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Abstrak :
[ABSTRAK
Latar Belakang: Pada tahun 1998-1999, kesintasan pasien karsinoma hepatoselular (KHS) yang berobat di Rumah Sakit Cipto Mangunkusumo (RSCM) sangat rendah karena sebagian besar datang dalam stadium lanjut dan hanya sedikit pasien yang dapat memperoleh terapi paliatif atau kuratif. Dalam tiga tahun terakhir, RSCM telah memiliki fasilitas tatalaksana KHS yang lebih baik, namun dampaknya terhadap perbaikan kesintasan pasien KHS belum diketahui.

Tujuan: Mengetahui perbandingan kesintasan satu tahun pasien KHS yang berobat di RSCM pada periode 2013-2014 dengan periode 1998-1999.

Metode: Data 114 pasien KHS yang berobat di RSCM pada periode 2013-2014 dan data sekunder penelitian 77 pasien KHS di RSCM pada tahun 1998-1999 dikumpulkan secara retrospektif lalu dilakukan penilaian karakteristik dan perbandingan kurva kesintasan dengan menggunakan metode Kaplan-Meier yang dilanjutkan dengan uji log-rank.

Hasil: Terdapat peningkatan hepatitis B sebagai etiologi KHS dari 32,5% pada 1998- 1999 menjadi 67,5% pada 2013-2014. Insidens pasien yang meninggal selama pengamatan adalah 57% (95% interval kepercayaan (IK) = 48-66%) pada periode 2013-2014 dan 61% (95% IK = 49-73%) pada periode 1998-1999. Median kesintasan secara keseluruhan adalah 141 hari. Meskipun terdapat perbaikan dalam fasilitas tatalaksana KHS, angka kesintasan satu tahun pada kedua periode tidak berbeda secara signifikan (29,4% pada 2013-2014 dan 24,1% pada 1998- 1999, p=0,913). Hal ini tampaknya disebabkan karena surveilans KHS pada populasi risiko tinggi masih rendah.

Simpulan: Tidak ada perbedaan kesintasan satu tahun pasien KHS pada periode 2013-2014 dengan periode 1998-1999.

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ABSTRACT
Background: In 1998-1999, the survival of hepatocellular carcinoma (HCC) patients in Cipto Mangunkusumo Hospital was very poor because most patients came in advanced stage and only few patients could receive palliative or curative treatment. In the last three years, Cipto Mangunkusumo Hospital has improved its facilities for HCC treatment. It is unclear whether this effort has resulted in improvement of patients? survival.

Objectives: To compare one-year survival rate of HCC patients between two periods (2013- 2014 and 1998-1999).

Method: We analyzed retrospectively 114 HCC patients who came to our department in 2013-2014 and 77 patients in 1998-1999. We compare the clinical characteristics and treatment between two periods and then we analyze the survival of both groups using Kaplan-Meier method and compare them using log-rank test.

Results: There was an increase in hepatitis B prevalence as the etiology of HCC from 32,5% in 1998-1999 to 67,5% in 2013-2014, causing hepatitis B as the main etiology of HCC in 2013-2014. Incidence rate of patients who died in 2013-2014 was 57% (95% confidence interval (CI) = 48-66%) and in 1998-1999 was 61% (95% CI = 49-73%). Overall median survival was 141 days. Despite improvement in treatment facilities, no significant difference was found in one-year survival rate (29,4% in 2013-2014 versus 24,1% in 1998-1999, p=0,913). It seems that this result was caused by low level of surveillance in high-risk population.

