Hasil Pencarian  ::  Simpan CSV :: Kembali

Abstrak :
ABSTRAK
Latar Belakang: Salah satu modalitas terapi untuk kanker paru stadium lanjut jenis Non-Small Cell (NSC) adalah kemoterapi. Jenis kemoterapi yang sering digunakan di Indonesia adalah Cisplatin-Etoposide (EC) dan Cisplatin-Docexatel (DC). Tolak ukur keberhasilan pengobatan adalah kesintasan dan Progression Free Survival (PFS). Keberhasilan kemoterapi dipengaruhi oleh banyak faktor seperti dosis obat, intensitas pemberian, jenis kemoterapi, jenis histologi, stadium, perfoma status, komorbiditas dan sosial ekonomi. Di Indonesia pendanaan dan jenis rejimen kemoterapi masih merupakan masalah terdahap keberhasilan terapi.

Tujuan: Mengetahui perbedaan kesintasan 2 tahun dan PFS antara pasien kanker paru jenis NSC yang diterapi menggunakan EC dibandingkan dengan DC.

Metode: Penelitian desain kohort retrospektif dengan analisis kesintasan. Pasien yang dimasukkan dalam penelitian ini adalah pasien kanker paru stadium lanjut (minimal stadium IIIa) jenis NSC, yang datang ke RSKD dan RSCM pada Januari 2006 – Desember 2010 yang baru pertama kali dikemoterapi sampai selesai, sebanyak 6 kali dan dilakukan pengamatan 2 tahun. Data dianalisis dengan program SPSS 16.0, dilakukan analisis cox regression dan ditampilkan dalam kurva Kaplan Meier.

Hasil: Didapatkan hasil 55 pasien diberikan cisplatin-etoposide dan 55 pasien diberikan cisplatin-docexatel. Kesintasan 1 tahun EC sebesar 30,9% dan DC sebesar 47,3%, (p=0.030). Kesintasan 2 tahun EC sebesar 0% dan DC sebesar 5,5%, (p 0.003). Median time survival antara EC selama 27 minggu dengan DC selama 38 minggu (p< 0,016). Dibandingkan DC, kemoterapi EC dapat meningkatkan risiko kematian dengan HR 1,684 (IK95% 1,010-2,810). Kelompok subyek yang menggunakan rejimen kemoterapi DC memiliki PFS 20,1 minggu, sedangkan kelompok subyek yang menggunakan rejimen kemoterapi EC memiliki PFS 16,8 minggu (p=0,022).

Kesimpulan: Kesintasan cisplatin-docexatel lebih baik bila dibandingkan dengan cisplatin-etoposide, demikian juga dengan progression free survivail.

---

ABSTRACT
Background: One of the therapy for the advanced Non-Small Cell Lung Cancer (NSCLC) is chemotherapy. The most frequent regiment used in Indonesia is Cisplatin-Etoposide (EC) and Cisplatin-Docetaxel (DC). The success of chemotherapy is measured with the 1-year survival, 2-year survival, and the Progression Free Survival (PFS) rate. The success is influenced by many factors, such as the dosage, administer intensity, chemotherapy regiment, type of histology, stage, performance status, comorbidity, and social economic. In Indonesia, funding and chemotherapy regiment are the common problems for the success of chemotherapy.

Goal: To determine the 2-year survival rate and PFS rate differences between EC against DC of advanced NSCLC patients.

Method: The study is a retrospective Cohort study with survival analysis. The Patients included to this study were the advanced NSCLC (At least Stadium IIIa) who came to RSKD and RSCM during January 2006 – December 2010 for their first chemotherapy until finished the cycle (6 times) and had 2-year monitoring. Data was analyzed by SPSS 16.0 by cox regression analysis, and featured on the Kaplan Meier Curve.

Result: Fifty five patients were given EC and the other 55 patients were given DC. One year survival rate of EC was 30,9% and DC was 47,3%, (p=0.030). Two year survival rate of EC was 0% and DC was 5.5% (p 0.003). The median time survival of EC was 27 weeks and DC was 38 weeks (p<0.016). Compared to DC, EC chemotherapy increased the death risk by HR 1,684 (CI 95% 1,010-2,810). The PFS rate of the subjects who were given EC chemotherapy regimen was 20.1 weeks, while the patients who were given DC chemotherapy regimen was 16.8 weeks (p=0.022).

Conclusions: The survival with cisplatin-docexatel was better compared to cisplatin-etoposide, this applies to PFS as well.

