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"[ABSTRAKTujuan: Insiden kanker prostat secara global terus meningkat. Meskipun dapat dilakukan deteksi dini kanker prostat, perlu dipahami bahwa progresivitas penyakit ? menjadi metastasis ? berbeda untuk setiap pasien. Penelitian ini bertujuan untuk mengamati aspek-aspek yang mungkin berperan sebagai faktor prediktif metastasis pada kanker prostat tidak terpalpasi.Material dan Metode: Data dikumpulkan dari Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo dan Rumah Sakit Pusat Kanker Nasional Dharmais sejak tahun 1995-2013. Pasien dengan kanker prostat tidak terpalpasi kemudian dibagi menjadi dua kelompok: dengan metastasis dan tanpa metastasis. Usia, volume prostat, nilai prostate-spesific antigen (PSA), Gleason score sum group, stadium tumor, Karnofsky performance score (KPS), kadar hemoglobin, dan kadar kreatinin serum merupakan faktor yang dianalisis dalam penelitian ini. Data dianalisis menggunakan analisis bivariat dan uji regresi logistik. Hanya pasien dengan data lengkap yang dimasukkan dalam penelitian ini.Hasil: Didapatkan 91 pasien dengan data lengkap, 59 pasien (64,83%) tanpa metastasis dan 32 pasien (35,16%) dengan metastasis. Terdapat perbedaan statistik yang signifikan antara kelompok tanpa metastasis dan kelompok dengan metastasis, yakni untuk PSA (13.7ng / mL vs 71.5ng / mL; p = 0,001), kadar hemoglobin (13,60 g / dL vs 12,25 g / dL; p = 0,002), dan KPS (90 vs 90 ; p = 0,004). Perbedaan yang signifikan secara statistik juga didapatkan pada kelompok GSS (35 dan 24 pada kelompok tanpa metastasis vs 12 dan 20 pada kelompok dengan metastasis; p = 0,047). Usia, volume prostat, stadium tumor, dan kadar kreatinin antara kedua kelompok tidak memiliki perbedaan signifikan secara statistik (p> 0,05). Nilai pretreatment PSA adalah satu-satunya faktor prediktif untuk metastasis dengan odds ratio 1.014 (95% CI, 1,005-1,022; p = 0,002).Kesimpulan: Sebagian besar pasien kanker prostat tidak terpalpasi terdeteksi pertama kali tanpa metastasis. Nilai pretreatment PSA yang diperoleh pada kunjungan awal pasien dapat digunakan sebagai faktor prediktif metastasis di masa depan.