Conclusion: No improvement was seen in one-year survival rate of HCC patients between 2013-2014 and 1998-1999.;Background: In 1998-1999, the survival of hepatocellular carcinoma (HCC) patients in Cipto Mangunkusumo Hospital was very poor because most patients came in advanced stage and only few patients could receive palliative or curative treatment. In the last three years, Cipto Mangunkusumo Hospital has improved its facilities for HCC treatment. It is unclear whether this effort has resulted in improvement of patients? survival. Objectives: To compare one-year survival rate of HCC patients between two periods (2013- 2014 and 1998-1999). Method: We analyzed retrospectively 114 HCC patients who came to our department in 2013-2014 and 77 patients in 1998-1999. We compare the clinical characteristics and treatment between two periods and then we analyze the survival of both groups using Kaplan-Meier method and compare them using log-rank test. Results: There was an increase in hepatitis B prevalence as the etiology of HCC from 32,5% in 1998-1999 to 67,5% in 2013-2014, causing hepatitis B as the main etiology of HCC in 2013-2014. Incidence rate of patients who died in 2013-2014 was 57% (95% confidence interval (CI) = 48-66%) and in 1998-1999 was 61% (95% CI = 49-73%). Overall median survival was 141 days. Despite improvement in treatment facilities, no significant difference was found in one-year survival rate (29,4% in 2013-2014 versus 24,1% in 1998-1999, p=0,913). It seems that this result was caused by low level of surveillance in high-risk population. Conclusion: No improvement was seen in one-year survival rate of HCC patients between 2013-2014 and 1998-1999.;Background: In 1998-1999, the survival of hepatocellular carcinoma (HCC) patients in Cipto Mangunkusumo Hospital was very poor because most patients came in advanced stage and only few patients could receive palliative or curative treatment. In the last three years, Cipto Mangunkusumo Hospital has improved its facilities for HCC treatment. It is unclear whether this effort has resulted in improvement of patients? survival. Objectives: To compare one-year survival rate of HCC patients between two periods (2013- 2014 and 1998-1999). Method: We analyzed retrospectively 114 HCC patients who came to our department in 2013-2014 and 77 patients in 1998-1999. We compare the clinical characteristics and treatment between two periods and then we analyze the survival of both groups using Kaplan-Meier method and compare them using log-rank test. Results: There was an increase in hepatitis B prevalence as the etiology of HCC from 32,5% in 1998-1999 to 67,5% in 2013-2014, causing hepatitis B as the main etiology of HCC in 2013-2014. Incidence rate of patients who died in 2013-2014 was 57% (95% confidence interval (CI) = 48-66%) and in 1998-1999 was 61% (95% CI = 49-73%). Overall median survival was 141 days. Despite improvement in treatment facilities, no significant difference was found in one-year survival rate (29,4% in 2013-2014 versus 24,1% in 1998-1999, p=0,913). It seems that this result was caused by low level of surveillance in high-risk population. Conclusion: No improvement was seen in one-year survival rate of HCC patients between 2013-2014 and 1998-1999., Background: In 1998-1999, the survival of hepatocellular carcinoma (HCC) patients in Cipto Mangunkusumo Hospital was very poor because most patients came in advanced stage and only few patients could receive palliative or curative treatment. In the last three years, Cipto Mangunkusumo Hospital has improved its facilities for HCC treatment. It is unclear whether this effort has resulted in improvement of patients? survival. Objectives: To compare one-year survival rate of HCC patients between two periods (2013- 2014 and 1998-1999). Method: We analyzed retrospectively 114 HCC patients who came to our department in 2013-2014 and 77 patients in 1998-1999. We compare the clinical characteristics and treatment between two periods and then we analyze the survival of both groups using Kaplan-Meier method and compare them using log-rank test. Results: There was an increase in hepatitis B prevalence as the etiology of HCC from 32,5% in 1998-1999 to 67,5% in 2013-2014, causing hepatitis B as the main etiology of HCC in 2013-2014. Incidence rate of patients who died in 2013-2014 was 57% (95% confidence interval (CI) = 48-66%) and in 1998-1999 was 61% (95% CI = 49-73%). Overall median survival was 141 days. Despite improvement in treatment facilities, no significant difference was found in one-year survival rate (29,4% in 2013-2014 versus 24,1% in 1998-1999, p=0,913). It seems that this result was caused by low level of surveillance in high-risk population. Conclusion: No improvement was seen in one-year survival rate of HCC patients between 2013-2014 and 1998-1999.]

Abstrak :
Skripsi ini bertujuan untuk merancang, fabrikasi dan menganalisis rangkaian generator sinyal frekuensi radio yang digunakan untuk terapi kanker hepatocellular carcinoma (HCC) dengan menggunakan prinsip bioresonansi. Rangkaian yang dirancang terdiri dari osilator, modulator, dan amplifier. Pada modulator, sinyal yang dihasilkan merupakan sinyal yang berasal dari rangkaian osilator gelombang pembawa dan pemodulasi. Kemudian, output dari modulator akan dikuatkan melalui amplifier agar menghasilkan daya yang lebih besar. Adapun spesifikasi dari rangkaian generator sinyal adalah menghasilkan keluaran dengan tegangan efektif sebesar 125 mV dan 3 Volt setelah hasil penguatan serta frekuensi sebesar 27,12 MHz. Pada simulasi, sudah sesuai dengan spesifikasi yang ditentukan. Kemudian, pada tahap fabrikasi, rangkaian generator sinyal menggunakan dua PCB, yaitu untuk rangkaian osilator gelombang pembawa dan komponen generator lainnya (power supply, osilator gelombang modulasi, modulator, dan amplifier). Setelah itu, pengujian generator sinyal menghasilkan keluaran dengan tegangan efektif sebesar 28,28 mV dan 763,56 mV setelah hasil penguatan serta frekuensi sebesar 27,10 MHz. Perbedaan hasil antara hasil simulasi dan fabrikasi disebabkan oleh tidak terintegrasinya rangkaian generator sinyal. Hal ini mengakibatkan adanya penghubung yang digunakan sehingga terjadinya penurunan tegangan dan frekuensi. Selain itu, penggunaan komponen yang tidak sesuai dengan simulasi juga menyebabkan terjadinya penurunan tegangan dan frekuensi. ......This research aims to design, fabricate and analyze the circuit of radio frequency signal generator that is used for hepatocellular carcinoma (HCC) with bioresonancy method. The circuit consists of an oscillator, modulator, and amplifier. On the modulator, the resulted signal is a signal derived from both carrier wave oscillator and modulation wave oscillator. Then, the output will be amplified in order to generate greater power. After that, the specification of signal generator is a circuit that can be producing an output voltage of 125 mV and 3 V after amplification at 27.12 MHz. Then, simulation has been approved. In its implementation, the generator circuit consists of two circuits which combines the oscillator circuit and a modulation of the carrier wave. From the test shows that the modulator circuit produces output voltage of 28.28 mV and 763.56 mV after amplification at 27.10 MHz. The difference between simulation and fabrication is caused by separated part of the generator so needing a connector which produces losses. Besides that, there is a changing component which is caused a decrement output voltage and frequency.

