisis dan dikorelasikan dengan derajat keganasan histopatologis. Variabel dianalisis menggunakan uji chi-square dan Kolmogorov-Smirnov. Hasil: Diperoleh 174 subyek karsinoma payudara. Usia rerata subyek 52 tahun. Ukuran massa <5 cm paling banyak ditemukan (61,1%) dan memiliki hubungan yang signifikan dengan derajat keganasan histopatologis (p<.05). Batas lesi, ekhogenisitas lesi dan kalsifikasilesi pada USG (p <.05) berhubungan dengan derajat keganasan histopatologis. Sedangkan untuk bentuk lesi, bentuk irregular lebih banyak ditemukan dibandingkan lesi lain dengan distribusi yang hampir sama antara derajat 1, 2, dan 3. Proporsi batas lesi paling banyak di derajat 3 yakni batas tidak tegas.Ekhogenisitas heterogen lebih sering ditemukan pada tumor derajat 2 dan lesi hipoekhoik lebih banyak ditemukan pada tumor derajat 3. Saat dilakukan analisis tambahan dengan membagi derajat keganasan menjadi 2 grup (derajat rendah dan derajat tinggi), batas dan orientasi lesi pada USG (p <.05) berhubungan dengan derajat keganasan histopatologis sedangkan kalsifikasi lesi dan ekhogenisitas lesi tidak berhubungan. Tidak ada hubungan antara karakteristik lesi pada mamogram (densitas payudara, bentuk,batas, densitas lesi, dan kalsifikasi) dengan derajat keganasan histopatologis (nilai p > 0,05). Proporsi batas spikulasi lebih banyak ditemukan pada lesi derajat rendah. Simpulan: Orientasi pararel lebih banyakditemukan pada tumor derajat tinggi. Batas tidak tegas paling banyak ditemui di kedua kelompok derajat keganasan namun proporsi lebih banyak ditemukan pada lesi derajat tinggi. Tidak ditemukan hubungan signifikan antara morfologis lesi pada mamogram dengan derajat keganasan.

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Background: Breast ultrasonography (USG) and mammography are widely used as effective diagnostic modalities to evaluate breast abnormalities. Histological grade plays big role in management of breast

carcinoma. The purpose of this study was to increase the value of mammography and ultrasound. Also, knowing which features on ultrasound and mammogram that can predict histological grade. The limited

availability of histopathological examinations and better access of ultrasound and mammography can assist clinicians in management of breast carcinoma. Method: A retrospective study was conducted by

reviewing imaging of women with breast cancer who had not undergone any procerdure. Mammogram and US findings were analyzed in compliance with operational definition and later compared with histopathological data. All variables were analyzed using chi-square and Kolmogorov-Smirnof. Result:

Mean age at diagnosis of breast cancer was 52 years. Tumor size <5 cm was the most common (61.1%) and had significant relation with tumor grade (p<.05). In terms of ultrasound findings, the only differential

findings between ultrasound findings and histopathological grade were margin, echogenicity, and calcifications (p < .05). As for the shape of the lesions, an irregular shape was more observed compared to other lesions with almost equal distribution between grade 1, 2, and 3. Heterogene echogenicity was more frequently found on grade 2 and hypoechoic lesions were more common in grade 3 tumor. When additional analysis was carried out by dividing the histological grade into 2 groups (low grade and high grade), margin and orientation on the ultrasound (p <.05) had relation to tumor grade while the

calcification of the lesion and the echigenicity were not related. No significant difference between mammogram features (breast density, shape, margin, lesion density, and calcifications) and tumor grade

(p>.05). The proportion of spiculated margin in mamogram is more common in low-grade lesions. No significant association between ultrasound features (shape, echogenicity, posterior pattern, and calcifications) with histological grade. Conclusion: Margin and orientation of the lesion on ultrasound have a relationship with histological grade. Parallel orientation is more common seen in high-grade

tumors. Indistinct borders were commonly found in both groups; however, a higher proportion was found

in high-grade lesions. No significant relation was found between mammogram features and tumor grade"

