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Abstrak :
ABSTRAK
Tujuan: Mengetahui batasan nilai PSA untuk memprediksi adanya metastasis tulang pada pasien kanker prostat di RS Sardjito. Metode: Penelitian retrospektif, dengan mengumpulkan rekam medis pasien kanker prostat telah dilakukan bone scintigraphy di RS Sardjito tahun 2006 - 2011. Hasil: Dari 83 pasien kanker prostat yang telah dilakukan bone scintigraphy, terdapat 55 pasien (66%) mengalami metastasis tulang dan terdapat 28 pasien (34 %) yang tidak mengalami metastasis tulang. Dari 55 pasien yang mengalami metastasis tulang, terdapat 11 pasien (20 %) dengan PSA kurang dari 20 ng/ml dan terdapat 44 pasien (80 %) yang memiliki PSA lebih dari 20 ng/ml. Cut-off point PSA 17.65 ng/ml memiliki sensitivitas terbesar yaitu 85.5% dan spesifisitas 53.6%. Kesimpulan: Pemeriksaan bone scintigraphy dianjurkan pada pasien dengan PSA > 17.65 ng/ml, sedangkan pada pasien dengan PSA < 17.65 dianjurkan pada pasien dengan gejala klinis nyeri tulang.

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ABSTRACT
Objective: Prostate cancer shows a strong predilection to spread to the bones, with bone metastases identified at autopsy in up to 90 % of patients dying from prostate cancer. Serum prostate specific antigen (PSA) concentration has been widely applied as a biomarker to diagnose and monitor prostate cancer. Technetium-99m methylene diphosphate (Tc—99m MDP) whole body bone scintigraphy is currently a well-accepted diagnostic procedure for bone metastasis in malignancy. The aim of this study was to establish a useful serum PSA cut-off value to predict the presence of bone metastasis in men with prostate cancer. Material and Methods: Consecutive male patients diagnosed with prostate cancer were retrospectively analyzed. All of the subjects had received Tc-99m MDP whole body bone scintigraphy and had their serum PSA concentration measured at Sardjito Hospital, Yogyakarta. The proper cut-off value was established based on statistical analysis in order to predict the possibility of bone metastasis among prostate cancer patients. Results: In total, 83 consecutive male patients with prostate cancer were enrolled, and 55 patients (66 %) were confirmed by scintigraphic findings to have bone metastases. A serum PSA concentration of 17,65 ng/ml gave the best sensitivity (78,33 %) and specificity (65,21 %). The positive predictive value, negative predictive value were 85,45 % and 53,57 %, respectively (p<0,05). Conclusion: A cut-off value of 17,65 ng/ml appears to be an appropriate benchmark for stratifying metastatic bone disease in prostate cancer patients at Sardjito Hospital, Yogyakarta, such that if a patient with newly diagnosed prostate cancer and without any skeletal symptoms has a serum PSA concentration of less than 17,65 ng/ml,we suggest that they would not need to undergo bone scintigraphy.