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ABSTRACTObjective: Prostate cancer incident is globally increasing. Despite early detection of prostate cancer, the progressivity of the disease itself toward metastatic disease remains different for each patient. The purpose of this study is to observe aspects that may have roles as predictive factors for metastasis in nonpalpable prostate cancer.Materials and Methods: Data was collected from National Hospital Cipto Mangunkusumo and Dharmais National Cancer Center Hospital from 1995-2013. Patients with nonpalpable prostate cancer then divided into two groups: metastasis-free group and metastasis group. Age, prostate volume, pretreatment Prostate-specific antigen (PSA) value, Gleason score sum group, tumor stadium, Karnofsky performance score (KPS), hemoglobin level, and serum creatinine level were factors that were analyzed in the study. The data was analyzed using bivariate analysis and logistic regression test. Only patients with complete data are included in the study.Results: There are 91 patients with complete data, 59 patients (64.83%) were patients without metastasis and 32 patients (35.16%) were with metastasis. There was significant statistical difference between no metastasis group with metastasis group for PSA (13.7ng/mL vs71.5ng/mL; p = 0.001), hemoglobin level (13.60 g/dL vs 12.25 g/dL; p = 0.002), and KPS (90vs90; p = 0.004). There was also significant statistical difference in GSS groups (35 and 24 in metastasis-free group vs 12 and 20 in metastasis group; p = 0.047). Age, prostate volume, tumor stadium, and creatinine level had no statistical difference between the two groups (p > 0.05). Pretreatment PSA value was the only predictive factor for metastasis with odds ratio 1.014 (95% CI, 1.005 to 1.022; p = 0.002).Conclusion: Most nonpalpable prostate cancer patients are first detected without metastasis. Pretreatment PSA value that was obtained at their initial visit might be used as predictive factor for metastasis for them in the future.;Objective: Prostate cancer incident is globally increasing. Despite early detection of prostate cancer, the progressivity of the disease itself toward metastatic disease remains different for each patient. The purpose of this study is to observe aspects that may have roles as predictive factors for metastasis in nonpalpable prostate cancer.Materials and Methods: Data was collected from National Hospital Cipto Mangunkusumo and Dharmais National Cancer Center Hospital from 1995-2013. Patients with nonpalpable prostate cancer then divided into two groups: metastasis-free group and metastasis group. Age, prostate volume, pretreatment Prostate-specific antigen (PSA) value, Gleason score sum group, tumor stadium, Karnofsky performance score (KPS), hemoglobin level, and serum creatinine level were factors that were analyzed in the study. The data was analyzed using bivariate analysis and logistic regression test. Only patients with complete data are included in the study.Results: There are 91 patients with complete data, 59 patients (64.83%) were patients without metastasis and 32 patients (35.16%) were with metastasis. There was significant statistical difference between no metastasis group with metastasis group for PSA (13.7ng/mL vs71.5ng/mL; p = 0.001), hemoglobin level (13.60 g/dL vs 12.25 g/dL; p = 0.002), and KPS (90vs90; p = 0.004). There was also significant statistical difference in GSS groups (35 and 24 in metastasis-free group vs 12 and 20 in metastasis group; p = 0.047). Age, prostate volume, tumor stadium, and creatinine level had no statistical difference between the two groups (p > 0.05). Pretreatment PSA value was the only predictive factor for metastasis with odds ratio 1.014 (95% CI, 1.005 to 1.022; p = 0.002).Conclusion: Most nonpalpable prostate cancer patients are first detected without metastasis. Pretreatment PSA value that was obtained at their initial visit might be used as predictive factor for metastasis for them in the future.;Objective: Prostate cancer incident is globally increasing. Despite early detection of prostate cancer, the progressivity of the disease itself toward metastatic disease remains different for each patient. The purpose of this study is to observe aspects that may have roles as predictive factors for metastasis in nonpalpable prostate cancer.Materials and Methods: Data was collected from National Hospital Cipto Mangunkusumo and Dharmais National Cancer Center Hospital from 1995-2013. Patients with nonpalpable prostate cancer then divided into two groups: metastasis-free group and metastasis group. Age, prostate volume, pretreatment Prostate-specific antigen (PSA) value, Gleason score sum group, tumor stadium, Karnofsky performance score (KPS), hemoglobin level, and serum creatinine level were factors that were analyzed in the study. The data was analyzed using bivariate analysis and logistic regression test. Only patients with complete data are included in the study.Results: There are 91 patients with complete data, 59 patients (64.83%) were patients without metastasis and 32 patients (35.16%) were with metastasis. There was significant statistical difference between no metastasis group with metastasis group for PSA (13.7ng/mL vs71.5ng/mL; p = 0.001), hemoglobin level (13.60 g/dL vs 12.25 g/dL; p = 0.002), and KPS (90vs90; p = 0.004). There was also significant statistical difference in GSS groups (35 and 24 in metastasis-free group vs 12 and 20 in metastasis group; p = 0.047). Age, prostate volume, tumor stadium, and creatinine level had no statistical difference between the two groups (p > 0.05). Pretreatment PSA value was the only predictive factor for metastasis with odds ratio 1.014 (95% CI, 1.005 to 1.022; p = 0.002).Conclusion: Most nonpalpable prostate cancer patients are first detected without metastasis. Pretreatment PSA value that was obtained at their initial visit might be used as predictive factor for metastasis