Abstrak :
Latar Belakang: Kanker hati adalah penyebab paling umum kedua kematian akibat kanker di seluruh dunia, dan kejadian keganasan hati 'primer' telah meningkat secara signifikan, terutama Hepatocellular Carcinoma/ HCC. Karakteristik jaringan pada keganasan biasanya lebih padat/ kaku dibandingkan jaringan normal. Ultrasonografi dengan teknologi shear wave (gelombang geser) adalah metode perhitungan kekakuan jaringan, saat ini terdapat dua tipe; elastografi gelombang geser titik (pSWE) dan elastografi gelombang geser dua dimensi (2D-SWE). Belum ada studi yang menggunakan dua tipe gelombang geser tersebut pada lesi HCC yang sama untuk melihat kesesuaian antara nilai keduanya. Tujuan: Mengetahui derajat korelasi antara nilai USG pSWE dan nilai USG 2D-SWE pada HCC. Metode: Sebanyak 17 subjek penelitian dengan diagnosis HCC dilakukan pemeriksaan USG pSWE dan dilanjutkan dengan 2D-SWE (pada hari yang sama atau maksimal tujuh hari setelahnya) pada lesi HCC untuk menentukan nilai kekakuan jaringan (dalam satuan kPa dan m/s). Setelah itu dilakukan analisis korelasi antara nilai USG pSWE dengan USG 2D-SWE, dan dilanjutkan dengan mencari formula regresi di antara kedua nilai tersebut. Hasil: Pada lesi HCC terdapat korelasi positif kuat yang signifikan antara hasil USG pSWE dengan 2D-SWE pada perhitungan dengan kPa (R = 0,882 / p < 0,01) dan m/s (R = 0,875 / p < 0,01) , didapatkan pula formula regresi nilai kPa pSWE = 2,99 + 0,75 x kPa 2D-SWE dan nilai m/s pSWE = 0,31 + 0,82 x m/s 2D-SWE. Kesimpulan: Pada lesi HCC, dapat dilakukan pemeriksaan nilai kekakuan jaringan menggunakan pSWE maupun 2D-SWE, baik menggunakan satuan kPa maupun m/s dengan hasil yang setara. ......Background: Liver cancer is the second most common cause of cancer death worldwide, and the incidence of 'primary' liver malignancies has increased significantly, particularly Hepatocellular Carcinoma / HCC. Characteristics of tissue in malignancy are usually denser / stiffer than normal tissue. Ultrasound with shear wave technology is a method of calculating tissue stiffness, currently there are two types; point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE). There have not been studies using these two types of shear waves in the same HCC lesions to see the congruence between the two values. Objective: To determine the degree of correlation between the USG pSWE value and the 2D-SWE USG value on HCC. Methods: A total of 17 study subjects with a diagnosis of HCC were subjected to pSWE ultrasound examination and followed by 2D-SWE (on the same day or a maximum of seven days thereafter) on HCC lesions to determine the value of tissue stiffness (in kPa and m/s units). After that, a correlation analysis was carried out between the USG pSWE and USG 2D-SWE values, and continued by looking for the regression formula between the two values. Results: In HCC lesions, there was a significant positive correlation between pSWE ultrasound results and 2D-SWE in the calculation with kPa (R = 0.882 / p <0.01) and m / s (R ​​= 0.875 / p <0.01), also obtained the regression formula for the kPa pSWE value = 2.99 + 0.75 x kPa 2D-SWE and the m/s pSWE value = 0.31 + 0.82 xm / s 2D-SWE. Conclusion: In HCC lesions, tissue stiffness values ​​can be examined using pSWE and 2D-SWE, using either kPa or m / s units with equivalent results.

