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"Penelitian ini bertujuan untuk mengetahui alat skrining malnutrisi yang sesuai untuk pasien kanker dewasa rawat inap pra bedah sehingga malnutrisi cepat dikenali dan dapat diberikan dukungan nutrisi secara dini. Penelitian ini merupakan uji diagnostik alat skrining Malnutrition Screening Tool (MST) dan Royal Marsden Nutrition Screening Tool (RMNST) dengan Subjective Global Assessment (SGA) sebagai pembanding terhadap 58 pasien kanker rawat inap pra bedah yang masuk rumah sakit kurang dari 24 jam. Sensitivitas, spesifisitas, nilai duga positif (NDP), nilai duga negatif (NDN), dan area under the curve (AUC) dihitung untuk mengetahui metode yang paling baik diantara dua alat skrining dibanding standar baku. Hasil penelitian didapatkan prevalensi malnutrisi berdasarkan SGA sebesar 34,6%. Sensitivitas, spesifisitas, NDP, NDN, dan AUC MST berturut-turut adalah 88.9%, 97%, 94,12%, 94,28%, dan 93% sedangkan sensitivitas, spesifisitas, NDP, NDN, dan AUC RMNST masing-masing adalah 94.4%, 82.35%, 73,9%, 96,55%, and 88%. Hal ini menunjukkan bahwa RMNST lebih baik dibanding MST dalam menapis malnutrisi pada pasien kanker rawat inap pra bedah.

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This study aimed to determine malnutrition screening tool which appropriate for adult hospitalized pre-surgical cancer patients, therefore, malnutrition could be recognized quickly and nutritional intervention could be provided at an early stage. This study was a diagnostic test of Malnutrition Screening Tool (MST) and the Royal Marsden Nutrition Screening Tool (RMNST) compared to Subjective Global Assessment (SGA) on 58 cancer pre-surgical inpatients who were admitted to the hospital less than 24 hours. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) were calculated to evaluate the perfomance of tools compared the standard. The result showed that the prevalence of malnutrition by SGA was 34.6%, the sensitivity, specificity, PPV, NPV, and AUC of MST were 88.9%, 97%, 94,12%, 94,28%, and 93% respectively while the sensitivity, specificity, PPV, NPPV, and AUC of RMNST were 94.4%, 82.35%, 73,9%, 96,55%, and 88% respectively. This indicated that RMNST better than MST in screening malnutrition in the cancer pre-surgical inpatients."

"Latar Belakang: Sel kanker membutuhkan asam amino untuk metabolismenya telah ditemukan pada beberapa studi. Metabolisme ini meyebabkan profil asam amino mengalami perubahan pada kanker payudara. Profil asam amino pada kanker payudara ini dapat menentukan prognosis penyakit pada kanker payudara.Tujuan: Mengetahui hubungan profil asam amino dengan faktor risiko kanker payudara di RS Ciptomangunkusumo, Indonesia.Metode: Penelitian ini merupakan penelitian cross-sectional pada 19 subjek kanker payudara dan 19 subjek kontrol yang memenuhi kriteria penelitian di RSCM, Jakarta, Indonesia. Asam amino dianalisis menggunakan teknik liquid chromatography. Data tersebut dianalisis menggunakan uji independent sample t-test dan uji Mann-Whitney U.Hasil:Perbedaan profil asam amino pada kanker payudara yang signifikan dibandingkan dengan kontrol ditemukan pada peningkatan asam amino sistin dan penurunan asam amino valin, lisin, histidin, alanin, ornitin, tirosin, glutamin, fenilalanin, dan asam amino prolin. Terdapat signifikansi antara asam amino dengan faktor risiko usia, jumlah paritas, riwayat pemberian ASI, usia menarke, dan kebiasaan berolahraga.

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Background: Cancer cell needs amino acids for its metabolism has been found in recent studies. Amino acids profile changes due to cancer cells’ metabolism. This amino acids profile in breast cancer could determine the prognosis of disease in breast cancer.

