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"Pendahuluan: Pendekatan muskuloskeletal dalam bidang onkologi, dengan fokus khusus pada bedah ortopedi, telah mengalami kemajuan yang signifikan, menghasilkan strategi bedah baru dalam pengelolaan osteosarcoma. Keefektifan limb-saving surgery telah meningkat, seiring dengan peningkatan pada pencapaian hasil fungsional optimal, penutupan luka, dan hasil kosmetik, semuanya dengan mematuhi prinsip onkologi. Kami menekankan pentingnya mempertimbangkan berbagai faktor untuk menentukan pengobatan yang paling sesuai untuk osteosarkoma. Kami juga menggarisbawahi penggunaan alat penilaian seperti skala penilaian Musculoskeletal Tumor Society (MSTS) untuk evaluasi pasien dengan sarkoma ekstremitas.Metode: Penelitian ini menggunakan pendekatan analitik observasional dengan desain cross-sectional untuk menganalisis pasien terdiagnosis osteosarkoma yang menjalani prosedur megaprostesis di rumah sakit tertentu. Penelitian ini menggunakan metode pengambilan sampel total dan menetapkan kriteria inklusi dan eksklusi bagi para peserta, dengan fokus pada pasien yang menjalani Limb Salvage Surgery menggunakan teknik megaprosthesis dan mengecualikan mereka yang memiliki masalah infeksi atau informasi klinis yang tidak memadai.Hasil: Pada penelitian ini, 32 pasien osteosarkoma menjalani operasi penyelamatan anggota tubuh dengan megaprostesis. Rata-rata usia pasien adalah 22,84 tahun dengan mayoritas berjenis kelamin laki-laki (59,4%). Lokasi tersering adalah femur distal (50%) diikuti tibia proksimal (40,6%). Tingkat rekurensi, metastasis, komplikasi dan survival rate masing-masing adalah 21,9%;43,8%;6,3%; dan 78,1%. Median Skor MSTS adalah 28. Berdasarkan hasil penelitian, terdapat hubungan kuat antara LDH dengan skor MSTS, namun hubungan ini tidak signifikan secara statistik (p>0.05). Berdasarkan hasil penelitian, terdapat hubungan antara usia dengan kejadian metastasis tumor, dimana hubungan ini signifikan secara statistik (p<0.05). Perbedaan rerata pada usia terhadap survival signifikan secara statistik (p<0,05). Terdapat hubungan antara durasi gejala dengan luaran survival tumor, dimana hubungan ini signifikan secara statistik (p<0.05).Diskusi: Penelitian ini berfokus pada pemanfaatan Megaprostesis, yang masih relatif jarang dilakukan di Indonesia karena kendala biaya dan teknis. Penelitian ini mencatat karakteristik pasien, termasuk usia, jenis kelamin, lokasi tumor, ALP, dan tingkat LDH di antara pasien yang menderita osteosarkoma. Insiden yang lebih tinggi pada pria mungkin disebabkan oleh faktor hormonal, genetika, dan peningkatan risiko osteoporosis pada pria. Osteosarcoma biasanya muncul di dekat metafisis tulang panjang atau lempeng pertumbuhan, terutama di tibia proksimal dan femur distal. Peran LDH, yang mempengaruhi berbagai proses biologis seperti proliferasi sel, kelangsungan hidup, apoptosis, angiogenesis, metabolisme zat besi dan glukosa, juga dieksplorasi dalam kaitannya dengan osteosarkoma. Namun, terbatasnya ukuran sampel penelitian ini dapat menghambat kemampuan penelitian ini untuk secara akurat mewakili tren populasi yang lebih luas.Kesimpulan: Terdapat hubungan yang bermakna antara usia dan angka kejadian metastasis osteosarcoma. Selain itu, ditemukan perbedaan rerata pada usia terhadap survival signifikan secara statistik.

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Introduction: The field of musculoskeletal oncology, with a specific focus on orthopedic surgery, has witnessed notable progress, resulting in the development of novel surgical strategies for the management of osteosarcoma. The efficacy of limb-saving surgery has increased, as it now emphasizes the attainment of optimal functional outcomes, wound covering, and cosmetic results, all while adhering to oncologic principles. We emphasizes the significance of considering multiple factors in order to determine the most suitable treatment for osteosarcoma. We also underscores the utilization of assessment tools such as the Musculoskeletal Tumor Society rating scale (MSTS) for the evaluation of patients with extremity sarcoma.

Method: The study uses an observational analytical approach with a cross-sectional design to analyze patients diagnosed with osteosarcoma who underwent megaprosthesis procedure at specific hospitals. The study has employed total sampling method and defined inclusion and exclusion criteria for the participants, focusing on patients who had Limb Salvage Surgery using the megaprosthesis technique and excluding those with infection problems or insufficient clinical information.