for them in the future.;Objective: Prostate cancer incident is globally increasing. Despite early detection of prostate cancer, the progressivity of the disease itself toward metastatic disease remains different for each patient. The purpose of this study is to observe aspects that may have roles as predictive factors for metastasis in nonpalpable prostate cancer.Materials and Methods: Data was collected from National Hospital Cipto Mangunkusumo and Dharmais National Cancer Center Hospital from 1995-2013. Patients with nonpalpable prostate cancer then divided into two groups: metastasis-free group and metastasis group. Age, prostate volume, pretreatment Prostate-specific antigen (PSA) value, Gleason score sum group, tumor stadium, Karnofsky performance score (KPS), hemoglobin level, and serum creatinine level were factors that were analyzed in the study. The data was analyzed using bivariate analysis and logistic regression test. Only patients with complete data are included in the study.Results: There are 91 patients with complete data, 59 patients (64.83%) were patients without metastasis and 32 patients (35.16%) were with metastasis. There was significant statistical difference between no metastasis group with metastasis group for PSA (13.7ng/mL vs71.5ng/mL; p = 0.001), hemoglobin level (13.60 g/dL vs 12.25 g/dL; p = 0.002), and KPS (90vs90; p = 0.004). There was also significant statistical difference in GSS groups (35 and 24 in metastasis-free group vs 12 and 20 in metastasis group; p = 0.047). Age, prostate volume, tumor stadium, and creatinine level had no statistical difference between the two groups (p > 0.05). Pretreatment PSA value was the only predictive factor for metastasis with odds ratio 1.014 (95% CI, 1.005 to 1.022; p = 0.002).Conclusion: Most nonpalpable prostate cancer patients are first detected without metastasis. Pretreatment PSA value that was obtained at their initial visit might be used as predictive factor for metastasis for them in the future.;Objective: Prostate cancer incident is globally increasing. Despite early detection of prostate cancer, the progressivity of the disease itself toward metastatic disease remains different for each patient. The purpose of this study is to observe aspects that may have roles as predictive factors for metastasis in nonpalpable prostate cancer.Materials and Methods: Data was collected from National Hospital Cipto Mangunkusumo and Dharmais National Cancer Center Hospital from 1995-2013. Patients with nonpalpable prostate cancer then divided into two groups: metastasis-free group and metastasis group. Age, prostate volume, pretreatment Prostate-specific antigen (PSA) value, Gleason score sum group, tumor stadium, Karnofsky performance score (KPS), hemoglobin level, and serum creatinine level were factors that were analyzed in the study. The data was analyzed using bivariate analysis and logistic regression test. Only patients with complete data are included in the study.Results: There are 91 patients with complete data, 59 patients (64.83%) were patients without metastasis and 32 patients (35.16%) were with metastasis. There was significant statistical difference between no metastasis group with metastasis group for PSA (13.7ng/mL vs71.5ng/mL; p = 0.001), hemoglobin level (13.60 g/dL vs 12.25 g/dL; p = 0.002), and KPS (90vs90; p = 0.004). There was also significant statistical difference in GSS groups (35 and 24 in metastasis-free group vs 12 and 20 in metastasis group; p = 0.047). Age, prostate volume, tumor stadium, and creatinine level had no statistical difference between the two groups (p > 0.05). Pretreatment PSA value was the only predictive factor for metastasis with odds ratio 1.014 (95% CI, 1.005 to 1.022; p = 0.002).Conclusion: Most nonpalpable prostate cancer patients are first detected without metastasis. Pretreatment PSA value that was obtained at their initial visit might be used as predictive factor for metastasis for them in the future., Objective: Prostate cancer incident is globally increasing. Despite early detection of prostate cancer, the progressivity of the disease itself toward metastatic disease remains different for each patient. The purpose of this study is to observe aspects that may have roles as predictive factors for metastasis in nonpalpable prostate cancer.Materials and Methods: Data was collected from National Hospital Cipto Mangunkusumo and Dharmais National Cancer Center Hospital from 1995-2013. Patients with nonpalpable prostate cancer then divided into two groups: metastasis-free group and metastasis group. Age, prostate volume, pretreatment Prostate-specific antigen (PSA) value, Gleason score sum group, tumor stadium, Karnofsky performance score (KPS), hemoglobin level, and serum creatinine level were factors that were analyzed in the study. The data was analyzed using bivariate analysis and logistic regression test. Only patients with complete data are included in the study.Results: There are 91 patients with complete data, 59 patients (64.83%) were patients without metastasis and 32 patients (35.16%) were with metastasis. There was significant statistical difference between no metastasis group with metastasis group for PSA (13.7ng/mL vs71.5ng/mL; p = 0.001), hemoglobin level (13.60 g/dL vs 12.25 g/dL; p = 0.002), and KPS (90vs90; p = 0.004). There was also significant statistical difference in GSS groups (35 and 24 in metastasis-free group vs 12 and 20 in metastasis group; p = 0.047). Age, prostate volume, tumor stadium, and creatinine level had no statistical difference between the two groups (p > 0.05). Pretreatment PSA value was the only predictive factor for metastasis with odds ratio 1.014 (95% CI, 1.005 to 1.022; p = 0.002).Conclusion: Most nonpalpable prostate cancer patients are first detected without metastasis. Pretreatment PSA value that was obtained at their initial visit might be used as predictive factor for metastasis for them in the future.]"