Objective: To aimed relationship between amino acids profile in breast cancer with its risk factor in Ciptomangunkusumo Hospital, Indonesia.

Method: A cross-sectional study in 19 breast cancer subjects and 19 control subjects that included into the criteria was conducted in this research. Amino acids was examined with liquid chromatography technique. The data was analyzed with independent sample t-test and Mann-Whitney U test.

Result: There are significant differences of amino acids profile between breast cancer subjects and control subjects, essentially for increased cystine profile and decreased valine, lysine, histidine, alanine, ornithine, tyrosine, glutamine, phenylalanine, and proline. There are also significance between amino acids profile in breast cancer with risk factors, including age, parity, breastfeeding history, menarche age, and workout habit."

"Kanker payudara adalah kanker yang paling umum didiagnosis pada wanita. angka kanker payudara di Indonesia mencapai 42,1 orang per 100 ribu penduduk. Rata-rata kematian akibat kanker ini mencapai 17 orang per 100 ribu penduduk. Obesitas dapat mewakili faktor risiko penting dari pengembangan kanker payudara. Prevalensi global kelebihan berat badan dan obesitas telah meningkat sebesar 27% pada usia dewasa dan 47% pada masa kanak-kanak selama dekade terakhir. Tujuan penelitian yaitu menganalisis hubungan obesitas dengan kejadian kanker payudara pada perempuan di Indonesia. Desain penelitian yaitu cross sectional dan menggunakan analisis regresi logistik dengan menggunakan data sekunder dari Riset Penyakit Tidak Menular Tahun 2016. Sampel yang memenuhi kriteria inklusi dan eksklusi pada penelitian ini berjumlah 27.186 orang. Hasil analisis menunjukkan proporsi perempuan obesitas yang mengalami kanker payudara adalah 0,9%. Hubungan antara obesitas dengan kanker payudara tidak terdeteksi setelah dikontrol oleh penggunaan kontrasepsi hormonal, usia, kebiasaan merokok, usia menarche, alkohol, dan aktivitas fisik. (POR=1,002 95% 0,777-1,291). Walaupun demikian, program intervensi untuk mengurangi masalah kesehatan kanker payudara dan obesitas perlu dilakukan mengingat proporsi kanker payudara dan obesitas yang terus meningkat.

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Breast cancer is the most common cancer diagnosed in women. Breast cancer rate in Indonesia reaches 42.1 people per 100 thousand population. The average death rate from this cancer reaches 17 people per 100 thousand population. Obesity may represent an important risk factor for developing breast cancer. The global prevalence of overweight and obesity has increased by 27% in adulthood and 47% in childhood over the past decade. The research objective was to analyze the relationship between obesity and the incidence of breast cancer in women in Indonesia. The research design was cross sectional and used logistic regression analysis using secondary data from the 2016 Non-Communicable Disease Research. The sample that met the inclusion and exclusion criteria in this study was 27,186 people. The analysis showed that the proportion of obese women who had breast cancer was 0.9%. The relationship between obesity and breast cancer is not detected after being controlled by hormonal contraceptive use, age, smoking habits, age of menarche, alcohol, and physical activity. (POR=1.002 95% 0.777-1.291). However, intervention programs to reduce breast cancer health problems and obesity need to be carried out given the increasing proportion of breast cancer and obesity."