Results: Thirty-two patients with osteosarcoma had limb-saving surgery using a megaprosthesis in this study. Patients' average age was 22.84 years, and 59.4% of them were men. The proximal tibia (40.6%) and distal femur (50%) were the most often reported locations. The rates of complications, recurrence, metastasis, and survival were, in order, 78.1%, 6.3%, 43.8%, and 21.9%. 28 is the median MSTS score. The study's findings indicate a substantial correlation between LDH and MSTS score, however this correlation is not statistically significant (p>0.05). Age and the incidence of tumor metastasis are related, according to the research findings, and this association is statistically significant (p<0.05). A statistically significant difference in survival was seen between the mean ages (p<0.05). There is a relationship between the duration of symptoms and tumor survival outcomes, where this relationship is statistically significant (p<0.05).

Dicussion: This study focused on the utilization of Megaprosthesis, which remains relatively rare in Indonesia due to cost and technical challenges. It examined patient characteristics, including age, gender, tumor location, ALP, and LDH levels among those with osteosarcoma. The higher incidence in males might be attributed to hormonal factors, genetics, and an elevated risk of osteoporosis in men. Osteosarcoma typically arises near long bone metaphysis or growth plates, notably in the proximal tibia and distal femur. The role of LDH, which influences various biological processes such as cell proliferation, survival, apoptosis, angiogenesis, iron and glucose metabolism, was also explored. However, the study's limited sample size may hinder its ability to accurately represent broader population trends.

Conclusion: Age is a key factor in the incidence of metastasis from osteosarcoma. Furthermore, a statistically significant variation in the mean age of survivors was discovered."

"[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]"