Abstrak :
Latar Belakang: Kanker payudara merupakan jenis kanker yang paling sering terjadi pada wanita di seluruh dunia dan menyumbangkan angka mortalitas yang tinggi akibat risiko metastasis. Metastasis dapat terjadi meskipun pasien telah diterapi secara adekuat. Epitel-mesenchymal transition (EMT) adalah salah satu mekanisme utama terjadinya metastasis. Sel yang mengalami perubahan fenotip menjadi mesenkimal bersifat agresif, motil dan potensial menjadi metastasis. Vimentin merupakan salah satu biomarker spesifik yang muncul ketika sel mengadopsi fenotip mesenkim. Vimentin dapat memprediksi metastasis dan survival pada kanker payudara. Tujuan: Mengetahui hubungan antara ekspresi vimentin terhadap kejadian metastasis dan survival pada pasien kanker payudara. Metode: Desain studi ini adalah kohort retrospektif. Subjek berasal dari pasien kanker payudara di RSUP dr. Ciptomangunkusumo periode 2017–2018. Dilakukan pemeriksaan imunohistokimia untuk mengetahui ekspresi vimentin. Pasien diobservasi selama 4 tahun untuk mengetahui keluaran metastasis dan survival. Hasil: Terdapat 43 subjek, terdiri dari 39 ekspresi vimentin positif (90,7%), 10 subjek metastasis (23,3%), 16 subjek meninggal (37,2%). Pasien dengan ekspresi vimentin positif memiliki risiko 2,99 kali terjadi metastasis. Rerata overall survival (OS) pasien ekspresi vimentin positif lebih rendah dibandingkan negatif (162,0 minggu vs 174,5 minggu). Namun, secara statistik tidak terdapat hubungan bermakna antara vimentin terhadap kejadian metastasis (p=1,000) dan survival (p=0.971). Kesimpulan: Ekspresi vimentin tidak berhubungan dengan kejadian metastasis dan survival. Namun, ekspresi vimentin positif memiliki kecenderungan meningkatkan risiko metastasis dan mortalitas yang lebih cepat pada pasien kanker payudara. ......Background: Breast cancer is the most common of cancer in women around the world and contributes to a high mortality rate because of the risk of metastases. Metastases can still occur even if the patient has been adequately treated. Epithelial-mesenchymal transition (EMT) is one of the main mechanisms of metastasis. Cells that have a phenotypic change to mesenchymal are aggressive, motile, and prone to become metastatic. Vimentin is the specific biomarker that appears when cells have changed to mesenchymal phenotype. Vimentin can predict metastasis and survival in breast cancer. Aim: to find the association between vimentin expression with metastases and survival in breast cancer patients. Methods: This study design is a retrospective cohort. The subjects are breast cancer patients at Dr. Ciptomangunkusumo from 2017 to 2018. Immunohistochemical staining was performed to analyze the expression of vimentin. Patients were followed-up for 4 years to determine metastasis event and survival outcome. Results: There were 43 subjects, consist of 39 positive vimentin expressions (90.7%), 10 metastases (23.3%), and 16 death (37.2%). Patients with positive vimentin expression have 2.99-times the risk of developing metastases. The mean overall survival (OS) of patients with positive was lower than negative vimentin expression (162.0 weeks vs. 174.5 weeks). However, the association between vimentin with metastatic (p=1,000) and survival (p=0.971) outcome was not statistically significant. Conclusion: Vimentin expression is not associated with metastatic events and survival outcome. However, positive vimentin expression tends to increase the risk of metastasis and increase mortality rates in breast cancer patients.

Abstrak :
Latar belakang: Insidens metastasis otak lebih tinggi dibanding tumor primer otak dan berisiko menimbulkan kematian dengan penyebab terbanyak berasal dari kanker paru (36,5%) di RSUPN Cipto Mangunkusumo (RSCM). Keterlambatan diagnosis berisiko menyebabkan herniasi otak, sehingga terjadi kecacatan dan kematian. Dibutuhkan data mengenai durasi penegakan diagnosis di RSCM. Metode penelitian: Penelitian ini merupakan studi deskriptif analitik dengan rancangan kohort retrospktif untuk mengetahui kesesuaian antara durasi penegakan diagnosis tumor otak metastasis akibat kanker paru dengan pedoman praktik klinis (durasi ≤2 minggu). Subjek merupakan pasien rawat inap di RSCM pada Januari 2019 s/d Desember 2021. Hasil: Terdapat 12 subjek (30%) dapat ditegakkan dalam waktu ≤2 minggu dengan  median durasi 18,5 hari (IQR (12-34 hari). Selain itu didapatkan durasi 7 hari (IQR 4-11 hari) untuk sampai didapatkannya massa di paru,  durasi 8 hari (IQR 4.5-13 hari) sampai dilakukannya biopsi, dan 6 hari (IQR 3.5-7 hari) sampai keluarnya hasil patologi anatomi. Tidak terdapat hubungan yang bermakna secara statistik antara variabel yang dinilai dengan durasi penegakan diagnosis ≤2 minggu (14 hari). Kesimpulan: Hanya 30% subjek dengan durasi yang sesuai dengan panduan praktik klinis di RSCM. Dibutuhkan diseminasi hasil dan kolaborasi antar bagian agar penegakan diagnosis lebih cepat. ......Background: Incidence of brain metastases is higher than primary brain tumors, with lung cancer as common etiology (36.5%) at Cipto Mangunkusumo General Hospital (RSCM). Delay in diagnosis can cause brain herniation, resulting in disability and death. Data is needed regarding the duration of diagnosis in RSCM. Method: This is a descriptive analytic study with a retrospective cohort design to determine the conformity between the duration of diagnosis of metastatic brain tumors due to lung cancer in daily clinical practice with clinical practice guidelines (duration 2 weeks). Subjects were inpatients at RSCM from January 2019 to December 2021 Results: There were 12 subjects (30%) who could be diagnosed within 2 weeks with a median duration of 18.5 days (IQR (12-34 days). Duration of 7 days (IQR 4-11 days) to obtain a lung mass, 8 days (IQR 4.5-13 days) until a biopsy was performed, and 6 days (IQR 3.5-7 days) until anatomic pathology results were released. There is no statistically significant relationship between the variables assessed and the duration of diagnosis 2 weeks. Conclusion: Only 30% of subjects with the duration matched the clinical practice guidelines at RSCM. Dissemination of results and collaboration between departments is needed to make diagnosis faster.