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Abstrak :
Latar Belakang: Kanker pankreas adalah penyebab kematian keempat yang berhubungan dengan keganasan di Amerika Serikat, dan diperkirakan akan menjadi penyebab kematian kedua di tahun 2030 di United Kingdom. Indonesia belum memiliki data kesintasan kanker pankreas dan faktor-faktor yang memengaruhinya.Tujuan: Mengetahui kesintasan 1 tahun kanker pankreas dan faktor- faktor yang memengaruhinya di RS dr. Cipto Mangunkusumo, Jakarta.Metode: Dilakukan penelitian kohort retrospektif menggunakan data dari rekam medis pasien kanker pankreas RS dr. Cipto Mangunkusumo antara Januari 2012 - Desember 2016. Faktor umur, jenis kelamin, metastasis, stadium, komorbid dan pengobatan dianalisis secara bivariat dan multivariat menggunakan Cox Proportional Hazards Regression untuk mendapatkan Hazard Ratio HR setiap faktor prognosis. Kesintasan kumulatif 1 tahun setelah diagnosis dinyatakan dengan kurva Kaplan- Meier.Hasil: Dari 83 subyek penelitian proporsi laki-laki adalah 62.7, usia ge; 50 tahun 68,7, dengan rentang usia 33-79 tahun, dan rata-rata 55 tahun. Pada analisis bivariat didapati hubungan bermakna secara statistik kesintasan dengan variabel komorbid HR 2,116 IK 95 1,335-3,513 p< 0,002, metastasis HR 3,802 IK 95 1,995-7,249 p ......Background Pancreatic cancer is the fourth leading cause of death associated with malignancy in the United States, and is thought to be the second leading cause of death in 2030 in the United Kingdom. Currently, Indonesia has no data on the survival of pancreatic cancer and the factors that affect it. Aim This study aims to know the 1 year survival of pancreatic cancer and its influencing factors. Methods A retrospective cohort study was performed using data from the medical record of pancreatic cancer patients in dr Cipto Mangunkusumo General Hospital, Jakarta, from January 2012 to December 2016. Age, sex, metastasis, stage, comorbidities, and treatment were analyzed bivariate and multivariate using Cox Proportional Hazards Regression to obtain Hazard Ratio HR for each prognostic factor. The 1 year cumulative survival rate after diagnosis is expressed by the Kaplan Meier Curve.Results Of 83 subjects, the proportion of male was 62,7, age ge 50 years 68,7, with age range 33 79 years, and 55 years on average. In bivariate analysis, there was a statistically significant relationship of survival with comorbidities HR 2.116 95 CI 1.335 3.513 p 0.002, metastasis HR 3.802 95 CI 1.995 7.249 p 0.001, palliative treatment HR 2.108 95 CI 1.077 4.125 p 0.029 and group without treatment HR 2.924 95 CI 1.496 5.716 p 0.002. Multivariate analysis showed that metastasis provided the greatest risk of death with HR 4.306 95 CI 2.125 8.724 p 0.001. Palliative group HR was 2.510 95 CI 1.245 5.061 p 0.010 while the group without treatment gave HR 2.535 95 CI 1.277 5.032 p 0.008. Conclusion The overall survival of 1 year of pancreatic cancer patients was 14, with median survival of 6 months. The presence of metastasis and the decision not to do curative therapy Whipple surgery in patients with pancreatic cancer in dr Cipto Mangunkusumo General Hospital are the primary factors that negatively affect the 1 year survival rate.