"ABSTRAK Pendahuluan Penggunaan megaprostesis sebagai pilihan dalam manajemen LSSmemberikan harapan baru bagi pasien tumor tulang di Indonesia. Namun, sampaisaat ini belum ada data hasil luaran dari tata laksana ini.Metode Penelitian ini merupakan prospektif observational pada 34 pasien tumortulang di RS Cipto Mangunkusumo pada tahun 2011-2015. Diagnosis ditegakkanmelalui Clinical Pathological Conference. Evaluasi pascaoperasi dilakukan padabulan ke-3, 6, 9, 12, 24, 36, dan 48 dengan menggunakan skoring dari MSTS.Luaran onkologi dievaluasi dengan adanya rekurensi dan metastasis jauh.Komplikasi berupa infeksi, dislokasi, cedera saraf dan pembuluh darah, sertagangguan mekanisme ekstensor juga dievaluasi. Hasil Dua orang ahli bedah muskuloskeletal onkologi melakukan operasi LSS danrekonstruksi dengan megaprostesis. Dua pasien dieksklusi karena keputusanintraoperatif untuk memakai non modular endoprostesis. Kehilangan darahintraoperatif memiliki median (RAK) 890,0 (700,0?1200,0) ml. Skor MSTSsebagian besar pasien menunjukkan kategori baik dan sangat baik, yaitu 67.9%baik pada MSTS 6 bulan, 79,2% baik pada MSTS 9 bulan, 63.4% sangat baikpada 12 bulan, 90% sangat baik pada 24 bulan dan 100% sangat baik pada MSTS36 bulan. Terdapat hubungan bermakna antara karakteristik pasien yaitu jenistumor (p=0,001), usia (p=0,039), jenis kelamin (p=0,049), dan hasil laboratoriumALP (p=0,031) dengan luaran fungsional MSTS 3 bulan. Terdapat hubunganbermakna antara karakteristik pasien yaitu perdarahan intraoperatif (p=0,013) danALP (p=0,009) dengan mortalitas; dan juga antara tumor tulang yang menjalanirekonstruksi jaringan lunak ekstensif dengan komplikasi (p=0,019) namun antaralokasi tumor dan komplikasi tidak terdapat hubungan bermakna. Kesimpulan Luaran fungsional pada pasien yang dilakukan rekonstruksimegaprostesis adalah baik dan sangat baik sehingga dapat menjadi tatalaksanapilihan bagi pasien tumor tulang yang akan menjalani LSS. Luaran onkologi padapasien yang dilakukan prosedur LSS baik dengan rendahnya rekurensi lokal, metastasi, dan komplikasi. ABSTRACT Introduction Advancement in bone tumor management has elaborated surgeon?schoice of treatment not merely sentenced the patients into a limb ablation.Likewise, patients with bone tumors, regardless its malignant nature and limitedsurvival time, had an equal privileges to opt for LSS to experience a better qualityof life. In this study, we manage to evaluate the functional and oncologic outcomeof lower extremity bone tumors following a LSS using megaprosthesis. Methods Thirty-four patients with lower extremity bone tumors wereprospectively reviewed between 2011 and 2015 in a tertiary referral generalhospital. All patients were managed through a Clinical Pathology Conference.Functional outcome was evaluated using MSTS score and follow up was recordedat 3, 6, 12 months; and 2, 3, 4 years.Results Two orthopedic musculoskeletal oncologic surgeons were performing thesurgeries. Two patients were excluded because the final instruments used werenot a modular type. The final result of functional score was good to excellent with67.9% good at 6 months, 79,2% good at 9 months, 63.4% excellent at 12 months,90% excellent at 24 months and 100% excellent at 36 months. Complicationsoccurred and varied. A statistical significant result was found between age(p=0,001), age (p=0,039), gender (p=0,049), SAP (p=0,031) and 3 monthsfunctional outcome; between intraoperative blood loss (p=0,013) and mortality,as well as SAP with mortality (p=0,009); between tumor that underwent extensivesoft tissue reconstruction procedure and complication (p=0,019).Conclusion Megaprosthesis reconstruction in bone tumors gives a good andexcellent result, which provides orthopaedic oncologic surgeons a rationalizationto make a selective decision-making in tumor cases regardless its survival andtumor type. Oncologic outcome as well gave out good result with low incidence of far metastasis and local recurrence.;Introduction Advancement in bone tumor management has elaborated surgeon?schoice of treatment not merely sentenced the patients into a limb ablation.Likewise, patients with bone tumors, regardless its malignant nature and limitedsurvival time, had an equal privileges to opt for LSS to experience a better qualityof life. In this study, we manage to evaluate the functional and oncologic outcomeof lower extremity bone tumors following a LSS using megaprosthesis. Methods Thirty-four patients with lower extremity bone tumors wereprospectively reviewed between 2011 and 2015 in a tertiary referral generalhospital. All patients were managed through a Clinical Pathology Conference.Functional outcome was evaluated using MSTS score and follow up was recordedat 3, 6, 12 months; and 2, 3, 4 years.Results Two orthopedic musculoskeletal oncologic surgeons were performing thesurgeries. Two patients were excluded because the final instruments used werenot a modular type. The final result of functional score was good to excellent with67.9% good at 6 months, 79,2% good at 9 months, 63.4% excellent at 12 months,90% excellent at 24 months and 100% excellent at 36 months. Complicationsoccurred and varied. A statistical significant result was found between age(p=0,001), age (p=0,039), gender (p=0,049), SAP (p=0,031) and 3 monthsfunctional outcome; between intraoperative blood loss (p=0,013) and mortality,as well as SAP with mortality (p=0,009); between tumor that underwent extensivesoft tissue reconstruction procedure and complication (p=0,019).Conclusion Megaprosthesis reconstruction in bone tumors gives a good andexcellent result, which provides orthopaedic oncologic surgeons a rationalizationto make a selective decision-making in tumor cases regardless its survival andtumor type. Oncologic outcome as well gave out good result with low incidence of far metastasis and local recurrence.;Introduction Advancement in bone tumor management has elaborated surgeon?schoice of treatment not merely sentenced the patients into a limb ablation.Likewise, patients with bone tumors, regardless its malignant nature and limitedsurvival time, had an equal privileges to opt for LSS to experience a better qualityof life. In this study, we manage to evaluate the functional and oncologic outcomeof lower extremity bone tumors following a LSS using megaprosthesis. Methods Thirty-four patients with lower extremity bone tumors wereprospectively reviewed between 2011 and 2015 in a tertiary referral generalhospital. All patients were managed through a Clinical Pathology Conference.Functional outcome was evaluated using MSTS score and follow up was recordedat 3, 6, 12 months; and 2, 3, 4 years.Results Two orthopedic musculoskeletal oncologic surgeons were performing thesurgeries. Two patients were excluded because the final instruments used werenot a modular type. The final result of functional score was good to excellent with67.9% good at 6 months, 79,2% good at 9 months, 63.4% excellent at 12 months,90% excellent at 24 months and 100% excellent at 36 months. Complicationsoccurred and varied. A statistical significant result was found between age(p=0,001), age (p=0,039), gender (p=0,049), SAP (p=0,031) and 3 monthsfunctional outcome; between intraoperative blood loss (p=0,013) and mortality,as well as SAP with mortality (p=0,009); between tumor that underwent extensivesoft tissue reconstruction procedure and complication (p=0,019).Conclusion Megaprosthesis reconstruction in bone tumors gives a good andexcellent result, which provides orthopaedic oncologic surgeons a rationalizationto make a selective decision-making in tumor cases regardless its survival andtumor type. Oncologic outcome as well gave out good result with low incidence of far metastasis and local recurrence.;Introduction Advancement in bone tumor management has elaborated surgeon?schoice of treatment not merely sentenced the patients into a limb ablation.Likewise, patients with bone tumors, regardless its malignant nature and limitedsurvival time, had an equal privileges to opt for LSS to experience a better qualityof life. In this study, we manage to evaluate the functional and oncologic outcomeof lower extremity bone tumors following a LSS using megaprosthesis. Methods Thirty-four patients with lower extremity bone tumors wereprospectively reviewed between 2011 and 2015 in a tertiary referral generalhospital. All patients were managed through a Clinical Pathology Conference.Functional outcome was evaluated using MSTS score and follow up was recordedat 3, 6, 12 months; and 2, 3, 4 years.Results Two orthopedic musculoskeletal oncologic surgeons were performing thesurgeries. Two patients were excluded because the final instruments used werenot a modular type. The final result of functional score was good to excellent with67.9% good at 6 months, 79,2% good at 9 months, 63.4% excellent at 12 months,90% excellent at 24 months and 100% excellent at 36 months. Complicationsoccurred and varied. A statistical significant result was found between age(p=0,001), age (p=0,039), gender (p=0,049), SAP (p=0,031) and 3 monthsfunctional outcome; between intraoperative blood loss (p=0,013) and mortality,as well as SAP with mortality (p=0,009); between tumor that underwent extensivesoft tissue reconstruction procedure and complication (p=0,019).Conclusion Megaprosthesis reconstruction in bone tumors gives a good andexcellent result, which provides orthopaedic oncologic surgeons a rationalizationto make a selective decision-making in tumor cases regardless its survival andtumor type. Oncologic outcome as well gave out good result with low incidence of far metastasis and local recurrence.;Introduction Advancement in bone tumor management has elaborated surgeon?schoice of treatment not merely sentenced the patients into a limb ablation.Likewise, patients with bone tumors, regardless its malignant nature and limitedsurvival time, had an equal privileges to opt for LSS to experience a better qualityof life. In this study, we manage to evaluate the functional and oncologic outcomeof lower extremity bone tumors following a LSS using megaprosthesis. Methods Thirty-four patients with lower extremity bone tumors wereprospectively reviewed between 2011 and 2015 in a tertiary referral generalhospital. All patients were managed through a Clinical Pathology Conference.Functional outcome was evaluated using MSTS score and follow up was recordedat 3, 6, 12 months; and 2, 3, 4 years.Results Two orthopedic musculoskeletal oncologic surgeons were performing thesurgeries. Two patients were excluded because the final instruments used werenot a modular type. The final result of functional score was good to excellent with67.9% good at 6 months, 79,2% good at 9 months, 63.4% excellent at 12 months,90% excellent at 24 months and 100% excellent at 36 months. Complicationsoccurred and varied. A statistical significant result was found between age(p=0,001), age (p=0,039), gender (p=0,049), SAP (p=0,031) and 3 monthsfunctional outcome; between intraoperative blood loss (p=0,013) and mortality,as well as SAP with mortality (p=0,009); between tumor that underwent extensivesoft tissue reconstruction procedure and complication (p=0,019).Conclusion Megaprosthesis reconstruction in bone tumors gives a good andexcellent result, which provides orthopaedic oncologic surgeons a rationalizationto make a selective decision-making in tumor cases regardless its survival andtumor type. Oncologic outcome as well gave out good result with low incidence of far metastasis and local recurrence."