"Pendahuluan. Tiroidektomi total merupakan prosedur baku pada penanganan keganasan tiroid maupun kelainan jinak tiroid yang gagal pengobatan. Namun sering terjadi komplikasi hipokalsemia akibat cedera kelenjar paratiroid. Upaya untuk mengurangi komplikasi tersebut telah banyak dilakukan, namun komplikasi hipokalsemia tetap tinggi. Banyak faktor dapat menimbulkan hipokalsemia pasca tiroidektomi total telah diteliti di seluruh dunia. Di RSCM sejauh ini belum ada studi yang terfokus pada faktor-faktor yang memengaruhi kejadian hipokalsemia pasca tiroidektomi total.Metode. Studi potong lintang dilakukan pada subjek yang menjalani tiroidektomi total dan completion pada periode Januari 2013 ? Desember 2015 di Divisi Bedah Onkologi FKUI/RSCM. Faktor yang memengaruhi hipokalsemia diketahui melalui telusur rekam medis.Hasil. Dari 250 subjek (33 laki-laki, 217 perempuan) dilakukan tiroidektomi total (197 subjek) dan completion (53 subjek). Diperoleh prevalensi hipokalsemia 39,6%. Rerata usia subjek 44,2 tahun. Ukuran tumor tiroid lebih besar dari 4 cm pada 161 subjek (64%). Metastasis KGB pada 56 subjek (26,8%). Histopatologik tiroid ganas pada 209 subjek (83,6%). Diseksi leher dilakukan pada 56 subjek (22,4%). Operator junior sebagai operator utama pada 129 subjek (51,6%). Rata-rata Lama rawat 4,85±2,2 hari bila timbul hipokalsemia. Mayoritas (70,7%) penurunan kalsium serum terjadi pada hari pertama pascaoperasi. Gejala hipokalsemia ringan pada 82 subjek (82,8%). Hanya 1% yang mengalami hipokalsemia berat. Analisis statistik menunjukkan diseksi leher dan operator junior merupakan faktor risiko yang bermakna (nilai P. 0,027 dan nilai P. 0,002).Kesimpulan. Prevalensi hipokalsemia pasca tiroidektomi total sebesar 39,6%. Faktor yang berisiko menyebabkan hipokalsemia pascaoperasi tiroidektomi total adalah dilakukan diseksi leher dan operator junior.

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ABSTRACTIntroduction: Total thyroidectomy is a standard procedure in the treatment of thyroid malignancies and benign thyroid disorder treatment failures. The most frequently complication of total thyroidectomy is hypocalcemia due to injury to the parathyroid glands. Efforts to reduce these complications has been widely applied, but the complication rate is still high. Many factors could cause hypocalcaemia recognizable after total thyroidectomy has been investigated throughout the world. In the Faculty of medicine / RSCM no study has focused on the factors that influence the incidence of hypocalcemia after total thyroidectomy.Methods: A cross-sectional study was conducted by taking medical record data subjects who have undergone total thyroidectomy and completion operations in the period January 2013 - December 2015 in the Division of Surgical Oncology Faculty of Medicine / RSCM. The factors that affect hypocalcemia identified through a search of medical records.Results: Of the 250 subjects (33 male, 217 female) with thyroid tumor action has been taken total thyroidectomy (197 subjects) and completion (53 subjects). Hypocalcemia prevalence of 39.6%. The mean age of subjects was 44.2 years. 64% (161 subjects) to measure thyroid tumors larger than 4 cm. 26.8% (56 subjects) had metastatic lymph nodes. 83.6% (209 subjects) with malignant thyroid tumors. 22.4% of the subjects underwent neck dissection. 51.6% (129 subjects) surgery performed by a junior operator. The average length of stay was 4.85 ± 2.2 days in case of hypocalcaemia. The majority (70.7%) decrease in serum calcium occur on the first day after surgery. 82.8% (82 subjects) experienced mild symptoms of hypocalcemia. Only 1% experiencing severe hypocalcemia. Factors that cause the risk of hypocalcemia is performed neck dissection and junior operator.Conclusion: The prevalence of post-thyroidectomy hypocalcemia total of 39.6%. These risk factors cause postoperative hypocalcemia total thyroidectomy was performed neck dissection and junior operator.Keywords: Total thyroidectomy; completion; hypocalcemia; parathyroid glands."

