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"This book aims to give a homogeneous approach to esophageal cancer treatment, based on the author’s lifetime experience in conjunction with exhaustive review of recent literature. In each chapter surgeons and oncologists will find appropriate tools for correct management of the diagnosis and therapy of this difficult disease. The book analyzes all the aspects of staging and treatment, such as modern diagnostic and staging techniques (MRI or PET-CT), endoscopic treatment of early cancer, new minimally invasive and open surgical techniques, and combined treatment. In addition, there are chapters dedicated to the postoperative course of these patients, as well as their quality of life, with indications for the correct follow-up and treatment of relapses."

"ABSTRACTPurpose: Endoscopic submucosal dissection (ESD) is widely used to treat esophageal cancer, but some patients require additional treatment due to the possibility of lymph node metastasis. The aim of this study was to elucidate the clinical outcomes of these additional treatments.Methods: The study included 59 patients who developed superficial esophageal squamous cell carcinoma after noncurative ESD treated between 2005 and 2016, of whom 28 underwent esophagectomy and 31 received chemoradiotherapy (CRT).Results: The median follow-up periods were 45 months in the esophagectomy group and 41 months in the CRT group. The overall survival did not differ significantly between the groups (P = 0.46). However, there were no recurrences in the esophagectomy group, and the disease-specific survival rate was significantly higher in this group (P = 0.042). Among the patients at high risk for recurrence due to massive tumor invasion (≥ SM2) with lymphovascular invasion (esophagectomy group, six patients; CRT group, ten patients), none in the esophagectomy group had recurrence, whereas four in the CRT group died of esophageal cancer (P = 0.031).Conclusion: The overall survival did not differ significantly between the groups. However, compared with CRT, esophagectomy provided more favorable disease control for patients with massive tumor invasion (≥ SM2) with lymphovascular invasion."

"Indonesian Journal of Dentistry 2006; Edisi Khusus KPPIKG XIV:239-242Oral squamous cell carcinorna ( OSCC ) is the most common malignant tumor of the oral cavity, and its account for 80-90% of all malignancies in oral cavity. The aim of this study was to detemine the presenceof p53 mutations and to associate these mutations with the histopathological type of OSCC such as well differentiated and poorly differentiated. Analitycal observational comparative study by cross sectional design was used. Forty untreated well and poorly differentiated OSCC biopsy sample and normal tissue biopsy material taken from 16 normal patients were analyzed for the presence of mutation in the conserved region of the p53 gene especially in exon 5 by polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP). The results of this study showed that p53 gene mutations were detected in exon 5; 11/40 (27,5%) with heterozygous mutation 9/11 (81,8%). The incidence in exon 5 of p53 gene mutation was significantly accociated with well differentiated 2/20 (l0%) and poorly diferentiated 9/20 (45%) OSCC(P=0,013). This study concludes that 1) mutation in exon 5 of p53 gene occured frequently in OSCC; 2) exon 5 of the p53 gene could be one of the the specific targets for histopathological grade of OSCC; 3) mutation in exon 5 of p53 gene could be important prognostic factor in OSCC."

"Latar Belakang : Sarkoma sinovial adalah sarkoma jaringan lunak derajat tinggi. Modalitas terapi yang ada saat ini belum cukup memuaskan sehingga mendorong perlunya modalitas terapi baru, yaitu imunoterapi yang menargetkan NY-ESO-1 yang diekspresikan oleh sel tumor. Dalam penelitian, perbedaan ekspresi imunohistokimia NY-ESO-1 pada sarkoma sinovial dan diagnosis bandingnya yaitu malignant peripheral nerve sheath tumor (MPNST) dan dermatofibrosarcoma protuberans (DFSP) akan diteliti.Bahan dan Cara Kerja : Penelitian analitik potong lintang dilakukan terhadap 28 kasus sarkoma sinovial, 10 kasus MPNST dan 17 kasus DFSP yang berasal dari Departemen Patologi Anatomik FKUI/RSCM selama Januari 2013 sampai Juni 2019. Dilakukan pulasan NY-ESO-1 pada ketiga kelompok dan dikategorikan sebagai positif apabila terpulas pada lebih dari 50% sel tumor dengan intensitas positif sedang sampai kuat.Hasil : Ditemukan perbedaan bermakna ekspresi NY-ESO-1 pada kelompok sarkoma sinovial (18/28), MPNST (2/10) dan DFSP (1/17) (p<0,001). Pada analisis lebih lanjut sarkoma sinovial memiliki ekspresi NY-ESO-1 lebih tinggi secara signifikan terhadap MPNST (OR 7,2; p = 0,016; power  68,7%) dan terhadap DFSP (OR 28.8; p<0,001; power 98,9%).Kesimpulan : Sarkoma sinovial yang mengekspresikan NY-ESO-1 berpotensi untuk mendapat pemberian imunoterapi. Terdapat perbedaan ekspresi imunohistokimia NY-ESO-1 pada sarkoma sinovial terhadap MPNST dan DFSP.