"Osteosarkoma merupakan salah satu tumor ganas tulang primer yang paling sering ditemukan. Kemoterapi neoadjuvan merupakan salah satu alternatif terapi yang dapat meningkatan luaran dan kesintasan pasien. Studi ini dilakukan untuk menilai luaran klinis, histopatologis, dan radiologis pada pasien osteosarkoma yang menjalani kemoterapi neoadjuvan beserta faktor-faktor yang mempengaruhinya. Penelitian ini merupakan suatu studi potong lintang yang menggunakan data pasien dengan diagnosis osteosarkoma yang telah menjalani kemoterapi neoadjuvan di RSUPN dr. Cipto Mangunkusumo pada bulan Januari 2017 hinggal Juli 2019. Terdapat 58 subjek dalam penelitian ini. Sebanyak 38 (65,5%) subjek berjenis kelamin laki-laki dengan median usia seluruh subjek 16 (5 hingga 67) tahun. Sebanyak 10 (17,2%) subjek merupakan good responder kemoterapi neoadjuvan. Dari hasil analisis data didaapatkan perbedaan bermakna kadar laboratoris ALP (p=0,002), LED (p=0,002), dan NLR (p<0,001) sebelum dan sesudah kemoterapi. Derajat nekrosis berkorelasi negatif dengan perubahan nilai LDH sebelum dan sesudah kemoterapi (r=-0,354; p=0,006), namun tidak didapatkan hubungan yang bermakna dengan parameter lain seperti perubahan kadar ALP (r=-0,186; p=0,162) dan LED (r=-0,104;  p=0,437). Secara radiologis didapatkan peningkatan nilai ADC yang bermakna (p=0,028) setelah pemberian kemoterapi neoadjuvan, namun perubahannya tidak berhubungan dengan persentase nekrosis tumor (r=-0,300; p=0,433). Pada pasien osteosarkoma yang menjalani kemoterapi neoadjuvan di RSUPN dr. Cipto Mangunkusumo bulan Januari 2017 hingga Juli 2019, didapatkan perbedaan bermakna kadar penanda inflamasi dan parameter radiologis berupa ADC sebelum dan sesudah pemberian kemoterapi adjuvan.