Abstrak :
Latar Belakang: Karsinoma narofaring (KNF) termasuk kanker dengan prevalensi yang cukup tinggi di Indonesia dengan prognosis yang cukup. Dalam menentukan progresifitas suatu kanker, didapatkan peranan penting dari penurunan tumor supresor gen dan peningkatan proliferasi. Hal tersebut ditandai oleh marker p53 sebagai gen supresor yang menginduksi apoptosis dan Ki67 sebagai marker proliferasi sel. Hingga saat ini belum terdapat penelitian mengenai hubungan overekspresi p53 dan Ki67 terhadap respon kemoradiasi dan analisis kesintasan selama 3 tahun pada KNF stadium lokal lanjut. Tujuan: Mencari hubungan antara overekspresi p53 dan Ki67 terhadap respon kemoradiasi dan kesintasan 3 tahun pasien KNF stadium lokal lanjut. Metode: Penelitian ini merupakan penelitian analitik observasional dengan desain analisis kesintasan. Penelitian ini menggunakan desain penelitian kohort retrospektif, dengan pengambilan data dari rekam medis kemudian ditelusuri riwayat perjalanan penyakitnya. Sample penelitian berupa jaringan pada blok parafin pasien KNF stadium lokal lanjut yang diambil secara consecutive sampling dari populasi penelitian dari periode 2015–2017 di RSUPN Dr. Cipto Mangunkusumo sejumlah 82 orang. Hasil: Dari total 82 pasien KNF stadium local lanjut, terdapat 65 pasien kelamin laki – laki (79,3%) dan 17 pasien perempuan (20,7%), dengan usia paling banyak pada kelompok 41 – 50 tahun sebanyak 31,8%. Overekspresi p53 ditemukan pada 36 pasien (43,9%), sementara overekspresi Ki67 ditemukan pada 35 pasien (42,7%). Dari respon kemoradiasi, pasien dengan overekspresi p53 dan Ki67 berpeluang memberikan respon negatif yang lebih tinggi dibandingkan dengan low ekspresi (RR = 3,052 dengan IK95%: 1,777 – 5,242, p = 0,009; RR = 2,573 dengan IK95%: 1,547 – 4,297, p = 0,002 berturut-turut). Dinilai dari kesintasan 3 tahun, pasien dengan overekspresi p53 memiliki kesintasan 3 tahun yang lebih buruk dibandingkan dengan low ekspresi (HR = 19,827 dengan IK95%: 5,974 – 65,798, p = <0,001). Begitu juga dengan overekspresi Ki67 memiliki kesintasan 3 tahun yang lebih rendah. ......Background: Naropharyngeal carcinoma (NPC) is a cancer with a fairly high prevalence in Indonesia with a fairly poor prognosis. Tumor supressor gene and cancer proliferation played an important roles in determining the progression of a cancer. This was indicated by the marker p53 as a suppressor gene that induces apoptosis and Ki67 as a marker of cell proliferation. There has been limited research on the relationship of p53 and Ki67 overexpression to the chemoradiation response and 3-year survival in locally advanced NPC. Objective: To determine the relationship between p53 and Ki67 overexpression with chemoradiation response to therapy and 3-year survival in locally advanced NPC patients. Methods: This research is an observational analytic study with a survival analysis design. This study used a retrospective cohort study design, by collecting data from medical records and then tracing the history of the disease. The research sample was tissue in the paraffin block of locally advanced NPC patients taken by consecutive sampling from the study population from period 2015–2017 at Dr. Cipto Mangunkusumo National Hospital with a total number of 82 patients. Results: From a total of 82 patients with locally advanced NPC, there were 65 male patients (79.3%) and 17 female patients (20.7%), with the most age being in the 41-50 years group as many as 31.8 %. Overexpression of p53 was found in 36 patients (43.9%), while overexpression of Ki67 was found in 35 patients (42.7%). Based on therapy response, patients with overexpression of p53 and Ki67 had a higher chance of giving a negative response compared to those with low expression (RR = 3,052 with IK95%: 1,777 – 5,242, p = 0,009; RR = 2,573 with IK95%: 1,547 – 4,297, p = 0,002 respectively). Assessed by 3- year survival, patients with p53 overexpression were statistically significantly worse than those with low-expression (HR = 19,827 with IK95%: 5,974 – 65,798, p = <0,001). Likewise, Ki67 overexpression was statistically significant and had a lower 3-year survival compared to low Ki67 expression (HR = 14,634 with IK95%: 5,074 – 42,204, p = <0,001). Conclusion: Locally advanced NPC patients with p53 overexpression and Ki67 overexpression have a tendency to give a negative chemoradiation response and have a lower 3-year survival.