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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 :
Latar Belakang: Kanker nasofaring (KNF) merupakan jenis keganasan yang paling umum terjadi di wilayah kepala dan leher di Indonesia. Saat ini, terjadi pergeseran paradigma ke konsep tumor microenvironment, yang menekankan pentingnya penanda biologis. Rasio limfosit monosit (RLM) mencerminkan Tumor-Infiltrating Lymphocytes (TIL) dan Tumor- Associated Macrophages (TAM). Namun, temuan penelitian tentang RLM, TIL CD8, dan TAM CD163 sebagai prediktor untuk Progression-Free Survival (PFS) masih kontroversial. Belum ada penelitian yang menyelidiki hubungan antara marker-marker ini dan PFS 3 tahun pada pasien KNF stadium lokal lanjut di Indonesia. Tujuan: Mengetahui PFS 3 tahun pada pasien KNF stadium lokal lanjut dan mengetahui hubungan antara RLM, TIL, dan TAM dengan PFS 3 tahun. Metode: Studi kohort retrospektif yang dilakukan di Rumah Sakit Cipto Mangunkusumo (RSCM) selama periode Januari 2015 hingga 2020. Kami menghimpun data mengenai karakteristik demografis pasien, menghitung RLM, dan pewarnaan imunohistokimia untuk TAM CD163 dan TIL CD8 pada blok biopsi jaringan. Analisis penentuan nilai titik potong dilakukan melalui kurva receiver operating curve (ROC) untuk ketiga ini. Setelahnya, kami melakukan analisis terhadap ketiga parameter tersebut terkait PFS 3 tahun dengan menggunakan kurva Kaplan-Meier dan uji log rank. Untuk mengatasi variabel perancu, dilakukan uji Cox Regression. Hasil: Didapatkan persentase PFS 3 tahun KNF stadium lokal lanjut sebesar 46,7%. Nilai titik potong terbaik untuk RLM, CD163, dan CD8 berturut – turut adalah 1,82, 1,96, dan 47,5%. Berdasarkan analisis bivariat dan multivariat, didapatkan RLM ≤ 1,82 (aHR 1,785, IK95% 1,057 – 3,018), CD163 ≥196 (aHR 6,126, IK95% 3,382 – 11,097), dan CD8 ≤47,5% (aHR 2,099, IK95% 1,232 – 3,575). Simpulan: Nilai RLM dan TIL CD8 yang tinggi berhubungan dengan PFS 3 tahun yang baik, sedangkan TAM CD163 yang tinggi berhubungan dengan PFS 3 tahun yang buruk pada pasien KNF lokal lanjut. ......Background: Nasopharyngeal cancer (NPC) is the most common malignancy in the head and neck region in Indonesia. Recently, there has been a paradigm shift towards the concept of the tumor microenvironment, emphasizing the significance of biological markers. The lymphocyte-to-monocyte ratio (LMR) reflects Tumor-Infiltrating Lymphocytes (TILs) and Tumor-Associated Macrophages (TAMs). However, findings on LMR, CD8 TILs, and CD163 TAMs as predictors for Progression-Free Survival (PFS) remain controversial. No study has yet investigated the relationship between these markers and 3-year PFS in patients with advanced local-stage NPC in Indonesia. Objective: To determine the 3-year PFS in patients with advanced local-stage NPC and to ascertain the relationship between LMR, TILs, and TAMs with 3-year PFS. Methods: A retrospective cohort study was conducted at Cipto Mangunkusumo Hospital (RSCM) from January 2015 to 2020. We gathered data on patient demographic characteristics, calculated LMR, and performed immunohistochemical staining for CD163 TAMs and CD8 TILs on tissue biopsy blocks. The determination of cutoff values was performed using receiver operating curve (ROC) analysis for all three. Subsequently, we analyzed these parameters in relation to 3-year PFS using Kaplan-Meier curves and log-rank tests. Cox Regression analysis was conducted to adjust for confounding variables. Results: The 3-year PFS rate for advanced local-stage NPC was found to be 46.7%. The optimal cutoff values for LMR, CD163, and CD8 were 1.82, 1.96, and 47.5%, respectively. Based on bivariate and multivariate analyses, we found LMR ≤ 1.82 (aHR 1.785, 95% CI 1.057 – 3.018), CD163 ≥196 (aHR 6.126, 95% CI 3.382 – 11.097), and CD8 ≤47.5% (aHR 2.099, 95% CI 1.232 – 3.575). Conclusion: High LMR and CD8 TIL values are associated with favorable 3-year PFS, while high CD163 TAM values are associated with poor 3-year PFS in patients with advanced local-stage NPC.

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.