"Latar Belakang: NAC neoadjuvant chemotherapy secara umum telah digunakan di LABC locally advanced breast cancer untuk mengurangi ukuran tumor dan membuat tumor tersebut bisa untuk dioperasi. Meskipun ukuran tumor telah berkurang, masih diperdebatkan batas pembedahan pasca NAC untuk LABC dengan karsinoma mastitis, ulkus payudara, dan fitur agresif lainnya bebas dari tumor karena kemoterapi tidak bisa membunuh 100 dari sel-sel tumor. Metode: Desain penelitian adalah studi potong lintang. Sampel diambil dari semua pasien dengan LABC yang datang ke klinik onkologi rawat jalan dari RS Cipto Mangunkusumo dan ditato untuk batas pembedahan berdasarkan ukuran tumor sebelum NAC. Penelitian ini dilakukan untuk menentukan batas pembedahan yang benar di LABC setelah NAC. Hasil: Dari total 85 pasien, 42 pasien termasuk dalam studi dan 30 pasien masih menjalani pemberian NAC. Umur pasien berkisar antara 27-70 tahun dengan frekuensi tertinggi adalah 40-50 tahun 47,6 . Frekuensi kasus tersering adalah pasien dengan stadium IIIB 92,9 , grade 2 66,7 , histopalogi karsinoma duktal invasif 92,8 hasil IHK imunohistokimia over-ekspresi HER2 42,8 , volume tumor sebelum NAC > 100cc 85,8 dan volume tumor setelah NAC 50-100cc 57,2 . Regimen kemoterapi yang banyak digunakan CAF 76,1 dengan respon parsial 95,2. Kesimpulan: Batas sayatan kulit berdasarkan ukuran tumor pasca NAC dapat menjadi acuan untuk operasi, namun pada dasar sayatan operasi masih perlu dilakukan frozen section untuk memastikan bebas tumor atau tidak. Seorang ahli bedah juga harus lebih berhati-hati dalam menentukan batas sayatan operasi pada kasus mastitis karsinomatosis, ulkus payudara yang besar dan tumor yang terletak di medial payudara dimana pada kondisi ini batas sayatan operasi dapat beresiko tidak bebas tumor.

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Introduction: There is limited evidence regarding the effectivness of neoadjuvant chemotherapy NAC to improve surgical margins for locally advanced breast cancer LABC patients. In this study, NAC was used to reduce tumor size to improve operability and reduce surgical margins, with confirmation of tumor free areas provided by post operative histopathology. The reduction of surgical margins has the potential to reduce the need for extensive surgery and the risk of complications in LABC patients.

Method: The study participants were patients diagnosed with LABC in Ciptomangunkusumo Hospital Jakarta and Awal Bros Bekasi Hospital Bekasi between 2014 and 2015. Patients underwent NAC, and those with partial or complete response were sent for surgery. Tumor excision was done according to the pre NAC surgical margin, which was marked by tattoo. Histopathology then checked for tumor cells in the surgical margins based on breast tumor size of pre and post NAC. Data was analyzed with SPSS version 20 with numerous statistical tests. Cross tabulation analyses were done to examine the characteristics of the study participants. McNemar test was used to determine and compare the pre and post NAC surgical margins.

Results: Out of 42 patients, 38 were observed to have tumor free surgical margins in both pre and post NAC. Of the remaining four patients, three patients had tumor cells in both surgical margins, and one patient had a tumor free pre NAC but positive tumor cells post NAC. McNemar analysis suggests no significant difference p 1,000 in the two surgical margins evaluated. Based on Wilson score analysis, agreement of negative result of surgical margin in pre NAC compare to post NAC is 97.3 CI 86,18 99.52 . Mean while, agreement of positive tumor cell in pre NAC to post NAC surgical margin is 100 CI 90.36 100.