Abstrak :
Latar belakang: Sebagian besar pasien karsinoma sel hati (KSH) tahap lanjut memiliki masalah vaskular seperti trombus tumoral vena porta. Terapi sistemik yang direkomendasikan cenderung mahal dan belum terjangkau oleh banyak pasien. Oleh karena itu, perlu mencari alternatif terapi, seperti transarterial chemoembolization (TACE). Di Indonesia, TACE telah menjadi pilihan terapi untuk pasien dengan trombus tumoral vena porta (TTVP) berdasarkan PNPK, tetapi belum ada penelitian yang mengkaji hubungan antara TTVP parsial pada KSH dan respons terapi sesuai mRECIST setelah TACE. Tujuan: Untuk menganalisa hubungan antara respons terapi secara mRECIST pasca TACE dengan ada tidaknya TTVP parsial pada pasien KSH. Metode: Selama periode Januari 2020 hingga Juli 2023 terdapat 36 pasien KSH diterapi TACE dan memiliki imaging sebelum serta sesudah tindakan. Respons terapi dievaluasi berdasarkan modified Response Evaluation Criteria in Solid Tumors (mRECIST). Hasil: Terdapat 36 pasien yang memenuhi kriteria inklusi dengan 27 pasien KSH tanpa TTVP dan 9 pasien KSH dengan TTVP parsial. Setelah TACE, 22% pasien dengan TTVP parsial masuk dalam kategori responder, sedangkan pada kelompok tanpa TTVP, 41% pasien termasuk dalam kategori responder, dengan nilai p = 0,438. Kesimpulan: Tidak terdapat perbedaan respons tumor yang bermakna antara kelompok subjek KSH dengan TTVP parsial dan kelompok tanpa TTVP. Meskipun proporsi non responder pada kelompok TTVP parsial lebih banyak dibandingkan kelompok tanpa TTVP, namun masih terdapat 22% yang menunjukkan respons subjektif sehingga TACE masih dapat dipertimbangkan sebagai terapi pada pasien KSH dengan TTVP. ......Background: Most advanced-stage hepatocellular carcinoma (HCC) patients face vascular complications such as portal vein tumor thrombus (PVTT). Recommended systemic therapies tend to be costly and often inaccessible to many patients. Therefore, alternative treatments, such as transarterial chemoembolization (TACE), need to be explored. In Indonesia, TACE has become a treatment option for patients with portal vein tumor thrombus (PVTT) based on national guidelines, but no studies have yet examined the relationship between partial PVTT in HCC and treatment response according to mRECIST. Objective: : To analyze the relationship between post-TACE treatment response according to mRECIST and the presence of partial PVTT in HCC patients. Methods: From January 2020 to July 2023, 36 HCC patients underwent TACE and had pre- and post-procedure imaging. Treatment response was evaluated using modified Response Evaluation Criteria in Solid Tumors (mRECIST). Results: Among the 36 included patients, 27 had HCC without partial PVTT, and 9 had HCC with partial PVTT. After TACE, 22% of patients with partial PVTT were classified as responders, while in the group without partial PVTT, 41% were responders, with a p-value of 0.438. Conclusion: There was no significant difference in tumor response between the HCC patient groups with partial PVTT and those without. Despite a higher proportion of non-responders in the partial PVTT group, 22% still showed subjective response, suggesting that TACE may still be considered as a treatment option for HCC patients with partial PVTT.

Abstrak :
ABSTRAK
Pendahuluan: Alfa fetoprotein AFP merupakan penanda tumor yang mengalami peningkatan pada karsinoma hepatoselular KHS namun dapat juga normal pada 40 kasus. Peningkatan AFP dikatakan menghasilkan diferensiasi tumor yang buruk. Kasus KHS yang datang ke RSCM cenderung lanjut dengan karakteristik tersendiri. Penelitian ini bertujuan menilai korelasi AFP terhadap derajat diferensiasi KHS di RSCM.Metode: Data 32 kasus KHS di RSCM yang dilakukan hepatektomi dikumpulkan secara retrospektif dari 2010-2016. Data dasar karakteristik pasien dinilai berdasarkan nilai AFP dan derajat diferensiasi. Lalu dilakukan analisis untuk melihat korelasi nilai AFP dengan derajat diferensiasi KHS.Hasil: Nilai rata-rata AFP adalah 20183 ng/mL, usia 51,75 tahun, 81 kasus terjadi pada laki-laki, 59,4 berdiferensiasi buruk, 50 berukuran >5-10 cm, 50 kasus sirosis, dan 68,8 terdapat invasi pembuluh darah. Diferensiasi buruk 42 pada laki-laki, 47,4 pada HbsAg positif, 50 pada Anti HCV positif, 31,2 sirosis, dan 40,9 mengalami invasi pembuluh darah. Nilai AFP 20 ng/mL 42,1 berdiferensiasi buruk. Pada analisis orelasi didapatkan r=0,203 dengan p>0,05.Kesimpulan: AFP tidak dapat memprediksi derajat diferensiasi karsinoma hepatoseluler pada karakteristik kasus KHS di tempat kami.

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ABSTRACT<>br> Background AFP is a tumor marker which is increased in HCC, but might be found normal in 40 cases. Increased AFP implies a worsen tumor differentiation. Correlation between AFP with HCC managed in RSCM Ciptomangunkusumo hospital remains unclear. This study aimed to find the correlation between histological differentiation grade of HCC and AFP serum level.Method A total of 32 of HCC cases following hepatectomy in RSCM during 2010 2016 were enrolled in a retrospective study. Subject characteristics, AFP levels and histological differentiation grade were the variables in this study, and subjected to statistical analysis. Significancy found if p 5 10cm in diameter, 50 subjects were cirrhotic, and 68.8 subjects with microvascular invasion. AFP level found in range of 0.5 400000 ng mL 20183 SD75580.08 . Among all the subjects 12.5 were well differentiated, 28.1 were moderate differentiated, and 59.4 were poorly differentiated. AFP level 20ng mL was 42.1 . Correlation analysis revealed an r 0.203 with p 0.05.Conclusion There is no correlation between AFP serum level and histological differentiation grade of HCC in our study