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Osteosarcoma is one of the most prevalent primary tumors of the bone. Neoadjuvant chemotherapy has been administered in osteosarcoma cases to increase the survival rate and improve outcomes. This study is conducted to investigate the clinical, histopathological, and radiological outcome of osteosarcoma patients who underwent neoadjuvant chemotherapy, as well as the various factors that contributes to said outcome. This study is a cross-sectional study that involves the data of patients diagnosed with osteosarcoma who underwent neoadjuvant chemotherapy in RSUPN dr. Cipto Mangunkusumo from January 2017 up to July2019. A total of 58 subjects was admitted in this study. Thirty-eight (65,5%) subjects are male, with the median age of all subjects being 16 years old (5 to 67). We found that 10 subjects (17,2%) is a good responder to neoadjuvant chemotherapy. From the data analysis, significant differences were observed in ALP (p=0,002), ESR (p=0,002) and NLR (p=<0,001) levels before and after neoadjuvant chemotherapy. The degree of necrosis is inversely correlated with the change in LDH level before and after neoadjuvant chemotherapy (r=-0,354; p=0,006), however, no significant correlation was observed in ALP (r=-0,186; p=0,162) dan ESR (r=-0,104;  p=0,437). Radiologically, there is an increase in ADC value (p=0,028) after neoadjuvant chemotherapy. However, this is not correlated with the degree of necrosis (r=-0,300; p=0,433) observed pathologically. There is a significant difference in inflammatory markers and radiological parameter (ADC) pre and post neoadjuvant chemotherapy among osteosarcoma patients in RSUPN dr. Cipto Mangunkusumo from January 2017 up to July 2019."

"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"

"Latar Belakang : Krisis Miastenia (KM) terjadi karena perburukan gejala miastenia gravis (MG) ditandai dengan gagal napas akut, pemanjangan intubasi pasca-timektomi atau kelemahan bulbar yang menyebabkan dispnoe. Therapeutic Plasma Exchange (TPE) telah diterima sebagai terapi lini pertama untuk KM. Keterbatasan sumber daya di RSUPNCM membuat tatalaksana TPE tidak ideal sesuai dengan rekomendasi American Society of Apheresis (ASFA). Tujuan dari penelitian ini untuk mengetahui faktor-faktor yang mempengaruhi luaran pasien KM di RSUPNCM yang menjalani TPE. Metode : Penelitian ini berdesain potong lintang dengan mengambil data sekunder kasus KM yang menerima TPE di Rumah Sakit Umum Cipto Mangunkusumo sejak Januari 2014-September 2018. Diagnosis KM didasarkan pada pemeriksaan klinis. Dilakukan analisa bivariat terhadap faktor-faktor yang diduga dapat mempengaruhi luaran TPE pada KM. Hasil : Sebanyak 38 kasus memenuhi kriteria inklusi. Luaran baik setelah menjalani TPE didapatkan pada 60,5% kasus. Awitan MG (p = 0,039) (OR 7,00; IK 1,18-41,5) dan jenis MG (p = 0,001) (OR 14,40; IK 2,88-71,82) memiliki hubungan bermakna dengan luaran TPE pada KM. MG awitan awal dan MG okular yang menjadi umum menunjukkan luaran yang lebih baik. Variabel spesifisitas antibodi menunjukkan trend kuat dalam mempengaruhi luaran TPE pada KM (p = 0,055) (OR 0,46; IK 0,27-0,80). Variabel lainnya : jenis kelamin, ada tidaknya pneumonia, patologi timus, durasi MG, terapi MG, durasi awitan KM-TPE, total sesi TPE, volume plasma tukar, interval TPE, komplikasi TPE dan kesesuaian dengan ASFA tidak memiliki hubungan bermakna secara statistik dengan luaran TPE pada KM. Penderita KM yang menjalani TPE sesuai ASFA menunjukan perbaikan klinis yang lebih cepat dibandingkan yang menjalani TPE tidak sesuai ASFA. Kesimpulan : MG awitan awal dan MG okular yang menjadi umum merupakan faktor yang dapat mempengaruhi luaran baik TPE pada KM. Penderita yang menjalani TPE sesuai ASFA menunjukan perbaikan klinis yang lebih cepat.

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Background: Myasthenic crisis (MC) occurs due to worsening symptoms of myasthenia gravis (MG) characterized by acute respiratory failure, prolongation of post-thymectomy intubation or bulbar weakness causing dyspnoea. Therapeutic Plasma Exchange (TPE) has been accepted as first-line therapy for MC. The limited resources in RSUPNCM make the management of TPE not ideal according to the recommendations of the American Society of Apheresis (ASFA). The purpose of this study was to determine the factors that influenced the outcomes of MC patients at RSUPNCM who underwent TPE.