Conclusion: Surgical margins in the skin based on the post NAC tumor size can be used as a guide for surgery, but not in the tumor base. If the surgical margin of tumor base is ambiguos, frozen section can be performed to confirm tumor free in the tumor base. This will reduce the risk of residual tumor cells in surgical margins. "

"Pendahuluan: Status batas sayatan merupakan faktor prognostik penting pada operasi tumor ganas solid. Frozen section (FS) sebagai baku emas batas sayatan intraoperatif butuh waktu tunggu dan alat FS mahal. Pewarnaan vital (PV) adalah metode pewarnaan pada sel hidup tanpa menyebabkan kematian sel. Tujuan penelitian ini adalah didapatkannya cara cepat untuk membedakan tumor ganas solid dengan jaringan normal. Metode: Studi dilakukan pada pasien tumor solid yang dioperasi oleh Bedah Onkologi RSCM periode Desember 2017 – April 2018. Penelitian ini disetujui oleh Komite Etik FKUI/RSCM. Kriteria eksklusi adalah sampel berukuran <5 mm, jaringan nekrosis, dan tidak setuju ikut penelitian. Total 150 pasien tumor solid (payudara, tiroid, mulut, dan lain-lain). Spesimen dibelah dua (mirroring technique) sebagai sampel perlakuan dan kontrol. Sampel perlakuan disemprot dengan asam asetat 10%, dibilas, lalu disemprot iodin, lalu bilas dengan akuades. Perubahan menjadi putih (acetowhitening) merupakan hasil positif. Bila berubah kuning kecoklatan merupakan hasil negatif. Ahli PA di-blinding. Hasil PA fokus ganas atau ganas tergolong hasil positif. Hasil PA selain hasil tersebut dicatat sebagai negatif. Analisis Data: Metode riset berdasarkan VIA (Visual Inspection Acetic Acid) dari WHO. Data dianalisis dengan IBM SPSS versi 25, menggunakan chi square. Hasil: Dari 150 pasien didapatkan 520 sampel. Sensitivitas staining 82%, spesifisitas 63,5%, PPV 65,8%, NPV 80,5%. Pada subgrup tumor payudara epitelial sensitivitasnya 100%, spesifisitas 79,3%, PPV 66,8%, NPV 100 %. Pada kasus tiroid sensitivitas 65,7%, spesifisitas 83,3%, PPV 92%, NPV 45%. Kasus tumor rongga mulut sensitivitasnya 94,1%, spesifisitas 33,3%, PPV 88,9%, NPV 50%. Diskusi: Staining ini bereaksi positif terhadap tumor ganas solid secara umum dan bereaksi negatif terhadap jaringan normal. Sensitivitas tertinggi pada kasus tumor payudara dan rongga mulut, dan spesifisitas tinggi pada kasus tiroid. Iodin bereaksi terhadap glikogen, namun struktur sel yang bereaksi dengan asam asetat adalah protein inti sel dan sitoplasma.

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Introduction: The surgical margin is an important prognostic factor in solid cancer surgery. Frozen section (FS) as the gold standard for intraoperative surgical margin evaluation but requires waiting time and expensive FS devices. Vital staining (VS) is a method of coloring on living cells without causing cell death. The purpose of this study was to obtain a quick way to distinguish solid cancer from normal tissue or nonmalignant tumor.

Methods: The study was conducted on solid tumor patients who were operated on by RSCM Surgical Oncologic Division in the period December 2017 - April 2018. This study was approved by the Ethics Committee of FMUI / RSCM. Exclusion criteria were samples measuring less than 5 mm, tissue necrosis, and the patient did not agree to join the study. A total of 150 of solid tumors (breast, thyroid, mouth, etc.) patients. The specimen is divided (mirroring technique) as a treatment and control sample. The treatment sample was sprayed with 10% acetic acid, rinsed, then sprayed with iodine, then rinse with distilled water. Acetowhitening reaction of the sample is a positive result. But if the sample turns brownish yellow, it is a negative result. The pathologist is blinded in this study. Focused or malignant lesion of PA results are classified as positive results. The results of PA other than these results are recorded as negative.

Data Analysis: Research method based on WHO (Visual Inspection Acetic Acid). Data were analyzed with IBM SPSS version 25, using chi square.

Results: From 150 patients 520 samples were obtained. Staining sensitivity was 82%, specificity was 63.5%, PPV was 65.8%, NPV was 80.5%. In the subgroup epithelial breast tumor, the sensitivity was 100%, specificity was 79.3%, PPV was 66.8%, NPV was 100%. In the case of thyroid sensitivity 65.7%, specificity 83.3%, PPV 92%, NPV 45%. For oral cancer cases sensitivity 94.1%, specificity 33.3%, PPV 88.9%, NPV 50%.