"Latar belakang: Kanker ovarium merupakan jenis kanker ke-3 yang paling sering dialami oleh wanita di Indonesia. Diagnosis yang terlambat berperan besar dalam tingginya angka mortalitas. Metode skrining cepat kanker ovarium semakin penting untuk diteliti, dengan beragam biomarker penanda kanker seperti CA-125, HE4, dan FOLR1 yang menawarkan indeks diagnostik dan kemudahan prosedur yang menjanjikan.Metode: Studi deskriptif desain potong lintang ini dilakukan di Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo, Jakarta pada Januari 2022 hingga Januari 2023. Kadar serum CA-125, HE4, dan FOLR1 dianalisis dari 48 subjek yang terbagi dalam kelompok tumor ovarium ganas dan jinak. Diagnosis pasti tumor merujuk hasil pemeriksaan histopatologis dan pencitraan. Data demografis pasien seperti usia, status menopause, ukuran tumor, hingga hasil analisis sitologi cairan asites dikumpulkan.Hasil: Hasil analisis demografis menunjukkan kecenderungan subjek menopause untuk memiliki tumor ovarium non-maligna (57,6% vs. 26,7%; p < 0,05), dan subjek dengan cairan asites ganas cenderung memiliki tumor ovaium maligna (3,0% vs. 40,0%; p < 0,05). Kadar ketiga biomarker serum meningkat pada kelompok tumor maligna, namun hanya HE4 (median 12,43 vs. 42,03; p < 0,05) yang memiliki perbedaan bermakna (CA-125 median 102,50 vs. 461,85; p = 0,062; FOLR1 median 0,070 vs. 0,172; p=0,213). Area under the curve (AUC) pada hasil analisis kurva receiver operating characteristic (ROC) menunjukkan hasil 0,630, 0,747, dan 0,794 secara berturut-turut untuk biomarker FOLR1, Ca125, dan HE4, dengan analisis beda proporsi signifikan pada titik potong 0,1165 ng/mL (Se 66,7%, Sp 60,6%), 208,00 U/mL (Se 73,3%, Sp 84,8%), dan 19,66 pg/mL (Se 86,7%, Sp 60,6%). Analisis kombinasi biomarker menunjukkan peningkatan sensitifitas namun penurunan spesifisitas.Kesimpulan: Kadar serum ketiga biomarker memiliki kemampuan yang baik sebagai prediktor keganasan tumor ovarium maligna. Pada populasi penelitian, HE4 secara tunggal memiliki indeks diagnostik terbaik, dan kombinasi biomarker tidak memberikan peningkatan kemampuan diagnostik.

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Background : Ovarian cancer is the third most common cancer in women in Indonesia. Late diagnosis significantly contributes to high mortality rates. Rapid screening methods for ovarian cancer are increasingly important, with biomarkers such as CA-125, HE4, and FOLR1 offering promising diagnostic indices and procedural ease.

Methods: This cross-sectional descriptive study was conducted at Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta from January 2022 to January 2023. Serum levels of CA-125, HE4, and FOLR1 were analyzed in 48 subjects divided into malignant and benign ovarian tumor groups. Tumor type diagnosis was based on histopathological examination and imaging. Patient demographic data including age, menopausal status, tumor size, and cytology analysis of ascitic fluid were collected.

Results: Demographic analysis showed tendencies of menopausal subjects to have non-malignant ovarian tumors (57.6% vs. 26.7%; p < 0.05), and subjects with malignant ascitic fluid were more likely to have malignant ovarian tumors (3.0% vs. 40.0%; p < 0.05). Serum levels of all three biomarkers were higher in the malignant group, but only HE4 (median 12.43 vs. 42.03; p < 0.05) showed significant differences (CA-125 median 102.50 vs. 461.85; p = 0.062; FOLR1 median 0.070 vs. 0.172; p = 0.213). The area under the curve (AUC) for the receiver operating characteristic (ROC) curve analysis showed 0.630, 0.747, and 0.794 for FOLR1, CA-125, and HE4, respectively. Significant cut-off points were 0.1165 ng/mL (Se 66.7%, Sp 60.6%), 208.00 U/mL (Se 73.3%, Sp 84.8%), and 19.66 pg/mL (Se 86.7%, Sp 60.6%). Biomarker combination analysis increased sensitivity but decreased specificity.

Conclusion: Serum levels of the three biomarkers are good predictors of malignancy in ovarian tumors. In this study population, HE4 alone had the best diagnostic index, and combining biomarkers did not enhance diagnostic capability."