Method: This study was a cross-sectional design by taking secondary data on MC cases that received TPE at RSUPNCM from January 2014 to September 2018. The diagnosis of MC is based on clinical examination. Bivariate analysis was carried out on factors that were thought to influence TPE outcomes in MC.

Results: A total of 38 cases met the inclusion criteria. Good outcomes after undergoing TPE are found in 60.5% of cases. Onset of MG (p = 0.039) (OR 7.00; IK 1.18-41.5) and type of MG (p = 0.001) (OR 14.40; IK 2.88-71.82) have a significant relationship with TPE outcome on MC. Early-onset MG and ocular to generalized MG show better outcomes. Antibody specificity variables showed a strong trend in influencing TPE outcome in MC (p = 0.055) (OR 0.46; IK 0.27-0.80).

Other variables: gender, pneumonia, thymic pathology, MG duration, MG therapy, duration of onset MC-TPE, total TPE session, plasma exchange volume, TPE interval, TPE complications and suitability with ASFA did not have a statistically significant relationship with TPE outcome on MC. Patients with MC who underwent TPE according to ASFA showed faster clinical improvement than those who underwent TPE not according to ASFA

Conclusion: Early onset MG and ocular to generalized MG are factors that can affect the good outcome of TPE in MC. Patients who undergo TPE according to ASFA show faster clinical improvement. "

"Pendahuluan dan tujuan: Peradangan yang berasal dari batu buli dapat dikaitkan dengan tumor buli. Meskipun infeksi saluran kemih dan batu buli sebelumnya dianggap sebagai faktor risiko terjadinya tumor buli, hingga saat ini hubungan antara batu buli dan tumor masih belum jelas. Sehingga studi ini bertujuan untuk menganalisa faktor-faktor resiko apa saja yang mempengaruhi terjadinya tumor buli pada penderita batu buli.Metode: Penelitian ini adalah penelitian analitik dengan rancangan Study Crossectional Analitik untuk mengetahui faktor-faktor apa saja yang mempengaruhi kejadian kanker buli pada pasien Batu Buli di RSUP H. Adam Malik Medan. Populasi terjangkau pada penelitian ini adalah pasien yang dirawat inap di RSUP H. Adam Malik Medan tahun 2014 s/d 2018 dan pasien diambil secara total sampling berdasarkan data registrasi pasien batu buli yang dilakukan biopsi dasar batu pada periode trsebut. Jumlah pasien yang diperoleh sebanyak 32 pasien. Tes korelasi digunakan untuk mengetahui hubungan perbaikan fungsi ginjal dengan faktor-faktor terukur. Dilakukan analisa multivariat dengan regersi linier untuk memperoleh faktor mana yang memiliki pengaruh paling besar terhadap pencetus terjadinya kanker. Data yang diperoleh diolah menggunakan SPSS 23.0 dan disajikan dalam bentuk tabel dan narasi.Hasil: pasien berjenis kelamin laki-laki sebanyak 31 orang, atau 96,9% berbanding 1 pasien perempuan hanya 1 pasien (3,1%). Keseluruhan rata-rata usia pasien adalah 43,72 (±16,79) tahun. Karsinoma sel skuamosa 15 sampel (46,9%), sel radang 10 sampel (31,3%), dysplasia 3 sampel (9,4%), karsinoma sel transisional 2 sampel (6,3%), dan metaplasia skuamosa 2 sampel (6,3%). Rata-rata ukuran batu buli adalah 5,88 (±2,00) cm. Batu tunggal yang dijumpai pada 27 sampel (84,4%), sedangkan untuk batu multipel pada 5 sampel (15,6%). Infeksi saluran kemih dijumpai pada 12 sampel (37,5%). Lebih dari setengah sampel memiliki riwayat merokok, yaitu pada 20 pasien (62,5%). Tidak terdapat hubungan antara infeksi saluran kemih dengan tumor buli (p = 0,314), terdapat perbedaan yang signifikan (p = 0,001) antara pasien dengan riwayat merokok dengan kejadian kanker buli, tidak terdapat hubungan bermakna antara jumlah batu dengan kanker buli (p = 0,737). Pada kelompok dengan kanker buli, rerata dari ukuran batunya adalah 6,65 (±2,09) cm berbanding pada kelompok tanpa kanker buli dengan nilai rerata 5,00 (±1,51) cm.Kesimpulan: Pasien dengan batu buli memiliki risiko yang lebih besar untuk terkena tumor buli dan terdapat hubungan yang bermakna antara tumor buli dan riwayat merokok.

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Introduction and purpose: Inflammation of bladder origin can be associated with bladder tumors. Although urinary tract infections and bladder stones were previously considered a risk factor for bladder tumors, the relationship between bladder stones and tumors is still unclear. So this study aims to analyze what risk factors influence the occurrence of bladder tumors in patients with bladder stones.