Abstrak :
Latar belakang: Karsinoma sel hati (KSH) merupakan jenis keganasan primer hati tersering dengan gambaran histologik menunjukkan diferensiasi sel hepatoselular. Selain insiden yang tinggi, beban yang berat dari keganasan ini adalah prognosis yang sangat buruk dengan angka rekurensi yang tinggi. Terdapat banyak faktor resiko secara klinikopatologik yang telah diketahui mempengaruhi prognosis KSH, seperti kadar alfa fetoprotein, derajat diferensiasi, dan invasi mikrovaskular. Secara molekular, mutasi p53 dan β-catenin merupakan dua mutasi tersering dalam KSH. β-catenin merupakan protein multifungsi yang dikode oleh gen CTNNB1 yang dapat ditemukan pada 3 kompartemen sel, yaitu di membran sel, sitoplasma dan inti. Jalur Wnt/β-catenin meregulasi proses seluler yang terkait inisiasi, pertumbuhan, survival, migrasi, diferensiasi, dan apoptosis. Meski sudah banyak diketahui beberapa jalur patofisiologi molekular hepatokarsinogenesis, hubungan dengan aplikasi klinik membutuhkan pemahaman lebih mengenai hubungan sifat molekuler dan sifat fenotip tumor, terutama dalam penentuan faktor prognosis dan pengembangan terapi target. Penelitian ini bertujuan untuk menilai ekspresi β-catenin pada KSH dan hubungannya dengan berbagai faktor prognosis yaitu AFP, derajat diferensiasi dan invasi mikrovaskular. Bahan dan cara: Penelitian ini menggunakan desain potong lintang. Sampel terdiri atas 35 kasus KSH yang sudah ditegakkan diagnosisnya berdasarkan pemeriksaan histopatologik dan/atau imunohistokimia di RSCM dari Januari 2013 sampai September 2019. Dilakukan pulasan β-catenin dan analisis statistik dengan uji komparatif terhadap berbagai karakteristik klinikopatologik dan faktor resiko berupa AFP, derajat diferensiasi dan invasi mikrovaskular. Hasil: Terdapat perbedaan bermakna ekspresi β-catenin terhadap AFP (p=0,037) dan derajat diferensiasi (p=0,043) pada KSH. Ekspresi β-catenin pada inti dengan/tanpa sitoplasma lebih sering ditemukan pada kasus KSH dengan kadar AFP rendah dan derajat diferensiasi baik-sedang. Tidak ditemukan perbedaan bermakna ekspresi β-catenin terhadap invasi mikrovaskular pada KSH (p=1,000). Kesimpulan: Terdapat perbedaan bermakna ekspresi β-catenin terhadap AFP dan derajat diferensiasi pada KSH.

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Background: Hepatocellular carcinoma (HCC) is the most common primary liver cancer, displaying histologically hepatocellular differentiation. In addition to its high incidence, the disease burden of HCC is due to its poor prognosis with high recurrence rate. Some of the previously known clinicopathologic prognostic factors of HCC include alpha-fetoprotein (AFP) level, tumor grade and microvascular invasion. At molecular level, p53 and β-catenin are the two most common driver mutations in HCC that are mutually exclusive. β-catenin is a multifunction protein that is encoded by CTNNB1 gen. It is found in 3 compartments of cells, which are membrane cell, cytoplasm and nucleus. Wnt/ β-catenin pathway regulates cellular process which is related to initiation, growth, survival, migration, differentiation and apoptosis. Although molecular pathogenesis pathways of hepatocarcinogenesis are known, clinical application warrants more understanding in terms of molecular characteristic and tumor phenotype, especially in determining prognosis and target therapy development. This current study aims to analyze the expression of β-catenin and its association with prognostic factors, such as AFP, tumor grade and microvascular invasion. Material and method: A cross-sectional study was conducted comprising 35 samples of surgically resected HCCs between January 2013 to September 2019 in Cipto Mangunkusumo General Hospital. The cases were diagnosed based on histopathological and immunohistochemical findings and was then performed β-catenin staining. β-catenin expression was analyzed with statistical tests to determine expression difference between AFP level, tumor grade and microvascular invasion. Result: There were statistically significant difference of β-catenin expression in AFP level and tumor grade (p=0.037 and 0.043, respectively). Nuclear with/without cytoplasmic expression of β-catenin was more frequently found in HCC with low AFP level and well-to-moderately differentiated tumors. No significant difference was observed in β-catenin expression between HCC with and without microvascular invasion (p=1.000). Conclusion: β-catenin expression was significantly different in AFP level and tumor grade.

Abstrak :

Tujuan: Penelitian ini membandingkan efikasi dan keamanan radioterapi tubuh stereotaktik (SBRT) dengan atau tanpa kemoembolisasi transarterial (TACE) untuk pasien dengan karsinoma hepatoselular (KHS) stadium BCLC B dan C yang tidak memenuhi syarat untuk reseksi atau ablasi. Metode: Dari Januari 2016 hingga Maret 2019, sebanyak 33 pasien KHS dengan stadium BCLC B dan C, menjalani SBRT+TACE (n = 22) atau SBRT saja (n=11) di RSUPN Dr.Cipto Mangunkusumo. Kesintasan hidup keseluruhan (OS), kesintasan hidup bebas progresifitas (PFS), kontrol lokal (LC), dan toksisitas, dianalisis secara retrospektif. Hasil: Usia rerata adalah 56,5 tahun, dengan mayoritas pasien datang dengan CTP A (81,8%), BCLC stadium B (60,6%). Sebagian besar pasien memiliki tumor dengan PVT (75,8%), ukuran tumor >10 cm (66,7%), dengan rerata diameter terbesar 12,3 cm. Dosis radiasi bervariasi antara 27,5-50 Gy dalam 4-10 fraksi, dengan median EQD2 48 (35-, 5-72) Gy dan median BED10 57,6 Gy (42,6-86,4) Gy. Waktu follow-up rerata adalah 41 minggu untuk semua pasien. Pasien yang diterapi dengan SBRT+TACE menunjukkan peningkatan OS yang signifikan (46 bulan vs 23 bulan, p=0,008). Tingkat OS 1, 2, dan 3 tahun adalah 51%, 37%, dan 27% untuk kelompok SBRT+TACE; dan 18%, 9%, dan 0% untuk kelompok SBRT, masing-masing (p=0,008). Tingkat PFS 1, 2, dan 3 tahun adalah 31%, 19%, dan 13% untuk kelompok SBRT+TACE; dan 10%, 10%, dan 0% untuk kelompok SBRT, masing-masing (p=0,114). Tingkat LC 3, 6, dan 12 bulan adalah 88,9%, 92,9%, dan 75%. Tidak ada perbedaan toksisitas akut dan lanjut antara dua kelompok. Kesimpulan: Kombinasi SBRT+TACE menunjukkan tingkat OS yang lebih baik daripada SBRT saja pada pasien dengan KHS BCLC Stadium B dan C.