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ABSTRAK
Latar Belakang dan tujuan: Karsinoma pankreas merupakan keganasan gastrointestinal kedua terbanyak dan merupakan salah satu tumor dengan angka kematian tinggi. Operasi reseksi merupakan satu-satunya terapi kuratif. Kegagalan dalam evaluasi preoperatif dari menyebabkan resiko operasi, terlambatnya pasien mendapat terapi paliatif serta meningkatkan biaya pengobatan. Penelitian ini bertujuan untuk mengevaluasi penilaian resektabilitas karsinoma pankreas pada CT-scan abdomen dibandingkan penemuan operasi serta faktor-faktor yang mempengaruhinya. Metode: Dilakukan pembacaan ulang CT scan pasien karsinoma pankreas pada sistem PACS Departemen Radiologi RSCM dan dibandingkan dengan laporan operasi pada rekam medis. Hasil: Uji statistik McNemar dari hubungan CT-scan dan operasi n=21 menunjukan p > 0,99, dengan nilai R = 0,52 p = 0,017 . Uji McNemar dari hubungan kesesuaian gambaran CT-scan abdomen dan penemuan operasi dengan teknik pemeriksaan CT-scan p > 0,05.Uji McNemar hubungan kesesuaian gambaran CT-scan abdomen dan penemuan operasi dengan interval CT-scan dan operasi p > 0,99. Uji McNemar hubungan kesesuaian gambaran CT-scan abdomen dan penemuan operasi dengan lama sakit p > 0,05. Kesimpulan: Terdapat kesesuaian antara gambaran CT-scan abdomen dengan penemuan saat operasi terhadap keterlibatan vaskuler pada karsinoma pankreas. Lama sakit, interval CT-scan dan operasi serta teknik pemeriksaan CT-scan memperlihatkan kecenderungan tidak berhubungan.Kata Kunci: CT-scan abdomen; karsinoma pankreas; laparatomi; resektabilitas ABSTRACT
Background and Objective : Pancreatic carcinoma is malignancy in gastrointestinal with high mortality. Surgery is the only curative therapy. Failure evaluation prior to surgery leads to the risk of non-curative surgery, delayed palliative and increased treatment costs. This study aims to evaluate the resectability assessment of pancreatic carcinoma in preoperatif CT-scan compared to surgical findings and the factors that influence it. Methods : Patients with pancreatic carcinoma whose CT scans were in the PACS system of the Radiology Department RSCM reevaluated and compared with surgical reports. Results : McNemar 39;s analysis of the preoperative CT-scan and surgical findings n=21 p>0.99, with R=0.52 p=0.017 . The McNemar analysis conformity relationship between preoperative abdominal CT scan and surgical findings with CT-scan technique p>0.05. McNemar analysis conformity relationship between preoperative abdominal CT-scan and surgical findings with CT-scan interval and surgery p> ?? ??0.99. McNemar analysis conformity relationship between preoperative abdominal CT-scan and surgical findings with prolonged illness p> ?? ??0.05. Conclusion : There is a suitability between preoperative abdominal CT-scan and the surgical findings of vascular involvement in pancreatic carcinoma. Length of prolonged illness, interval between CT-scan and surgery as well as CT-scan technique showed a tendency not to correlate.

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ABSTRACT
Purpose Adenosquamous carcinoma (ASC) of the pancreas is a rare malignancy, associated with a poor prognosis after surgical resection, with reported median survival times (MSTs) ranging from 4.4 to 13.1 months. We conducted this study to investigate the long-term outcomes of patients after the resection for ASC. Methods Between 2002 and 2016, a total of 456 patients underwent resection for ASC or adenocarcinoma (AC) of the pancreas. ASC was confirmed in 17 (3.7%) of these patients. We analyzed the clinicopathological characteristics and survival of these 17 patients in comparison with those of patients with AC of the pancreas. Results The operative procedures performed were pancreaticoduodenectomy (n = 6) and distal pancreatectomy (n = 11). Seven (41.2%) of the 17 patients underwent combined organ resection. R0 resection was achieved in 16 (94.1%) patients. The 5-year overall survival (OS) rate and MST were 40.3% and 20.9 months, respectively. A squamous component of ≥ 60% (P = 0.001) and R1 resection (P < 0.001) were significantly associated with poor OS for patients with ASC Conclusion This study revealed longer survival and a higher R0 resection rate after aggressive combined resection in our ASC patients than those in previous studies. Although this was only a small series, our findings suggest that local control with aggressive resection may be an effective treatment protocol for ASC patients.