"ABSTRAKTujuan: 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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ABSTRACTObjective: 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."

"ABSTRAKKarsinoma sel ginjal terhitung sekitar 3% dari kanker pada orang dewasa dan 85% dari semua keganasan primer ginjal. Tumor ini biasanya tidak memberikan gejala hingga penyakit sudah berada pada stadium lanjut. Metastasis pada kelenjar getah bening dan metastasis jauh diketahui merupakan faktor prognostik yang penting pada karsinoma sel ginjal. Parameter klinis diperlukan untuk memprediksi metastasis sebelum operasi. Penelitian ini merupakan penelitian prospektif dengan mengambil data dari rekam medis dari Januari 1995 hingga Desember 2015 di Rumah Sakit Cipto Mangunkusumo. Penelitian ini mengevaluasi faktor prediktif klinis untuk kejadian metastasis pada karsinoma sel ginjal.

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ABSTRACTRenal cell carcinoma (RCC) accounts for about 3% of cancers in adults as well as 85% of all primary malignancies arising from the kidney. RCC is commonly large at presentation and symptoms may not occur until relatively late in the disease. Lymph node and distant metastases were known as the prognostic factor in renal cell carcinoma. Clinical parameters are needed to predict the metastases preoperatively. This is a prospective-analytic using medical record data from January 1995 - December 2015 at Cipto Mangunkusumo Hospital. This study evaluate clinical predictive factors for metastatic renal cell carcinoma incidence;"

"[Tujuan: Mengidentifikasi korelasi dan insiden metastasis tulang pada pasien kanker prostat dengan Gleason Score (GS) dan Prostate Specific Antigen (PSA) yang rendah.Material dan Metode: Studi deskriptif retrospektif pada pasien kanker prostat di Rumah Sakit Cipto Mangunkusumo periode 2006-2011. Ada 478 pasien dengan kanker prostat. Pasien kanker prostat dengan PSA rendah, telah menjalani pemeriksaan histopatologi, dan bone scan diikutsertakan dalam studi, sehingga didapatkan 358 pasien sebagai subjek penelitian.Nilai PSA diukur dengan sandwich electrochemiluminescent immunoassay. Pemeriksaan histopatologi diklasifikasikan menurut sistem grading Gleason dan dibagi menjadi 3 kategori: diferensiasi baik (GS ≤6), diferensiasi sedang (GS 7), dan diferensiasi buruk (GS 8-10). Bone scan dikerjakan dengan dengan agen radiofarmaka (Tc99m methylenendiphosphonate) dan kemudian gambar ditangkap dengan kamera gamma.Hasil: Rerata usia 67.52±7.8 tahun, rerata GS 7.7±1.3, dan median PSA adalah 56.9 (rentang: 0,48-17000 ng/mL). Ada 11 orang pasien (3,0%) dengan bone scan positif dengan PSA <20 ng/mL dan GS<8. Lebih lanjut, ada 2 pasien (0,6%) dengan GS≤6 dan PSA<10 ng/mL memperlihatkan metastasis ke tulang.Kesimpulan: Pada studi ini, ada sebagian kecil pasien mengalami metastasis tulang dengan PSA (PSA<10 mg/mL) dan GS (GS≤6) rendah., Objective This study was aimed to identify correlation and incidence of bone metastases in prostate cancer patient with low Gleason Score GS and Prostate Specific Antigen PSA Materials and Methods A descriptive restrospective study to patients with prostate cancer in Cipto Mangunkusumo Hospital in 2006 2011 There were 478 patient with prostate cancer Patients with prostate cancer who had PSA value histological examination and bone scan were included in the study resulting in 358 eligible patients for the study PSA value was measured using the sandwich electrochemiluminescent immunoassay Histological examination was graded according to Gleason rsquo s grading system and divided into 3 category well differentiated GS le 6 moderately differentiated GS 7 and poorly differentiated GS 8 10 Bone scan was done using radiopharmaceuticals agent Tc 99m methylenen diphosphonate and then the image was captured using gamma camera Results The mean age was 67 52 7 8 mean GS was 7 7 1 3 and median PSA was 56 9 range 0 48 17000 ng mL There were 11 patients 3 0 with positive bone scan with PSA]"

"Latar Belakang: Omentum merupakan tempat metastasis yang paling sering pada kanker ovarium jenis epitel. Selain sebagai tempat metastasis utama, omentum memiliki  peran imunologi. Omentum memiliki kemampuan mengkolonisasi penyebaran sel kanker dengan terbentuknya omental caking. Penelitian ini bertujuan untuk mengetahui hubungan antara faktor klinikopatologi dengan metastasis di omentum pada kanker ovarium jenis epitel. Metode: Penelitian dilakukan dengan desain penelitian potong lintang. Populasi penelitian adalah pasien dengan kanker ovarium jenis epitel yang dilakukan pembedahan di RS Cipto Mangunkusumo antara tanggal 1 Januari 2010 sampai dengan 31 Desember 2017. Hasil : Terdapat hubungan antara tipe serosa dan tipe musinosa, nodul omental, dan CA 125 dengan metastasis pada omentum (OR 1,7, IK 95% 24,1-47,7; p = 0,002, OR 14,5, IK 95% 2,5-82,2; p = 0,002, OR 61, IK 95% 11,4-324,8; p <0,01, dan OR 3,5, IK 95% 1,2-9,7; p = 0,013). Analisis multivariat menunjukkan hubungan yang signifikan antara jenis musinosa dengan metastasis di omentum (aOR 9.71, IK 95% 1.11-84.89; p = 0,04) dan antara nodul omentum dan metastasis di omentum (aOR 40.92, IK 95% 6.64-251.96; p <0,01). Kesimpulan: Terdapat hubungan antara metastasis di omentum pada kanker ovarium epitel dengan tipe histologi musinosa dan nodul pada omentum.Background: Aside from being a major metastatic site in epithelial type ovarian cancer, omentum has an immunological role. Omentum has the ability to colonize the spread of cancer cells by forming omental caking. This study aims to determine the relationship between clinicopathology factors with metastasis in omentum in epithelial type ovarian cancer. Methods: The study used cross-sectional study design. Subjects were patients diagnosed with epithelial type ovarian cancer who underwent surgery at Cipto Mangunkusumo Hospital between January 2010 and December 2017. Result: There was an association between serous as well as mucinous type, omental nodules, and between CA 125 and metastasis in omentum (OR 1.7, CI 95% 24.1-47.7; p = 0.002, OR 14.5, CI 95% 2.5-82.2; p = 0.002, OR 61, CI 95% 11.4-324.8; p <0.01, and OR 3.5, CI 95% 1.2-9.7; p = 0.013). Multivariate analysis demonstrated a significant association between mucinous types with metastases in the omentum (aOR 9.71, CI 95% 1.11-84.89; p = 0.04) and between the omental nodules and metastases in the omentum (aOR 40.92, CI 95% 6.64-251.96 ; p <0.01). Conclusion: There is a relationship between metastasis in the omentum in epithelial ovarian cancer with mucinous histology type and nodules in the omentum."