"Latar belakang: Kesintasan 5 tahun tumor ovarium borderline pada stadium awal cukup baik, sekitar 95-100%. Tatalaksana dari tumor ini adalah dengan pembedahan, pada pasien yang masih ingin mempertahankan fungsi reproduksinya, operasi sebisanya dilakukan dengan tetap meninggalkan uterus dan satu ovariumnya. Kemoterapi tidak dianjurkan untuk tumor ovarium borderline stadium awal. Di Indonesia penelitian tentang kesintasan tumor ovarium borderline masih sangat terbatas, oleh karena itu diperlukan penelitian lebih lanjut. Tujuan: Untuk mengetahui kesintasan tumor ovarium borderline di RSCM. Metode: Studi ini merupakan studi analitik deskriptif. Pasien yang didiagnosis dan dilakukan pembedahan di Departemen Obstetri dan Ginekologi RSCM pada periode Januari 2008-Desember 2010 dengan hasil histopatologi tumor ovarium borderline, di follow up untuk mengetahui kesintasan selama 5 tahun.Hasil: Subyek penelitian didapat 42 orang. Hasil kesintasan tumor ovarium borderline didapat sebesar 97,6%. Pada penelitian ini faktor umur, paritas, riwayat keluarga dan kontrasepsi oral, CA 125, asites, dan tindakan pembedahan didapatkan tidak mempunyai hubungan yang konsisten dengan tumor ovarium borderline. Jenis histopatologi yaitu tumor ovarium borderline serosum dan tatalaksana pembedahan tanpa dilanjutkan tindakan kemoterapi mempengaruhi kesintasan tumor ovarium borderline di RSCM dengan nilai p = 0,000 dan p = 0,001.Kesimpulan: Kesintasan 5 tahun penderita tumor ovarium borderline yang ditatalaksana di RSCM cukup baik. Tatalaksananya dititikberatkan pada pasien dengan jenis histopatologi serosum karena faktor ini mempengaruhi kesintasan 5 tahun pasien tumor ovarium borderline dan tanpa tindakan lanjutan kemoterapi hasilnya cukup baik.

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Background: Five years survival of ovarian borderline tumors at early stage is quite good, about 95-100%. The procedures of this tumor is surgery, for patients who still want to maintain reproductive function, the best procedure by leaving the uterus and ovary. Chemotherapy is not recommended for early-stage borderline ovarian tumors. In Indonesia research on borderline ovarian tumors is limited, therefore more research is needed.Objective: To determine survival of ovarian borderline tumors in RSCM Hospital. Methode: This study is a descriptive analytic. Patients were diagnosed and surgery at Department of Obstetrics and Gynaecology RSCM on January 2008-December 2010 with a borderline ovarian tumor histopathology results, in the follow-up to determine the survival rate for 5 years, simple random sampling. Analysis of survival use Kapplan Meier Analysis.Result: The study gained 42 patients. Borderline ovarian tumor survival results obtained for 97.6%. In this study, age, parity, family history and oral contraceptive, CA 125, surgery, ascites have no consistent relationship with a borderline ovarian tumor's survival. Histopathology and chemotherapy have consistent relationship with p = 0,000 and p = 0,001.Discussion: Five years survival of patients with borderline ovarian tumors were administered in RSCM is good. It is important to pay attention to histopathology result and patient have a good survival without chemotherapy."

"Kanker Nasofaring KNF merupakan salah satu kasus keganasan paling sering di Indonesia dengan karakteristik yang unik secara epidemiologi, patologi dan klinis. Faktor prognosis KNF telah menjadi fokus penelitian yang cukup penting dalam sejumlah studi yang telah dilakukan. Penelitian ini bertujuan mengetahui karakteristik pasien KNF yang terdiagnosis di Poli THT RSCM serta angka kesintasan dengan melakukan analisis terhadap faktor yang berperan terhadap prognosis. Penelitian ini merupakan suatu penelitian kohort retrospektif dengan subjek penelitian bersifat total sampling pasien KNF yang terdiagnosis di Poli THT. Sebanyak 561 subjek penelitian ini, pria memiliki prevalensi sebanyak 2.8 kali daripada wanita. WHO tipe 3 dan WF tipe A menjadi jenis histopatologi paling dominan. Stadium IV A didapatkan pada 30.1 subjek dan 18.9 subjek sudah berada dalam kondisi metastasis jauh. Nilai tengah untuk waktu tunggu radiasi adalah 91 12-344 hari dengan durasi radiasi 53 39-95 hari. Stadium IVC, p= 0,000 , N3 p= 0,018 , metastasis jauh p= 0,000 , dan drop out atau tidak mendapat terapi p= 0,000 menjadi faktor yang memberikan kesintasan lebih buruk pada penelitian ini.

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Nasopharyngeal Cancer NPC is one of the most frequent cancer in Indonesia which has a unique characteristic in epidemiology, pathology and clinical features. Prognostic factors are recently became the most important research foci, and a large number of investigation in this area have been performed. The objective of this study is to know the characteristics of NPC patients that have been diagnosed in ENT Department of RSCM and analyzed some factors that might have role in overall survival. This is the retrospective cohort study with total sampling subject. From 561 subjects, Male has 2.8 higher prevalence than female. WHO type 3 92,3 and WF type A 97,1 are the majority hisopathological result. Stage IV A is found in 30,1 subjects and 18,9 subjects were already in metastatic state. The median value of radiation waiting time was 91 12 344 days, duration time of radiation was 53 39 95 days. Stage IVC p 0,000 , N3 p 0,018 , distant metastatic p 0,000 , and drop out or no treatment p 0,000 are found to be the factors that give a negative impact in overall survival."