Discussion: This staining reacts positively to solid malignant tumors in general and reacts negatively to normal tissue. The highest sensitivity in breast and oral cavity tumors cases, and high specificity in the of thyroid cases. Iodine reacts to glycogen, but the cell structure that reacts with acetic acid is nuclear and cytoplasmic protein."

"Pendahuluan: Kanker payudara kanker dengan prevalensi, morbiditas dan mortalitas terbanyak di dunia. Kemoterapi neoadjuvan merupakan terapi sistemik pada kanker yang ditujukan untuk meningkatkan prognosis pasien. Proses imunologi dan inflamasi berperan dalam prognosis tumor. Beberapa indikator inflamasi antara lain neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), dan platelet-lymphocyte ratio (PLR). Penelitian ini ditujukan untuk menganalisa NLR, PLR, dan LMR terhadap respons klinis kanker payudara stadium lokal lanjut.Metode: Desain penelitian ini adalah cross-sectional yang ditujukan untuk menilai hubungan NLR, LMR, dan PLR terhadap respons klinis dengan metode WHO. Penelitian ini akan dilakukan di RSCM pada wanita dengan kanker payudara stadium lokal lanjut yang menjalani kemoterapi neoajuvan RSCM tahun 2016-2021. Pengumpulan data akan dilakukan secara konsekutif (consecutive sampling) pada rekam medis.Hasil: Pada penelitian ini didapatkan 84 subjek penelitian dengan usia rerata 50 tahun dan stadium klinis T4. Pada penelitian ini didapatkan nilai median NLR sebesar 2,62, PLR sebesar 186,9 dan LMR sebesar 3,78 pada populasi sampel. Analisis bivariat antara NLR, LMR, dan PLR dengan respons klinis didapatkan tidak bermakna secara statistik (p>0,05) dengan nilai OR 1,3 (CI95% 0,7-2,2), 0,81 (CI95% 0,04-1,4), dan 1,06 (CI95% 0,5-1,9) secara berurutan. Terdapat hubungan yang bermakna antara NLR dengan kejadian mortalitas 1 tahun (p<0,05) dengan nilai OR 2,27 (CI95% 1,1-4,5).Kesimpulan: Penelitian ini tidak mendapatkan adanya hubungan antara NLR, LMR, dan PLR dengan respons klinis pada kanker payudara lokal lanjut pasca KNA di RSCM.

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Introduction: Breast cancer is one of the most prevalent cancer around the globe with significant morbidity and mortality. Neoadjuvant chemotherapy is a systemic therapy with the aim of reducing the size of tumor, including breast cancer. The role of immunologic and inflammatory process has been reported as a prognostic factors in breast cancer including neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), and platelet-lymphocyte ratio (PLR). We aimed to analyze the role NLR, PLR, and LMR to the clinical response of locally advanced breast cancer after neoadjuvant chemotherapy regimen.

Methods: We used cross-sectional research design for this study with the aim of observe the relation between NLR, LMR, and PLR and clinical response of neoadjuvant chemotherapy. We conducted this study in Cipto Mangunkusumo General Hospital. Our subjects include women with locally advanced breast cancer that has been treated with neoadjuvant chemotherapy between 2016-2021. We collected the subject consecutively using medical record as the primary data source.

Result: We obtained 84 subjects with the mean age of 50 years and clinical stage of T4. The median of NLR, LMR, and PLR were 2.62, 186.9, and 3.78 consecutively. Bivariate analysis of NLR, LMR, dan PLR with clinical response showed no significant association with the odd ratio of 1,3 (CI95% 0,7-2,2), 0,81 (CI95% 0,04-1,4), and 1,06 (CI95% 0,5-1,9) consecutively. We found significant association between NLR and 1 year mortality rate with the odd ratio of 2,27 (CI95% 1,1-4,5).