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Pendahuluan: Pembedahan merupakan pilihan tatalaksana kuratif terbaik kanker pancreas, oleh karena itu sangat penting untuk dapat menegakkan diagnosis secara akurat sejak awal. Skor BACAP dan CA 19-9 telah diterima sebagai prediktor resektabilitas kanker pancreas yang cukup baik, dan akurasinya diharapkan akan meningkat apabila keduanya dikombinasikan. Studi ini bertujuan untuk mengetahui keluaran yang dihasilkan oleh kombinasi skor BACAP dan penanda tumor CA 19-9. Metode: Penelitian potong lintang retrospektif ini melibatkan pasien kanker pankreas yang telah menjalani operasi di RSUPN Dr. Cipto Mangunkusumo Indonesia pada periode Januari 2017 hingga April 2023. Data diperoleh dari medical record. Pasien dengan penyakit penyerta seperti jaundice karena obstruksi batu bilier, pankreatitis, sirosis hati, kelainan paru dan pasien dengan neoadjuvant akan diekslusi. Nilai  CA 19-9 diperoleh melalui pemeriksaan Chemiluminescent Immunoassay, titik potong 140,6 dipilih berdasarkan penelitian sebelumnya di RSCM. Nilai skor BACAP melibatkan enam variabel klinis dan radiologis dan dapat diperoleh dengan mengaplikasikan kalkulator yang terdapat pada http://jdlp.fr/resectability/. Hasil: Total 87 pasien yang dilibatkan pada penelitian ini didapatkan keluaran skor BACAP yaitu sensitivitas sebesar 50,0%, spesifisitas 100%; PPV 100%; NPV 73,8%, dan akurasi 75,9% (AUC 94,6%). Sementara modifikasi skor BACAP menghasilkan sensitivitas 83,1%, spesifisitas 85,7%, PPV 70,5%, NPV 92,5%, dan akurasi 83,9% (AUC 89,4%). Kesimpulan: Kombinasi CA 19-9 dan skor BACAP menghasilkan skor modifikasi dengan keluaran yang lebih baik dibandingkan skor BACAP dalam memprediksi resektabilitas karsinoma pankreas. ......Background: Surgery remains the best choice curative treatment for pancreatic cancer. Therefore, it is crucial to establish accurate diagnosis from the beginning. BACAP score and CA 19-9 have been identified as good predictors of pancreatic cancer resectability, and their accuracy is expected to increase when combined. This study aimed to determine the outcomes produced by the combination of the BACAP score and CA 19-9 tumor marker Methods: This was a retrospective cross-sectional study involved 87 pancreatic cancer patients who underwent surgery between January 2017 and April 2023. The research data was obtained from medical records. The presence of other diseases such as biliary stones, strictures, pancreatitis, liver cirrhosis, or other pulmonary abnormalities, and prior neoadjuvant chemotherapy were excluded. The CA 19-9 value was obtained through a blood examination using the Chemiluminescent Immunoassay method. The cut-off point of 140.6 has been selected and determined based on previous studies at RSCM. The BACAP score, comprising 6 variables (Abdominal pain, weight loss, tumor size, thrombosis, tumor location, and performance status), was applied to the entire research sample using the BACAP score calculator available at http://jdlp.fr/resectability/. Results: A total 87 patients were included. BACAP score yields a sensitivity of 50.0%, specificity of 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 73.8%, and accuracy of 75.9% (AUC 94.6%). While modified BACAP score yielded a sensitivity of 83.1%, specificity of 85.7%, PPV of 70.5%, NPV of 92.5%, and accuracy of 83.9% (AUC 89.4%). Conclusion: The combination of CA 19-9 and the BACAP score yields a modified score with better outcomes compared to the BACAP score alone in predicting the resectability of pancreatic carcinoma.

