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Abstrak :

Pendahuluan: Karsinoma rongga mulut adalah keganasan tersering ke-6 di Asia. Mayoritas pasien karsinoma sel skuamosa rongga mulut (KSSRM) di RSCM datang dalam kondisi lanjut. Namun belum ada studi yang meneliti mengenai kesintasan penyakit ini di Indonesia. Penelitian ini bertujuan untuk menilai kesintasan KSSRM di RSCM berdasarkan stadium klinis AJCC ke-8.

Metode: dilakukan studi analisis kesintasan secara retrospektif dengan menggunakan data pasien KSSRM yang didiagnosis di Divisi Bedah Onkologi RSCM pada tahun 2014-2018. Luaran pasien didapatkan dari rekam medis dan menghubungi pasien via telepon. Data dianalisis menggunakan metode Kaplan-Meier.

Hasil: Mayoritas pasien adalah laki-laki (perbandingan laki-laki:perempuan adalah 1,03:1) dengan rerata usia  51,12±13,821 tahun. Tumor ditemukan paling banyak di daerah lidah (72,8%) dan kebanyakan pasien didiagnosis pertama kali pada stadium IV (83,4%). Kesintasan keseluruhan satu dan dua tahun adalah 58,6% dan 43,1%, dengan kesintasan spesifik-penyakit adalah 66,9%. Kesintasan satu dan dua tahun terendah adalah pada kelompok stadium IV (53,5% dan 36,1% secara berurutan). Namun tidak terdapat hubungan yang bermakna secara statistik antara kesintasan dan stadium klinis pada studi ini.

Simpulan:  Kesintasan KSSRM yang rendah di RSCM menunjukan tingginya patient delay. Penapisan dan edukasi mengenai penyakit ini dibutuhkan untuk meningkatkan angka kesintasan.

 

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Introduction: Oral cancer carcinoma is the 6^th most frequent malignancy in Asia. In Cipto Mangunkusumo Hospital, most patient comes in late stage. Yet, there is no survival study available for this disease in our country.

Objectives: This study aims on revealing the survival rate oral squamous cell carcinoma (OSCC) patients in Cipto Mangunkusumo based on the 8^th AJCC staging.

Methods: We performed a retrospective survival analysis study from a database of OSCC patients diagnosed at Cipto Mangunkusumo Hospital in 2014-2018. Follow-up details were updated from medical record and by phone calls. Data was analysed using the Kaplan-Meier method.

Results: Majority of the patients were male (male-to-female ratio was 1.03:1) with the mean age was 51,12±13,821 years old. Tumors occurred mostly in the tongue (72,8%), and most patients were initially diagnosed as stage IV (83,4%). The one and two year overall survival rate were 58,6% and 43,1%, with a disease-specific survival rate was 66,9%. The worst one and two year survival rate was found constantly in the stage IV group (53,5% and 36,1%, consecutively). Though there was no statistically significant association between overall survival and clinical staging in this study (p>0,05).

Conclusion: The low OSCC survival rate in Cipto Mangunkusumo Hospital indicated a high level of patient delay. Screening and education regarding this disease are needed to increase the survival rate.

Abstrak :
Latar Belakang: Karsinoma sel skuamosa rongga mulut (KSSRM) menempati urutan keenam dari keganasan yang paling sering terjadi di Asia. Kebanyakan pasien datang berobat dalam kondisi stadium lanjut sehingga KSSRM memiliki mortalitas yang tinggi. Angka kesintasan KSSRM satu tahun dan dua tahun di RSCM adalah 58,6% dan 43,1%; angka kesintasan spesifik penyakit adalah 66,9%. Studi ini bertujuan untuk mencari faktor-faktor yang memengaruhi kesintasan KSSRM. Metode: Studi ini merupakan kohort retrospektif berdasarkan data rekam medis pasien. Variabel yang diteliti adalah usia, jenis kelamin, lokasi tumor, stadium klinis, derajat diferensiasi sel tumor, derajat invasi tumor, dan batas sayatan. Analisis kesintasan menggunakan Kaplan-Meier dan uji log-rank. Analisis bivariat dan multivariat menggunakan regresi Cox untuk mendapatkan hazard ratio (HR). Hasil: Ada 169 subjek yang menderita KSSRM dan diterapi di RSCM tahun 2014 – 2018. Mayoritas pasien merupakan laki-laki (51,5%) dengan usia di atas 50 tahun (55,6%). Lokasi tumor paling banyak dijumpai di lidah (72,8%) diikuti mukosa bukal (13%). 82,2% pasien datang pada stadium IV, 60,4% memiliki diferensiasi baik, dan 53,8% memiliki grade rendah. Berdasarkan analisis bivariat, didapatkan bahwa ukuran dan ekstensi tumor (T), keterlibatan kelenjar getah bening regional (N), stadium klinis, dan batas sayatan memengaruhi kesintasan KSSRM (p <0,05). Keterlibatan KGB (HR: 1,212; 95% CI: 0,997-1,474; p <0,05) dan stadium klinis (HR: 1,749; 95% CI: 1,261-2,425; p <0,05) memengaruhi mortalitas secara signifikan. Kesimpulan: Faktor-faktor yang memengaruhi kesintasan KSSRM adalah stadium klinis dan keterlibatan kelenjar getah bening regional (N). ......Background: Oral squamous cell carcinoma (OSCC) is the sixth most common malignancy in Asia. Most patients were diagnosed in advanced stage; thus, the mortality rate is high. The one-year and two-year overall survival rate in Cipto Mangunkusumo Hospital are 58.6% and 43.1%, the disease-specific survival rate is 66.9%. This study is aimed to investigate the prognostic factors correlated with OSCC. Methods: A retrospective cohort study was done on OSCC patients diagnosed and treated in Cipto Mangunkusumo Hospital from 2014 to 2018. Data regarding age, gender, site of the primary lesion, clinical stage of the disease, tumor differentiation, invasion, and surgical margins were collected. Prognostic variables were identified with bivariate analysis using Kaplan-Meier curves and log-rank testing for comparison. Results: One hundred and sixty nine patients were included. Majority of patients were male (51.5%), age above 50 years old (55.6%). The most prevalent tumor site was the tongue (72.8%) followed by buccal mucosa (13%). 82.2% of patients had advanced (clinical stage IV) disease at diagnosis. Majority of patients had well-differentiated tumor (60.4%) and low-grade tumor (53.8%). Bivariate analysis showed that tumor size (T), nodal status (N), clinical stage, and marginal status significantly affected the overall survival (p <0.05). Nodal status (HR: 1.212; 95% CI: 0.997-1.474; p <0.05) and clinical stage (HR: 1.749; 95% CI: 1.261-2.425; p < 0.05) were independently associated with the risk of death. Conclusion: Clinical stage and lymph node involvement are the most significant prognostic factors of OSCC.