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Purpose: This study compared the efficacy and safety of stereotactic body radiation therapy (SBRT) with or without transcatheter arterial chemoembolization (TACE) for patients with BCLC stage B and C hepatocellular carcinoma (HCC) who were ineligible for resection or ablation therapies. Methods and materials: From January 2016 to March 2019, 33 patients with BCLC stage B and C HCC, underwent either SBRT+TACE (n = 22) or SBRT only (n =11) in RSUPN Dr.Cipto Mangunkusumo. The overall survival (OS), progression free survival (PFS), local control (LC), and toxicities were analyzed retrospectively. Results: The mean age was 56.5 years, with the majority of patients presenting with CTP A (81.8%), BCLC stage B (60.6%). Most patients had tumor with PVT (75.8%), tumor size >10 cm (66.7%), with the mean of largest diameter of tumor was 12.3 cm. The radiation dose varies between 27.5-50 Gy in 4-10 fractions, with a median of EQD2 is 48 (35-, 5-72) Gy and a median of BED10 is 57.6 Gy (42.6-86.4) Gy. The median follow-up time was 41 weeks for all patients. Patients treated with SBRT+TACE showed significantly improved OS (46.0 months vs. 23 months, p = 0.008).  The 1-, 2-, and 3-year OS was 51%, 37%, and 27% for the SBRT+TACE group; and 18%, 9%, and  0% for the SBRT group, respectively (p=0,008). The 1-, 2-, and 3-year PFS was 31%, 19%, and 13% for the SBRT+TACE group; and 10%, 10%, and  0% for the SBRT group, respectively (p=0,114). The 3, 6, and 12 month LC was 88,9%, 92,9%, dan 75%. However, there was no difference in acute and late toxicities between two groups. Conclusions: SBRT+TACE had better OS rates than SBRT only in patients with BCLC stage B and C HCC.

 