"Model prediksi kesintasan kanker prostat metastasis tulang sudah pernah dilakukan sebelumnya. Namun, model prediksi kesintasan kanker prostat metastasis tulang pra-terapi belum pernah dialukan sebelumnya. Tujuan penelitian ini adalah untuk menganalisis faktor-faktor klinis yang mempengaruhi ketahanan hidup (survival) pada kanker prostat dengan metastasis tulang serta mengembangkan nomogram prognostik ketahanan hidup pada pasien dengan kondisi tersebut. Terdapat 392 subyek dengan kanker prostat dengan metastasis tulang yang mendapat terapi Androgen Deprivation Therapy (ADT) dalam penelitian ini. Parameter pra-perawatan dianalisis menggunakan model cox-proportional untuk mengidentifikasi prediktor ketahanan hidup secara keseluruhan. Kovariat yang menunjukkan nilai signifikansi secara statistik pada analisis multivariat akan dipakai untuk membentuk nomogram. Model prediktor linier digunakan untuk mengembangkan nomogram. Nilai median ketahanan hidup keseluruhan adalah 40,3 bulan (95% CI: 32.2 - 48.5). Analisis univariat menunjukkan bahwa T-stage, Gleason Score, nilai antigen spesifik prostat inisial, dan jumlah lesi metastasis merupakan faktor-faktor prognostik independen terhadap angka ketahanan hidup keseluruhan. Semua prediktor ini tetap menunjukkan hasil yang signifikan secara statistik sebagai faktor prognostik independen pada analisis model multivariat cox-regression. Nomogram yang terbentuk dari faktor-faktor prediktor tersebut menunjukkan diskriminasi yan baik dalam memprediksi ketahanan hidup dalam 5 tahun dengan area under the curve (AUC) sebesar 0.69. Kesepakatan yang diterima dari probabilitas yang diamati dan diprediksi telah dinilai dalam plot kalibrasi. Nilai median ketahanan hidup keseluruhan adalah 40,3 bulan. Prediksi nomogram ini dapat berguna sebagai alat untuk memprediksi angka ketahanan hidup keseluruhan pada sebelum terapi kanker prostat metastasis, secara spesifik pada populasi Indonesia. Penelitian lebih lanjut dibutuhkan untuk memberikan validasi eksternal untuk mendukung penggunaan nomogram ini.

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A survival prognostic model of prostate cancer with bone metastasis had been done before. However, a prognostic model of pre-treatment prostate cancer with bone metastasis had not yet done. This study aims to analyze the clinical factors among bone-metastatic prostate cancer and their relationships with survival as well as to develop a prognostic nomogram for overall survival in patients with this condition. This study included 392 patients with bone metastatic prostate caner treated with androgen deprivation therapy. Pre-treatment parameters were analyzed using cox-proportional hazard model to identify the predictors of overall survival. Covariates, which showed statistical significance on multivariate analysis, were used to develop a nomogram. Linear predictor model was utilized to develop the nomogram. Median overall survival was 40.3 months (95% CI: 32.2 to 48.5). Univariate analysis showed that clinical T-stage, Gleason Score, initial prostate specific antigen value, and number of metastatic lesion were independent prognostic factors for OS. These predictors still remained significant as independent prognostic factors for overall survival following analysis using multivariate cox-regression model. The nomogram constructed from those prognostic factors showed good discriminaton for predicting the 5-year OS with an Area Under the Curve of 0.69. Acceptable agreement of the observed and predicted probabilites was observed in the calibration plot. The median overall survival of patient with bone metastatic prostate cancer was 40.3 months. The prediction nomogram might be a useful tool for predicting overall survival in pre-treatment bone metastatic prostate cancer, specifically among Indonesian patients. Further studies are needed to provide external validation to support the utilization of this nomogram."