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Background : Synovial sarcoma is a rare high grade soft tissue sarcoma. Nowdays, the available therapeutic modalities has not given a satisfactory result yet. Currently, there is a promising therapeutic strategy through immunotherapy targeting NY-ESO-1 which is expressed on tumor. The aim of this study was comparing NY-ESO-1 immunoexpression between synovial sarcoma and its histologic mimics i.e. malignant peripheral nerve sheath tumor (MPNST) and dermatofibrosarcoma protuberans (DFSP)Material and Methode : A cross sectional study was done in 28 cases of synovial sarcoma, 10 cases of MPNST and 17 cases of DFSP from archieval material in Department Anatomical Pathology, FMUI/RSCM from January 2013 to June 2019. Immunohistohemical stainning was performed using an antibody NY-ESO-1 and it was described positive if it was expressed in more than 50% of tumor with moderate to strong positive intensity.Results : There is a significant difference p<0,001) in NY-ESO-1 immunoexpression among synovial sarcoma (18/28), MPNST (2/10) and DFSP (1/17). Furthermore, synovial sarcoma showed a significantly higher immunoexpression compared to MPNST (OR 7,2; p = 0,016; power 68,7%) and DFSP (OR 28,8; p<0,001; power 98,9%).Conclusion : Synovial sarcoma showed a higher expression of NY-ESO-1 thus makes it as a good candidates for immunotherapy. There are differences in the expression of NY-ESO-1 in synovial sarcoma against MPNST and DFSP."

"Receptor activator of nuclear factor-kappa (RANK)/receptor activator of nuclear factor-kappa B ligand (RANKL) signaling helps putative cancer stem cells (CSC) to maintain their stemness. Expression of CD44 and RANKL was analyzed in oral squamous cell carcinoma specimen (n = 191). Moreover, RANKL expression was measured in cancer cell lines (BICR3, BICR56) by immunohistochemistry and western blot analysis. Scanned images were digitally analyzed using ImageJ and the immunomembrane plug-in. CD44 and RANKL expression on protein level was correlated with clinical characteristics and impact on survival. RANKL was co-labeled with CD44 in immunohistochemical and immunofluorescence double labeling experiments. Although high CD44+/RANKL+ co-expression was significantly associated with clinicopathological factors and worse survival, multivariate analysis did not demonstrate high CD44+/RANKL+ co-expression as independent prognostic factor. Immunohistochemical and immunofluorescence double labeling experiments revealed RANKL expression by CD44+ cancer cells. RANKL specificity was confirmed by western blot analysis. For the first time, this study provides evidence that RANKL expression in OSCC might be associated with disease recurrence and a cell compartment measured by CD44+/RANKL+ co-expression within the mucosal epithelial basal layer cells."

"Latar belakang: Kanker serviks menduduki peringkat kedua sebagai kanker tersering di seluruh dunia. Karsinoma sel skuamosa KSS adalah jenis histopatologi kanker serviks tersering. Prognosis terapi dan kesintasan KSS serviks menjadi informasi yang penting untuk pasien dan klinisi.Tujuan: 1.Memperbaiki prognosis dan respon terapi radiasi pasien KSS serviks; 2.Mengetahui respon pasca terapi radiasi pada pasien KSS serviks stadium IIIB; 3.Mengetahui prevalensi dan deskripsi sosiodemografi pasien KSS serviks stadium IIIB; 4.Mengetahui perbedaan klinikopatologik pasien KSS serviks stadium IIIB ditinjau dari: diameter massa serviks, derajat diferensiasi sel kanker, dan jenis histopatologi sel kanker; Mengetahui kesintasan 1 tahun setelah menjalani terapi radiasi. Metode: Dilakukan telaah historical kohort pada 76 pasien KSS serviks stadium IIIB di RSCM dari tahun 2016-2017. Pasien dikelompokkan menjadi KSS serviks stadium IIIB dengan pembesaran KGB dan tanpa pembesaran KGB. Dilakukan analisis univariat, bivariat, dan multivariat. Kesintasan 1 tahun dianalisis dengan menggunakan Kaplan-Meier. Hasil: Prevalensi terbagi menjadi 36 pasien 47,4 dengan pembesaran KGB, dan 40 pasien 52,6 tanpa pembesaran KGB. Respon terapi radiasi pada KSS serviks IIIB dengan pembesaran KGB lebih rendah, RR 4,26 1,96 -9,27, IK 95 . Skor prediktor 2.1 sebagai titik potong untuk menentukan diagnosis respons negatif pada terapi radiasi LR 2,31, sensitivitas 96,3 , spesifisitas 58,3 , dan akurasi 77,3 . Deskripsi sosiodemografi dan klinikopatologi sebanding antara kedua kelompok. Kesintasan 1 tahun KSS serviks stadium IIIB tanpa pembesaran KGB lebih baik HR 9,57. Kesimpulan: Terdapat perbedaan bermakna terhadap respon terapi radiasi antara kelompok KSS serviks stadium IIIB dengan pembesaran KGB dan tanpa pembesaran KGB.