Abstrak :
Latar belakang: Karsinoma sel hati (KSH) merupakan salah satu kanker dan penyebab kematian akibat kanker tersering. Magnetic resonance imaging (MRI) abdomen multifase adalah modalitas pilihan untuk diagnosis KSH, karena dapat menggambarkan perubahan patofisiologi selama hepatokarsinogenesis melalui sekuens dynamic contrast enhanced (DCE), T1-weighted imaging (T1WI) dengan chemical shift imaging, T2- weighted imaging (T2WI), diffusion-weighted imaging (DWI), peta apparent diffusion coefficient (ADC), serta fase hepatobilier. Alpha fetoprotein (AFP) sebagai penanda serologis KSH terkait surveilans, diagnostik, dan prognostik, juga berperan dalam hepatokarsinogenesis dengan menunjukkan perbedaan agresivitas tumor. Penelitian ini bertujuan menganalisis hubungan antara temuan morfologi dan karakteristik KSH pada MRI dengan kadar serum AFP. Metode: Studi retrospektif ini dilakukan pada pasien KSH yang menjalani MRI abdomen multifase kontras spesifik hepatobilier dan kadar serum AFP di RSUPN dr. Cipto Mangunkusumo, serta belum menjalani prosedur pengobatan apapun. Dilakukan analisis menggunakan uji Chi Square atau uji Mutlak Fisher antara temuan morfologis dan karakteristik KSH pada MRI, serta menggunakan uji Mann-Whitney antara nilai rerata apparent diffusion coefficient (ADC) dengan kadar serum AFP. Hasil: Diperoleh 82 subyek dengan usia rerata subyek 58 tahun, diameter tumor >5cm (58,5%) dan tumor multipel (59,8%) paling banyak ditemukan, serta memiliki perbedaan proporsi yang bermakna dengan kadar serum AFP (nilai p = 0,030 dan p = 0,000). Vaskularisasi tumor, kapsul tumor, lemak intratumoral, tumor hiperintens T2, restriksi difusi, dan tumor hipointens fase hepatobilier lebih banyak ditemukan pada kadar serum AFP ≥ 100ng/mL, namun tidak ditemukan perbedaan proporsi bermakna. Terdapat perbedaan bermakna nilai rerata ADC antara 39 subyek dengan kadar serum AFP < 100ng/mL dan 43 subyek dengan AFP ³ 100ng/mL. Median nilai rerata ADC 1,19 (0,71 – 2,20) pada subyek dengan kadar serum AFP < 100ng/mL, median 0,97 (0,72 – 1,77) pada subyek dengan AFP ≥ 100ng/mL, dan nilai p = 0,003. Simpulan: Proporsi tumor berdiameter > 5cm dan tumor multipel pada subyek dengan AFP ≥ 100ng/mL secara bermakna lebih tinggi dibandingkan pada subyek dengan AFP < 100ng/mL. Nilai rerata ADC pada subyek dengan AFP ≥ 100ng/mL secara bermakna lebih rendah dibandingkan AFP < 100ng/mL. Sehingga nilai rerata ADC dapat membantu memprediksi kadar serum AFP pada pasien KSH. ......Background: Hepatocellular carcinoma (HCC) is one of the most common cancers and cancer-related death. Multiphase contrast-enhanced abdominal magnetic resonance imaging (MRI) is the modality of choice for the diagnosis of KSH, as it can depict pathophysiologic changes during hepatocarcinogenesis through sequences: dynamic contrast enhanced (DCE), T1-weighted imaging (T1WI) with chemical shift imaging, T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) maps, and hepatobiliary phase. Alpha fetoprotein (AFP) as a serological marker of HCC related to surveillance, diagnostics, and prognostics, also plays a role in hepatocarcinogenesis by showing differences in tumor aggressiveness. This study aims to analyze the relationship between morphological findings and characteristics of HCC on MRI with serum AFP levels. Methods: This retrospective study was conducted on HCC patients who underwent hepatobiliary-specific contrast-enhanced multiphase abdominal MRI and serum AFP levels at Dr. Cipto Mangunkusumo Hospital, had not undergone any treatment procedures. Chi Square or Fisher's exact test between morphological findings and characteristics of HCC on MRI, and Mann-Whitney test between mean apparent diffusion coefficient (ADC) values and serum AFP levels were analyzed. Results: There were 82 subjects with a mean age of 58 years, tumor size >5cm (58.5%) and multiple tumors (59.8%) were more common, had a significant difference in proportion with AFP serum levels (p value = 0.030 and p = 0.000). Tumor vascularization, tumor capsule, intratumoral fat, T2 hyperintense tumor, diffusion restriction, and hepatobiliary phase hypointense tumor were more common in serum AFP level ≥ 100ng/mL, but there was no significant difference in proportion. There was a significant difference in mean ADC between 39 subjects with serum AFP level < 100ng/mL and 43 subjects with AFP 100ng/mL. The median ADC score was 1.19 (0.71 – 2.20) in subjects with serum AFP level < 100ng/mL, median 0.97 (0.72 – 1.77) in subjects with AFP ≥ 100ng/mL, and p value is 0.003. Conclusion: The proportion of tumors > 5cm in diameter and multiple tumors in subjects with AFP ≥ 100ng/mL was significantly higher than that in subjects with AFP < 100ng/mL. The mean value of ADC in subjects with AFP ≥ 100ng/mL was significantly lower than AFP < 100ng/mL. So that the mean value of ADC can help predict serum AFP levels in patients with HCC.

Abstrak :
Latar belakang dan tujuan: Karsinoma sel hati merupakan keganasan primer hati yang paling sering dan menempati urutan kelima sebagai kanker tersering di seluruh dunia. Meskipun faktor risiko karsinoma sel hati sudah diketahui, namun insidensnya tetap tinggi dengan angka kesintasan yang tetap rendah. Bedah merupakan terapi definitif untuk pasien karsinoma sel hati. Penelitian ini bertujuan untuk mengetahui angka kesintasan pascareseksi dan faktor-faktor yang memengaruhi. Metodologi: Penelitian ini merupakan suatu penelitian kohort dengan analisis kesintasan di Departemen Klinik Ilmu Bedah Fakultas Kedokteran Universitas Indonesia RSCM. Data diperoleh dari rekam medis pasien karsinoma sel hati di RSCM selama periode Januari 2010 hingga Desember 2020. Variabel bebas yang diteliti adalah jenis kelamin, jumlah lesi, ukuran tumor, invasi vaskular, kadar AFP, sirosis hati, skor Child-Pugh, derajat histopatologi. Uji chi-square dilakukan untuk mengetahui hubungan antara variabel bebas dan terikat. Analisis multivariat dilakukan dengan Cox Proportional Hazard Regeresion test. Metode Kaplan Meier digunakan untuk menentukan tingkat kesintasan. Hasil: Sebanyak 86 subjek dikumpulkan pada penelitian ini. Terdapat 17 subjek dieksklusi karena data penelitian yang tidak lengkap. Median usia keseluruhan subjek adalah 54 tahun (33-76). Tingkat kematian subjek secara keseluruhan adalah 62,3%. Kesintasan subjek 6 bulan, 1 tahun, dan 3 tahun masing-masing adalah 66,6%; 56,5%; dan 37,6%. Pada penelitian ini tidak didapatkan satupun faktor risiko yang berhubungan dengan kesintasan. Kesimpulan: Dari hasil penelitian ini belum didapatkan faktor-faktor risiko yang signifikan memengaruhi kesintasan pasien karsinoma sel hati pascareseksi,.Perlu dilakukan penelitian dengan jumlah subjek lebih besar agar dapat diketahui faktor-faktor apa saja yang memengaruhi kesintasan pada pasien karsinoma sel hati pascareseksi. ......carcinoma is the most common primary liver cancer and the fifth most common cancer in the world. Despite the risk factors of hepatocellular carcinoma have been identified, its incidence is still high and survival rate is still low. Surgery is thought to be a definitive treatment for hepatocellular carcinoma patients. This research focuses on postresection survival rate and its associated factors. Method: This cohort retrospective data study was conducted at DR Cipto Mangunkusumo National General Hospital between January 2010 and December 2020. Information about sex, number of tumor, tumor size, vascular invasion, Alpha fetoprotein level, hepatic cirrhosis, Child-Pugh Score, and histopathologic stage were collected from medical record. Chi square analysis was done to investigate relationship between independent variables and dependent variable. Multivariate analysis was performed by using Cox Proportional Hazard Regression test. Kaplan Meier method was used to calculate survival rate. Result: A total of 86 subjects were recruited in this study, 17 subjects were excluded due to incomplete medical record. The median age of subjects in this study was 54 years old (33-76). The overall mortality in this study was 62.3%. Six months, 1 year, and 3 years survival rate were 66.6%; 56;5%; and 37.6% respectively. Our study showed that none of the factors analyzed associated with survival rate. Conclusion: We had not found any risk factors which associated with survival of patients with hepatocellular carcinoma. We suggest future research with larger number of subjects to identify any factors associated with survival of hepatocellular carcinoma subjects following resection.