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Latar Belakang: Pulau Langerhans adalah kumpulan sel pernghasil insulin yang tersebar di seluruh pankreas. Resistensi insulin adalah salah satu tanda dari diabetes tipe 2, pada pasien diabetes tipe 2 terjadi penurunan pada ukuran dan jumlah dari pulau Langerhans yang berdampak pada produksi insulin dan menyebabkan pasien dengan kondisi ini memiliki kadar gula darah yang tinggi. Alpha-mangostin diduga berperan dalam proses regenerasi pancreas pada kondisi resistensi insulin. Tujuan dari penelitian ini adalah untuk mengetahui efek dari alpha-mangostin terhadap regenerasi pankreas, baik pada kelenjar endokrin (pulau Langerhans) maupun kelenjar eksokrin. Metode: Tikus jantan galur wistar diacak dan dibagi menjadi 6 kelompok berdasarkan perlakuan yang diterima; Kelompok Normal/Kontrol, Kelompok Normal + Alpha Mangostin 200mg/kgBB, Kelompok Resistensi Insulin (Induksi STZ + HF + HG), Kelompok Resistensi Insulin + Alpha Mangostin 100mg/kgBB, Kelompok Resistensi Insulin + Metformin 200mg/kgBB, Kelompok Resistensi Insulin + Alpha Mangostin 200mg/kgBB. Diameter pulau Langerhans dihitung menggunakan aplikasi ImageJ computer software, sedangkan struktur histologi bagian eksokrin diobservasi dibawah mikroskop cahaya. Hasil: Pemberian alpha mangostin menyebabkan peningkatan pada luas area Langerhans islet secara signifikan. Tidak ditemukan pengaruh signifikan pada pemberian alpha mangostin pada kelenjar eksokrin pulau Langerhans. Kesimpulan: Terdapat hubungan bermakna antara pemberian alpha-mangostin dengan regenerasi pulau Langerhans pankreas pada tikus model insulin resisten. Alphamangostin tidak menyebabkan terjadinya perubahan struktur histologi pada bagian eksokrin pancreas. ......Background: The islets of Langerhans are clusters of insulin-producing cells scattered throughout the pancreas. Insulin resistance is one of the signs of type 2 diabetes, in patients with type 2 diabetes there is a decrease in the size and number of the islets of Langerhans which affects insulin production and causes patients with this condition to have high blood sugar levels. Alpha-mangostin is thought to play a role in the process of pancreatic regeneration in conditions of insulin resistance. The purpose of this study was to determine the effect of alpha-mangostin on pancreatic regeneration, both in endocrine glands (island of Langerhans) and exocrine glands. Method: Wistar male rats were randomized and divided into 6 groups based on the treatment received; Normal/Control Group, Normal Group + Alpha Mangostin 200mg/kgBB, Insulin Resistance Group (STZ Induction + HF + HG), Insulin Resistance Group + Alpha Mangostin 100mg/kgBB, Insulin Resistance Group + Metformin 200mg/kgBB, Insulin Resistance Group + Alpha Mangostin 200mg /kgBB. The diameter of the islets of Langerhans was calculated using the ImageJ computer software application, while the histological structures of the exocrine sections were observed under a light microscope. Results: Administration of alpha mangostin caused a significant increase in the Langerhans islet area. No significant effect was found on the administration of alpha mangostin on the exocrine glands of the islets of Langerhans. Conclusion: There is a significant relationship between the administration of alphamangostin and the regeneration of the pancreatic islets of Langerhans in insulin-resistant rats. Alpha-mangostin does not cause changes in the histological structure of the exocrine pancreas.

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ABSTRAK
Tujuan: Menilai ekspresi protein Epidermal Growth Factor Receptor (EGFR) pada Karsinoma Sel Ginjal (KSG) serta kaitannya dengan faktor-faktor prediktor prognosis yang dinilai secara histopatologik (subtipe, staging histopatologik, derajat anaplasia inti Fuhrman)

Metode: Studi potong lintang terhadap jaringan yang difiksasi formalin dan diletakkan di dalam parafin dari pasien-pasien dengan KSG, yang diwarnai menggunakan metode imunohistokimia terhadap protein EGFR.

Hasil: Ekspresi EGFR pada membran ditemukan pada 46% dari keseluruhan kasus (N=41) dan ekspresi EGFR di sitoplasma ditemukan pada 49% dari keseluruhan kasus (N=41). Terdapat hubungan antara subtipe histopatologik dan derajat anaplasia inti Fuhrman dengan ekspresi EGFR di sitoplasma (nilai p 0,017 dan 0,014 dengan uji Fisher’s exact). Tidak ditemukan asosiasi antara staging histopatologik dengan ekspresi EGFR.

Diskusi: Perlu dibuat penelitian lanjutan dengan membandingkan ekspresi EGFR terhadap angka kesintasan pasien serta dibandingkan dengan faktor prediktor prognosis yang lain. Kemaknaan lokasi ekspresi EGFR di sitoplasma juga memerlukan perhatian khusus dan pembuktian secara ilmiah.

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ABSTRACT
Objective: To study the expression of Epidermal Growth Factor Receptor protein in Renal Cell Carcinoma (RCC) and its relationship with prognostic predictor factors evaluated histopathologically (subtype, histopathological staging, Fuhrman nuclear grading).

Methods: This was a cross-sectional study on 41 formalin-fixated paraffin-embedded tissue of patients with RCC, stained using immunohistochemical method against EGFR protein.

Result: Membranous EGFR expression was found in 46% of cases (N=41), while cytoplasmic EGFR expression was found in 49% of cases. There was a significant association between histopathological subtype or Fuhrman nuclear anaplasia grading and cytoplasmic expression of EGFR (p value 0,017 and 0,014, respectively, using Fisher’s exact test). No significant association was found between histopathological staging and EGFR expression

Discussion: A further study on the association EGFR expression and survival, and its comparison to other prognostic factors is necessary. The significance of EGFR expresion in the cytoplasm requires special attention and further scientific evidence.