Abstrak :
Angka kematian kanker serviks masih tinggi karena banyak pasien datang berobat pada tahap lanjut. Respons terapi radiasi pada pasien kanker serviks stadium lanjut bervariasi walau dengan faktor klinikopatologi yang sama seperti stadium, massa tumor, jenis histopatologi, derajat diferensiasi, invasi limfovaskular, reaksi limfosit dan nekrosis. Oleh karena itu dipikirkan faktor prognosis lain seperti faktor apoptosis-survivin, telomerase dan sitokrom c. Penelitian ini bertujuan untuk mengetahui peran survivin, telomerase, dan sitokrom c sebagai prediktor respons terapi radiasi pada kanker serviks stadium lanjut khususnya stadium IIIB.Studi ini bersifat prospektif menggunakan metode nested case control. Pengambilan data dilakukan di Poliklinik Onkologi Departemen Obstetri dan Ginekologi RSCM serta Departemen Patologi Anatomi FKUI pada bulan Januari 2016 hingga Mei 2017. Pada subjek penelitian dilakukan wawancara, pemeriksaan histopatologi dan pemeriksaan biokimia secara ELISA untuk mengetahui kadar survivin, telomerase, sitokrom c, dan MRI pra-radiasi serta pasca-radiasi. Dari 90 subjek penelitian didapatkan rerata usia pasien 50 tahun, rerata massa tumor 6,7 cm dan sebagian besar berkeratin 84,4 , berdiferensiasi baik 81,1 , reaksi limfosit negatif 75,6 dan nekrosis 74,4 . Rerata faktor apoptosis-survivin, telomerase dan sitokrom c adalah 591,2 pg/mL, 5.223,2 pg/mL dan 191,3 ng/mL. Dari analisis bivariat didapatkan variabel yang berhubungan dengan respons terapi secara independen adalah massa tumor p = 0,1 , diferensiasi p = 0,17 , kadar survivin p = 0,01 , kadar telomerase p = 0,08 dan kadar sitokrom c p = 0,47. Hasil analisis multivariat didapatkan hubungan kadar survivin dan kadar telomerase dengan respons terapi radiasi p = 0,01 dan p = 0,07 . Tidak terdapat hubungan kadar sitokrom c dengan respons terapi radiasi p = 0,64 . Dengan model cox regresi survival didapatkan hazard ratio subjek dengan kadar survivin tinggi dan kadar telomerase tinggi terhadap respons terapi radiasi negatif adalah 4,20 dan 1,97.Simpulan: kadar survivin dan telomerase tinggi berhubungan dengan respons terapi radiasi negatif. ......Cervical cancer mortality rate is still high mostly due to patients seeking for help in advanced stage of the disease. Even with the same clinicopathologic features such as stage of the diseases, size of the tumor, histopathological types, level of differentiation, lymphocyte reaction and tumor necrosis, the radiotherapy outcomes still vary from patient to patient. Therefore, we thought another predictive factors like apoptosis inducing factors i.e. survivin, telomerase and cytochrome c as a new predictor of therapeutic resp onses on patients with stage IIIB squamous cell carcinoma of cervix. This is a prospective study with nested case control method. Data collection was conducted in Oncology Polyclinic, Department of Obstetrics and Gynecology RSCM and Department of Pathological Anatomy of FKUI from January 2016 to May 2017. Subjects were interviewed, conducted histopathological and biochemical examination with ELISA to determine levels of survivin, telomerase, cytochrome c, and patients undergo pre and post radiation MR imaging. There were 90 patients in this study with the mean of ages was 50 years, mean of tumor size was 6.7 cm and most subjects were keratinizing 84.4 , well differentiated 81.1 , negative lymphocyte reaction 75.6 and tumor necrosis 74.4 . The mean levels of apoptosis inducing factors survivin, telomerase and cytochrome c were 591.2 pg mL, 5,223.2 pg mL, and 191.3 ng mL. Bivariate analysis showed the independent association between tumor size, level of differentiation, levels of survivin and telomerase p 0.1, p 0.17, p 0.01, p 0.08 . Multivariate analysis showed the correlation between levels of survivin and telomerase with radiation therapeutic response p 0.01 and p 0.07 and there was no association with level of cytochrome c p 0.64 With the survival cox regression models, the hazard ratio of subjects with high levels of survivin and telomerase on the negative radiation therapy responses were 4.20 and 1.97.Conclusion there were association between high levels of survivin and telomerase on the negative radiation therapy response.