Abstrak :
Pendahuluan: Efikasi neoadjuvan kemoembolisasi transarterial (N-TACE) pada karsinoma hepatoseluler (KSH) yang dapat direseksi masih diperdebatkan. Meskipun N-TACE dapat mengurangi ukuran tumor, dampaknya terhadap luaran jangka panjang masih belum dapat disimpulkan. Metode: Meta-analisis ini meninjau studi terkait N-TACE vs. Reseksi Hati (RH) pada karsinoma sel hati soliter besar (KSHSB) hingga Maret 2023 dari empat database online. Hasil: 5 penelitian dengan total sampel 1556 pasien (N-TACE = 474; LR = 1082) dilakukan analisis. Dari hasil analisis, tidak ada perbedaan signifikan antara kelompok N-TACE dan RH yang diamati pada KS dan KBT 1, 3, atau 5 tahun. Odds Ratio yang didapatkan adalah 0,91 (95% CI 0,54 – 1,54), 0,80 (95% CI 0,56 – 1,15), dan 0,88 (95%CI 0,47 – 1,65) untuk KS 1, 3, dan 5 tahun dan 0,66 ( 95% CI 0,32 – 1,34), 0,70 (95% CI 0,37 – 1,33), dan 0,75 (95% CI 0,28 – 1,98) masing- masing untuk KBT 1, 3, dan 5 tahun. Tidak ada perbedaan signifikan yang diamati pada kehilangan darah intraoperatif antar kelompok. Analisis subgroup menunjukkan KS 1, 3, dan 5 tahun yang mengarah ke N-TACE pada kombinasi kemoterapi dan KS 1 tahun yang lebih baik pada kelompok RH di kemoterapi agen tunggal. Selain itu, KBT 5 tahun lebih mengarah pada RH di kelompok agen kemoterapi tunggal (OR 2,82 95% CI 1,18 – 6,72) dan N-TACE pada kelompok kombinasi (OR 0,75 95%CI 0,28 – 1,98). Kesimpulan: Pengelolaan KSHSB memerlukan pertimbangan yang rumit dan diperlukan peningkatan strategi pengobatan untuk subkelompok HCC yang ini. Pengaruh N-TACE terhadap kelangsungan hidup jangka panjang dan kehilangan darah intraoperatif pada KSHSB memiliki hasil tidak signifikan. Namun, kombinasi kemoterapi pada N-TACE memberikan hasil yang lebih baik terhadap kesintasan pasien KSHSB. ......Introduction: The efficacy of neoadjuvant transarterial chemoembolization (N- TACE) in resectable hepatocellular carcinoma (HCC) remains debated. While N- TACE may reduce tumor size, its impact on long-term outcomes is inconclusive. Methods: This meta-analysis reviewed studies on N-TACE before surgical resection vs. LR SLHCC up to March 2023 from four online databases. Results: 5 studies with 1556 patients (N-TACE = 474; LR = 1082) were analyzed. No significant differences between N-TACE and LR groups were observed in 1-, 3-, or 5-year OS and DFS. The pooled HRs were 0.91 (95% CI 0.54 – 1.54), 0.80 (95% CI 0.56 – 1.15), and 0.88 (95%CI 0.47 – 1.65) for the 1-, 3-, and 5-year OS and 0.66 (95% CI 0.32 – 1.34), 0.70 (95% CI 0.37 – 1.33), and 0.75 (95% CI 0.28 – 1.98) for 1-, 3-, and 5-year DFS respectively. No significant differences were observed in intraoperative blood loss between groups as well. Subgroup analysis showed favorable 1-, 3-, and 5-year OS with combination chemotherapy N-TACE (combination group) and better 1-year OS in the LR group with single-agent chemotherapy N-TACE (single-agent group). In addition, 5-year DFS favored LR in the single-agent group (OR 2.82 95% CI 1.18 – 6.72) and N-TACE in the combination group (OR 0.75 95%CI 0.28 – 1.98). Conclusion: Managing SLHCC requires intricate considerations and enhancement of treatment strategies for this challenging subgroup of HCC is needed. The influence of N-TACE on long-term survival and intraoperative blood loss in SLHCC appears limited. However, combination chemotherapy in N-TACE results in better outcomes.