"ABSTRAKLatar Belakang: Kanker payudara sampai saat ini memiliki insiden dan prevalensi yangtertinggi dalam diantara penyakit kanker pada perempuan. Lokasi tersering metastasis kanker payudara adalah tulang dimana memiliki overall survival yang baik yang berakibat padapengeluaran biaya yang tinggi dibandingkan dengan metastasis organ viseral. CXCR4 dan RANK diketahui memiliki peran dalam homing sel kanker ke tulang.Dibandingkan dengan biomarker-biomarker yang lain, CXCR4 dan RANK berada padakaskade paling awal dari proses metastasis tulang. Aksis CXCR4 dengan SDF-1 sebagailigannya merupakan pengaturan utama dalam trafficking sel pada beberapa sel punca tubuhmanusia. Aksis RANK/RANKL/OPG mengontrol proses osteoklastogenesis dan resorpsitulang. Dari berbagai studi didapatkan CXCR4 dan RANK diekspresikan tinggi pada kankerpayudara dan berkaitan dengan metastasis tulang. Tujuan Penelitian: Mengetahui hubungan kombinasi ekspresi protein CXCR4 danRANK sebagai faktor prediktor metastasis tulang pada kanker payudara. Metode Penelitian: Jenis penelitian ini adalah case control, analitik, dengan observasional,untuk diagnostik dan prognostik. Penelitian ini dilakukan pada penderita kanker payudarastadium I-IV dengan jumlah sampel 58 pasien. Hasil Penelitian: Faktor Klinikopatologi stadium tumor, mempunyai hubungan yang signifikan terhadap ekspresi kombinasi CXCR4 dan RANK pada metastasis tulang padakasus kanker payudara. Pada penderita kanker payudara terdapat hubunngan yang signifikanantara nilai kombinasi ekspresi CXCR4 dan RANK tinggi dengan kejadian metastasis tulang. Kesimpulan: Faktor Klinikopatologi stadium tumor mempunyai hubungan yang signifikanterhadap ekspresi kombinasi CXCR4 dan RANK pada metastasis tulang pada kasus kankerpayudara. Kombinasi CXCR4 dan RANK dapat digunakan sebagai alat prediktor diagnostikuntuk mengetahui status metastasis tulang kanker payudara, sehingga dapat diberikan terapiawal yang dapat meningkatkan kualitas hidup dan menekan biaya kesehatan di kemudianhari.

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ABSTRACT<>br>Background Until recently, breast cancer has the highest prevalence and incidence offemale cancer. Breast cancer often metastasised to bone, which have better overall survival but consume more health cost than visceral metastasis. CXCR4 and RANK have been known for it's role in cancer cell homing to bone. Instead ofother biomarkers of bone metastasis, CXCR4 and RANK act in the early cascade of bonemetastasis process. CXCR4 SDF 1 axis plays a great role in cell trafficking of many types ofhuman stem cell. RANK RANKL OPG axis mediates osteoclastogenesis and boneresorption. In several studies, CXCR4 and RANK are highly expressed in breast cancer andcorrelate with bone metastasisAim To establish the combination, CXCR4 and RANK are highly expressed in breast cancer and correlate with bone metastasisMethods Case Control study, analytical, observational for prognostic and diagnostic byinvolving 58 patiens with stadium I,II,II,IV at breast cancer Result Clinic pathalogical factor, stadium had significant correlation with combination CXCR4 and RANK expression in breast cancer patients. The High combination CXCR4 and RANK expression in breast cancer patients had significant correlation with bone metastasis. Conclusion: Clinic pathalogical factor stadium tumor had significant correlation with combination CXCR4 and RANK expression in breast cancer patients. The high Combination of CXCR4 and RANK expression can act as a predictor for bone metastasis inbreast cancer, so the patient can start early therapy which increase the quality of life andreduce treatment cost."

"ABSTRAKPendahuluan : Docetaxel telah menunjukkan efek dalam pengobatan CRPC biladigunakan sebagai monoterapi atau dalam kombinasi dengan kemoterapi lainnya.Banyak penelitian telah menunjukkan korelasi penurunan Prostate Specific Antigen PSA dengan kesintasan pasien CRPC yang mendapatkan terapi Docetaxel.Penelitian-penelitian sebelumnya juga menyatakan adanya korelasi antara volumeprostat, Gleason Score, dan insiden metastasis dengan nilai PSA. Penelitian inibertujuan untuk menganalisis hubungan antara volume prostat, Gleason Score, danada tidaknya metastasis terhadap penurunan PSA sebagai prediktor respon padapasien CRPC yang mendapatkan Docetaxel.Metode : Penelitian analitik retrospektif dengan mengunakan data rekam medisRumah Sakit Umum H. Adam Malik Medan yang dilaksanakan pada periode 1Januari 2016-31 Juli 2016. Populasi dan sampel dalam penelitian ini adalah seluruhpasien dengan penderita CRPC yang telah menjalani kemoterapi Docetaxelsebanyak 10 siklus. Pasien yang memenuhi kriteria inklusi, dipaparkan denganvariabel independen Taksiran Besar Prostat, Skor Gleason, Status Metastase danvariabel dependen perubahan PSA .Hasil : Sebanyak 8 pasien yang memenuhi kriteria inklusi yang berusia rata-rata 65tahun dengan taksiran berat prostat 38,6 gram dengan skor gleason ge; 7 sebanyak 6orang 75 sedangkan

