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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.

Abstrak :
Pendahuluan : Kemoradiasi pada kanker rektum menghasilkan radical oxygen species (ROS) yang dapat memicu kematian sel. ALDH1A1 merupakan antioksidan yang mampu mengurangi ROS dan merupakan marker sel punca kanker. Penelitian ini bertujuan untuk mengetahui hubungan kadar ALDH1A1 dengan respon kemoradiasi berdasarkan metode RECIST 1.1 pada pasien kanker rektum stadium lanjut lokal. Metode : Penelitian ini merupakan studi retrospektif terhadap 14 pasien kanker rektum stadium lanjut lokal yang memenuhi kriteria inklusi dari januari 2012 sampai januari 2015. ALDH1A1 diperiksa menggunakan metode ELISA dari sampel blok parafin kanker rektum. Respon pengecilan tumor dari CT scan dan MRI dihitung berdasarkan metode RECIST 1.1. Hasil : Didapatkan rerata kadar ALDH1A1 sebesar 9,014 ± 3,3 pg/mL, rerata persentase respon radiasi 7,89 ± 35,7 % dan diklasifikasikan berdasarkan RECIST didapatkan proporsi respon parsial sebesar 28,6 % , respon stabil sebesar 50% dan respon progresif sebesar 21,4%. Terdapat korelasi negatif kuat yang bermakna (r = - 0,890 dan p < 0,001) antara kadar ALDH1A1 dengan respon kemoradiasi berdasarkan RECIST. Kesimpulan : pada penderita kanker rektum stadium lanjut lokal respon kemoradiasi dipengaruhi oleh kadar ALDH1A1 dalam jaringan tumor. Semakin tinggi kadar ALDH1A1 semakin buruk respon kemoradiasi. ...... Introduction : Chemoradiation in rectal cancer produce radical oxygen species (ROS) wich can cause cell death. ALDH1A1 is an antioxidant that can reduce ROS and known as cancer stem cell marker. The purpose of this study is to determine the correlation between ALDH1A1 level with tumor shrinkage using RECIST methode in locally advance rectal cancer. Methode : This is a retrospective study to 14 locally advance rectal cancer patients who meet the inclusion criteria from january 2012 to january 2015. ALDH1A1 level was measured by ELISA from paraffin embeded tissue. Tumor shrinkage was measured from CTscan or MRI using RECIST 1.1 methode. Result : The mean ALDH1A1 level is 9,014 ± 3,3 pg/mL, the mean of tumor shrinkage is 7,89 ± 35,7 %, Partial respond proportion is 28,6 % , Stable dissease proportion is 50% and progressive dissease proportion is 21,4%. There was a significant strong negative correlation (r = -0,890, p < 0,001) between ALDH1A1 with tumor shrinkage. Conclusion : This study showed that tumor shrinkage in locally advanced rectal cancer after chemoradiation is influenced by ALDH1A1 level. The increase od ALDH1A1 level will decrease tumor shrinkage after chemoradiation.