Methods: This research is an analytical study with an analytical cross-sectional study design to determine what factors influence the incidence of bladder cancer in patients with bladder stones at H. Adam Malik Hospital, Medan. The affordable population in this study were patients who were hospitalized at H. Adam Malik Hospital Medan from 2014 to 2018 and patients were taken by total sampling based on the registration data of bladder stone patients who underwent a stone base biopsy during that period. The number of patients obtained were 32 patients. Correlation test was used to determine the relationship between improvement in kidney function and measurable factors. Multivariate analysis was performed with linear regression to obtain which factors had the greatest influence on the originator of cancer. The data obtained were processed using SPSS 23.0 and presented in the form of tables and narratives.

Results: 31 male patients, or 96.9% compared to 1 female patient, only 1 patient (3.1%). The overall mean age of the patients was 43.72 (±16.79) years. Squamous cell carcinoma 15 samples (46.9%), inflammatory cell 10 samples (31.3%), dysplasia 3 samples (9.4%), transitional cell carcinoma 2 samples (6.3%), and squamous metaplasia 2 samples (6.3%). The average bladder size is 5.88 (±2.00) cm. Single stones were found in 27 samples (84.4%), while for multiple stones in 5 samples (15.6%). Urinary tract infection was found in 12 samples (37.5%). More than half of the sample had a history of smoking, namely in 20 patients (62.5%). There was no relationship between urinary tract infections and bladder tumors (p = 0.314), there was a significant difference (p = 0.001) between patients with a history of smoking and the incidence of bladder cancer, there was no significant relationship between the number of stones and bladder cancer (p = 0.737) . In the group with bladder cancer, the mean stone size was 6.65 (±2.09) cm compared to the group without bladder cancer with a mean value of 5.00 (±1.51) cm.

Conclusion: Patients with bladder stones have a greater risk of developing bladder tumors and there is a significant relationship between bladder tumors and smoking history"

"Perilaku pencegahan COVID-19 pada pasien kanker menjadi salah satu fakor yang perlu dikaji. Hal ini karena pasien kanker sangat berisiko terhadap penularan virus yang akan memperburuk prognosis penyakit. Banyak faktor perilaku yang mempengaruhi pasien kanker dalam pencegahan COVID-19 seperti usia, pekerjaan, pendidikan, pengetahuan, sikap, dukungan keluarga, dan layanan transportasi yang digunakan untuk ke fasilitas kesehatan. Penelitian ini bersifat deskriptif analitik dengan desain cross sectional. Pengambilan sampel dilakukan dengan teknik consecutive sampling (N=175), dan data diuji dengan chi-square. Hasil penelitian menunjukan bahwa usia, jenis kelamin, pengetahuan, sikap, dan dukungan keluarga menunjukan hubungan namun tidak signifikan secara statistik.  Faktor pendidikan memiliki pengaruh yang signifikan pada perilaku pencegahan COVID-19 dengan (p-<0.001). Faktor pemungkin yakni transportasi ke pelayanan kesehatan juga berpengaruh signifikan terhadap perilaku pencegahan COVID-19 pada pasien kanker dengan nilai (p<0.005). Hasil analisis multivariat menunjukan terdapat interaksi yang signifikan antara pendidikan dengan transportasi (p<0.05) dan OR tidak mengandung angka 1 sehingga dapat disimpulkan bahwa interaksi Pendidikan dan transportasi bermakna terhadap perilaku pencegahan COVID-19. Nilai OR pada interaksi Pendidikan dengan transportasi dikatakan bermakna dengan angka 1,622 sehingga dapat disimpulkan bahwa pasien kanker dengan pendidikan terakhir SMA/Perguruan tinggi sekaligus menggunakan transportasi pribadi memiliki kemungkinan 1,6 kali untuk melakukan pencegahan COVID-19.Untuk penelitian selanjutnya dapat mengkaji faktor lain yang dapat mempengaruhi perilaku pencagan COVID-19 pada pasien kanker seperti faktor budaya, ekonomi dan kebiasaan.

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The behavior of preventing COVID-19 in cancer patients is one of the factors that need to be studied. This is because cancer patients are very at risk of transmitting the virus which will worsen the prognosis of the disease. Many behavioral factors influence cancer patients in preventing COVID-19 such as age, occupation, education, knowledge, attitudes, family support, and transportation services used to go to health facilities. This research is descriptive analytic with cross sectional design. Sampling was done by consecutive sampling technique (N=175), and the data was tested by chi-square. The results showed that age, gender, knowledge, attitudes, and family support showed a relationship but not statistically significant. The education factor had a significant influence on COVID-19 prevention behavior with (p-<0.001). The enabling factor, namely transportation to health services, also significantly affected the behavior of preventing COVID-19 in cancer patients with a value (p<0.005). The results of the multivariate analysis showed that there was a significant interaction between education and transportation (p<0.05) and the OR did not contain the number 1 so it could be concluded that the interaction between education and transportation had a significant impact on COVID-19 prevention behavior. The OR value on the interaction of education with transportation is said to be significant with the number 1.622 so it can be concluded that cancer patients with the latest education in high school/college while using private transportation have 1.6 times the possibility to prevent COVID-19. For further research, it is possible to examine other factors that can influence the behavior of preventing COVID-19 in cancer patients, such as cultural, economic and habitual factors."