Conclusion: We found no correlation between NLR, LMR, and PLR with clinical response after neoadjuvant chemotherapy in locally advanced breast cancer."

"Latar Belakang: Kanker payudara merupakan salah satu kanker terbanyak di dunia dengan angka kematian yang juga tinggi. Kasus kematian pada pasien kanker payudara paling banyak disebabkan oleh metastasis. Salah satu yang berperan pada proses perkembangan tumor primer menjadi metastasis yaitu sel imun tubuh Tumor-infiltrating Lymphocytes (TiLs) yang akan terstimulasi dan menyerang sel kanker. Selain itu, proses Epithelial-Mesenchymal Transition (EMT) yang ditandai sebagai penurunan regulasi penanda epitel khususnya E-cadherin, juga berkontribusi dalam perkembangan metastasis.Tujuan Penelitian: Penelitian ini bertujuan untuk mengetahui hubungan ekspresi TiLs dan E-cadherin dengan kejadian kanker payudara metastasis.Metode: Penelitian ini dilakukan pada 94 sampel dengan metode kohort retrospektif. Pengambilan data melalui rekam medis dan sediaan jaringan payudara yang kemudian dilakukan pulasan imunohistokimia E-cadherin dan pembuatan slide HE untuk pemeriksaan TiLs.Hasil Penelitian: Hasil penelitian menunjukkan nilai TiLs yang rendah bermakna signifikan (p=0,047) dengan kejadian metastasis kanker payudara. Sedangkan tidak ditemukan hubungan yang signifikan secara statistik nilai E-cadherin dengan metastasis pada kanker payudara (p=0,106). Namun, terdapat hubungan klinis yang tampak dari E-cadherin yang rendah terhadap metastasis kanker payudara. Selain itu, terdapat hubungan signifikan antara nilai TiLs dan E-cadherin yang rendah terhadap insiden metastasis (p= 0,011). Penelitian multivariat menunjukkan bahwa LVI, stadium dan E-cadherin memiliki pengaruh independen yang kuat terhadap kanker metastasis (p=0,043, p0,003, p=0,041).Kesimpulan: Penelitian ini menunjukkan nilai TiLs mempunyai hubungan yang signifikan dengan kejadian metastasis pada kanker payudara, namun LVI, stadium dan E-cadherin merupakan faktor prediktor independen kejadian metastasis pada kanker payudara.

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Background: Breast cancer is one of the most abundant cancers in the world with a high mortality rate. Cases of death in breast cancer patients are the most caused by metastasis. One of the role in the process of developing primary a tumor into metastatic is the immune cell body called tumor-Infiltrating lymphocytes (TILs) which will stimulate and attack the cancer cells. In addition, the Epithelial-mesenchymal Transition (EMT) process which marked as a reduction of the regulation of the epithelial marker specifically E-cadherin, also contributes to the development of metastasis.Aim: This study aims to determine the relationship of TiLs and E-cadherin expression with the incidence of metastatic breast cancer.Method: The study was conducted on 94 samples with retrospective cohort method. Data retrieval through medical records and breast tissue preparations that were then conducted in the immunohistochemistry E-cadherin staining and slide HE for TiLs examination.Result: The results showed lower TiLs significantly correlate (p = 0,047) with the incidence of metastatic breast cancer. Whereas there is no statistically significant relationship found between E-cadherin value with metastatic in breast cancer (p = 0,106). However, there are clinically visible relationship between low level E-cadherin with metastatic breast cancer. In addition, there is a significant correlation between low level TiLs and E-cadherin with metastatic incident (p = 0.011). Multivariate studies showed that LVI, staging and E-cadherin had a strong independent effect on metastatic cancer (p = 0.043, p0.003, p = 0.041).Conclussion: This study shows the value of TiLs has a significant relationship with the incidence of metastasis in breast cancer, but LVI, staging and E-cadherin are independent predictors of metastatic events in breast cancer."