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ABSTRACTIntroduction Docetaxel has shown efficacy in CRPC treatment as monotherapy or combination therapy. Previous research showed a correlation between prostat volume, Gleason score, and metastases with PSA value. This study aimed toanalyze the correlation between prostat volume, gleason score, and metastases withPSA value decrement as a response predictor in CRPC patients who receiveDocetaxel.Methods This is a retrospective analytic research, using data in medical recordsin RSU H. Adam Malik Medan, conducted on January 1 July 31 2016. Populationand samples in this research are patients with CRPC who already received 10 cyclesof Docetaxel chemotherapy. Patients that fulfilled the inclusion criteria areanalyzed with dependent and independent variables estimated prostate volume,Gleason Score, and metastatic status . Results Total of 8 patients who fulfilled inclusion criteria were averagely 65 yearsold, estimated prostate weight of 38.6 gram, and 6 people had Gleason score ge 7 75 and 2 people had Gleason score "

"Latar Belakang/Tujuan. Angka kematian dan kejadian metastasis kanker payudara cukup tinggi. Faktor metabolik termasuk resistensi insulin mempunyai peranan terhadap progresivitas kanker payudara namun terdapat hanya sedikit penelitian yang menilai hubungan resistensi insulin dengan kejadian metastasis kanker payudara. Terdapat hubungan yang erat antara beberapa variabel dalam kelompok pasca-menopause terhadap kejadian metastasis, pemberian terapi hormonal aromatase inhibitor dan kemoterapi terhadap nilai HOMA-IR. Mengetahui hubungan resistensi insulin yang dinilai menggunakan nilai homeostatic model assessment for insulin resistance (HOMA-IR) dengan kejadian metastasis kanker payudara.Metode. Studi potong lintang yang meneliti 150 pasien kanker payudara di Rumah Sakit Cipto Mangunkusumo (RSCM) dan Rumah Sakit Siloam Mochtar Riady Comprehensive Cancer Centre (MRCCC) Jakarta dalam rentang waktu agustus 2019-april 2020. Terdapat 150 subjek penelitian, nilai titik potong HOMA-IR ditentukan dengan kurva receiver operating curve (ROC). Dilakukan analisis subgrup kelompok pasca menopause terhadap metastasis, terapi hormonal dan kemoterapi terhadap HOMA-IR.Hasil. Tidak didapatkan nilai titik potong optimal HOMA-IR terhadap kejadian metastasis (Area under curve (AUC) 0,50, P : >0,05, interval kepercayaan (IK) 95% : 0,406-0,593). Tidak terdapat hubungan bermakna variabel pasca-menopause dengan kejadian metastasis dan kemoterapi terhadap nilai HOMA-IR. Terdapat hubungan bermakna pemberian terapi hormonal aromatase inhibitor terhadap peningkatan nilai HOMA-IR, P : <0,01Simpulan. Tidak terdapat hubungan yang bermakna antara resistensi insulin dengan kejadian metastasis pada pasien kanker payudara.

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Background/Purpose. Mortality and incidence rate of metastatic breast cancer is quite high.

Metabolic factors including insulin resistance have a role in the progression of breast cancer,

but there are only a few studies that assess the relationship of insulin resistance with the incidence of breast cancer metastases. There is a close relationship between variables in the postmenopausal group for the occurrence of metastases, administration of hormonal aromatase inhibitors and chemotherapy to the value of HOMA-IR. Knowing the relationship of insulin resistance which was assessed using the value of

the homeostatic model assessment for insulin resistance (HOMA-IR) with the incidence of metastatic breast cancer.

Method. A cross-sectional study examining 150 breast cancer patients at Cipto Mangunkusumo General Hospital and Siloam Hospital Mochtar Riady Comprehensive Cancer Center Jakarta in August 2019-April 2020. There are 150 subjects research, the HOMA-IR cutoff value is determined by the receiver operating curve (ROC) curve. Postmenopausal subgroups were analyzed for metastases, hormonal therapy and chemotherapy for HOMA-IR.