"Lansia mengalami penurunan fungsi fisiologis tubuh dan penurunan masa tulang, sehingga resiko jatuh dan fraktur meningkat seiring bertambahnya usia. Fraktur pada lansia dipengaruhi faktor yang spesifik mengingat dapat terjadi bahkan dengan minimal trauma. Identifikasi faktor yang mempengaruhi fraktur pada lansia perlu dilakukan sebagai salah satu upaya preventif dalam menekan angka kejadian fraktur. Penelitian ini menggunakan analisa deskriptif sederhana dengan menggunakan data 97 Rekam Medis pasien fraktur di RSUP Fatmawati pada rentang tahun 2012-2016. Dari penelitian ini didaptkan angka kejadian fraktur terbesar terjadi pada usia 65 tahun ke atas yaitu sebesar 56,7 dengan dominasi pasien perempuan sebesar 64,95. Tempat kejadian fraktur pada lansia paling banyak terjadi di dalam ruangan sebesar 70,10. Sebanyak 87,63 pasien memiliki riwayat jatuh dan 59,79 memiliki riwayat penyakit sebelumnya. Pengembangan penelitian lebih lanjut menggunakan data bone mass density BMD sangat direkomendasikan mengingat BMD merupakan salah satu faktor utama kepadatan masa tulang. Selain itu, diperlukan inovasi dalam upaya promotif terkait tata letak ruang dan lingkungan yang ramah lansia.

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Elderly has decreases physiological function of the body and decreases bone mass, so the risk of falls and fractures increases with age. Fractures in the elderly are influenced by specific factors since they can occur even with minimal trauma. Identification of factors that affect fractures in the elderly should be done as one of the preventive efforts in decreasing the incidence of fracture. This study used a simple descriptive analysis using data of 97 Medical Records of fracture patients at RSUP Fatmawati in the year 2012 2016 range.

The greatest fracture occurrence occurred at age 65 years and above that is equal to 56,7 with female patient dominance equal to 64,95. Fractures in the elderly is most prevalent in the room indoor by 70.10. A total of 87.63 of patients had a history of falling and 59.79 had a prior history of disease. The development of further research using data of bone mass density BMD is highly recommended since BMD is one of the major factors of bone density. In addition, innovative promotion efforts are needed related to spatial design and environmental for the elderly. "

"ABSTRAKEpilepsi merupakan suatu gangguan kronis pada otak manusia yang dapat terjadi padasemua jenis usia. Kualitas hidup pasien epilepsi dipengaruhi oleh berbagai faktor.Tujuan penelitian ini untuk mengidentifikasi faktor determinan yang mempengaruhikualitas hidup pasien epilepsi. penelitian ini menggunakan metode cross sectional. Dari100 pasien epilepsi yang dipilih dengan teknik consecutive sampling. Hasil penelitianini menunjukan bahwa mayoritas pasien epilepsi memiliki kualitas hidup buruk 62orang (62%). Tingkat pendidikan berhubungan secara signifikan dengan kualitas hiduppasien epilepsi (p=0,001), frekuensi kejang (p=0,001), tipe serangan kejang (p=0,001),stigma (p=0,001) dan kepatuhan minum obat (p=0,009). Hasil analisis multivariatmenunjukan faktor yang paling berpengaruh terhadap kualitas hidup pasien epilepsiadalah tipe serangan kejang dengan nilai OR 9,716. Penelitian ini diharapkan dapatmemberikan masukan kepada perawat sebagai data rujukan dalam pengembanganpengkajian keperawatan pada pasien epilepsi terkait kualitas hidup

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ABSTRACTEpilepsy is a chronic disorder in the human brain and may occurs in all types of ages.Low quality of life occurs in people with epilepsy various factors. The aim of this studyis to identify determinant factors affecting the quality of life in people with epilepsy.This study was a cross sectional analytic design involved. 100 peoples with epilepsywere selected by consecutive sampling technique. The results of this study indicate thatthe majority of people with epilepsy have low quality of life 62 peoples (62%). Thelevel of education is significantly related to the quality of life in people with epilepsy(p=0,001), seizure frequency (p=0,001), seizure type (p=0,001), stigma (p=0,001), andmedication adherence (0,009).Multivariate analysis, showed that the most influentialdominant factor in the quality of life in people with epilepsy was seizure type(OR=9,716). This study is expected to provide input to nurses as reference indeveloping nursing assessment in people with epilepsy related quality of life."