Results. There was no optimal HOMA-IR cut off value for metastatic events (Area under curve (AUC) 0.50,

P:> 0.05, 95% confidence interval (IK): 0.406-0.593). There was no significant relationship between postmenopausal variables with the incidence of metastasis and chemotherapy on the value of HOMA-IR. There was a significant

relationship between the administration of hormonal aromatase inhibitor therapy to the increase of HOMA-IR value, P: <0.01"

"Latar belakang: Kanker payudara (KPD) mempunyai angka kejadian tertinggi pada wanita di dunia yang apabila tidak terdeteksi secara dini akan mengalami perkembangan menjadi stadium lanjut yang berujung pada metastasis ke organ-organ penting tubuh lainnya terutama di tulang. Keterlambatan pendeteksian akan meningkatkan kerusakan tulang secara permanen. Saat ini berbagai macam studi dilakukan untuk mencari parameter metastasis tulang secara dini dan salah satunya adalah keberadaan mikroklasifikasi pada mamografi sebagai salah satu parameters kejadian metastasis tulang.Tujuan: Penelitian ini bertujuan mencari hubungan gambaran mikrokalsifikasi pada mamografi KPD sebagai parameter terjadinya metastasis tulang dan faktor faktor yang memengaruhinya.Metode Desain studi ini adalah kasus kontrol menggunakan data sekunder pasien kanker payudara yang berobat di poli bedah onkologi RSCM dari Juni Tahun 2019 sampai dengan Juni Tahun 2021. Kelompok kasus adalah pasien KPD yang mengalami metastasis tulang dan kelompok kontrol adalah yang tidak mengalami metastasis tulang yang dilihat berdasarkan pemeriksaan Bone Scan, Ct Scan dan foto polos. Dilihat keberadaan mikroklasifikasi melalui mamografi. Dilakukan uji statistik univariat untuk melihat proporsi (%) dan dilanjutkan dengan uji bivariat yaitu chi square dan fisher jika syarat tidak terpenuhi. Hasil Didapatkan 81 subjek penelitian dengan kriteria inklusi dengan hasil 56,8% pasien dengan di atas 50 tahun, 86,4% IMT dibawah 30, 76,5% premenopause, 71,6% pada stadium lanjut, 70,4% dengan histopatologi NST, 58% luminal B, dan 30,9 % dengan metastasis tulang. Uji bivariat menunjukkan terdapat hubungan yang bermakna antara keberadaan mikroklasifikasi dengan metastasis tulang (OR 3,284 CI 95% 1,212-8,889 p=0,017cs) dan hubungan bermakna antara stadium lanjut dengan keberadaan mikrokalsifikasi (OR 3,74, CI 95% 1,28-10,86 p=0,012cs) .Kesimpulan Keberadaan mikrokalsifikasi pada penderita kanker payudara berhubungan secara bermakna dengan metastasis tulang dan stadium lokal lanjut memiliki hubungan yang bermakna dengan keberadaan mikroklasifikasi.

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Background: Breast cancer (BC) has the highest incidence in women in the world which if not detected early will develop into an advanced stage which leads to metastasis to other important organs of the body, especially in the bones. Delay in detection will increase morbidity in the form of permanent bone damage. Currently, various studies have been carried out to find parameters of early bone metastases and one of them is the presence of microclassification on mammography as one of the parameters for the incidence of bone metastasis

Objective: The design of this study is a case control using secondary data of breast cancer patients seeking treatment at the RSCM oncology surgery from June 2019 to June 2021. The case group was BC patients who had bone metastases and the control group was those who did not experience bone metastases taken from examination of Bone Scan, CT Scan and plain photo. Seen the existence of microclassification through mammography. Univariate statistical test was conducted to see the proportion (%) and continued with the bivariate test, namely chi square and fisher if the conditions were not met.

Methods The design of this study was a retrospective case-control study. Data were taken from breast cancer patients who were treated at the Oncology Surgery Clinic of RSCM who had undergone histopathological examination, mammography and imaging examinations such as bone prints or other additional investigations that confirmed whether the patient had bone metastases or not. Some of the data collected were age, body mass index, menopausal status, immunohistochemistry, tumor stage and histopathology.

Results There were 81 study subjects with inclusion criteria with results 56,7% of patients with over 50 years, 86,4% BMI below 30, 76,5% premenopausal 71,6% in advanced stages, 70,4% with NST histopathology, 58% luminal B, and 30,9% with bone metastases. The bivariate test showed a significant relationship between the presence of microclassification and bone metastases (OR 3.284 CI 95 1.212-8.899 p 0.017cs) and a significant relationship between the presence of advanced stage and the presence of microcalcifications (OR 3.74, 95% CI 1.28-10.86, p=0.012cs) .

Conclusion The presence of bone metastases in BC was significantly associated with the presence of microcalcification on mammography and locally advanced stages had a significant relationship with the presence of microcalcifications."