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Background: Cervical cancer is second rank as the most common cancer worldwide. Squamous cell carcinoma SCC is the most common histopathology type for cervical cancers. The radiotherapy prognostic and survival rate of cervical SCC becomes important information for patients and clinicians.

Objectives: 1 To improve prognostic and radiotherapy respond from SCC; 2 knowing the radiotherapy response in patients stage IIIB cervical SCC with lymph node enlargement LNE compared to without LNE; 3 knowing the prevalence and description of sociodemographic; 4 knowing clinicopathologic differences in stage IIIB cervical SCC patients in terms of: cervical mass diameter, differentiated grade of cancer cells, and histopathologic type of cancer cells. 5 Knowing 1 year survival rate after radiotherapy.

Method: A historical cohort study was undertaken in 76 patients with stage IIIB cervical SCC in RSCM from 2016-2017. Patients are grouped into stage IIIB cervical SCC with LNE and without LNE. Univariate, bivariate, and multivariate analyzes were performed. The 1-year survival was analyzed using Kaplan-Meier.

Results: Prevalence was divided into 36 patients 47.4 with LNE, and 40 patients 52.6 without LNE. The radiotherapy respon for stage IIIB cervical SCC with LNE is worst than without LNE, RR 4.26 1.96-9.27, 95 IK . Predictor score ge;2.1 as the cutoff point to determine negative response on radiotherapy LR 2.31, sensitivity 96.3 , specificity 58.3 , and accuracy 77.3 . Sociodemographic and clinicopathologic descriptions were comparable between the two groups. The 1-year survival of stage IIIB cervical SCC without LNE better than with LNE, HR 9.57 3.28 ndash;27.88 95 IK.

Conclusion: There was a significant difference to radiotherapy response between the stage IIIB cervical SCC with LNE and without LNE."

"Profil hTERT dan P73 pada kultur sel kanker mulut dibandingkan mukosa normal: studi pendahuluan. Perubahan genetik pada p53 memungkinkan terjadinya imortalisasi sel dan meningkatkan predisposisi terjadinya transformasi ke arah neoplasma. Hal ini terkait dengan aktivitas telomerase yang menjaga panjang telomer, yang aktivitasnya seharusnya dibatasi oleh p53. p73, yang merupakan homolog p53, mempunyai kemampuan supresi tumor yang mirip dengan p53. Tingkat ekspresi P73 dan human TERT kemungkinan berbeda pada berbagai jenis sel kanker dibandingkan dengan jaringan normalnya. Saat ini belum terdapat data tentang profil protein human TERT dan P73 pada sel lini karsinoma sel skuamosa oral (KSSO) dibandingkan dengan jaringan mukosa oral normal. Tujuan: Studi ini bertujuan untuk mendapatkan profil human TERT dan P73 pada sel lini KSSO dengan mutasi p53 dibandingkan dengan mukosa oral normal. Metode: Sel lini HSC-3 dan HSC-4 dengan mutasi p53 dikultur sedangkan mukosa oral normal dikumpulkan dari pasien tanpa kanker yang menjalani perawatan bedah mulut. Ekstraksi protein dan analisis profil human TERT dan P73 dilakukan dengan SDS-PAGE dan ditentukan berdasarkan perkiraan berat protein. Hasil: Pita human TERT jelas terlihat pada sel HSC-3 dan HSC-4 namun tidak pada mukosa oral normal. Densitas pita P73 pada sel HSC-3 terlihat lebih tebal dibandingkan pada sel HSC-4. Hanya 50% sampel mukosa oral normal memperlihatkan pita P73. Simpulan: Terlihat profil human TERT dan P73 yang berbeda pada sel kanker dan sel normal. Perbedaan ini kemungkinan bersifat spesifik tergantung jenis sel dan dipengaruhi oleh status p53. Perlu dilakukan penelitian lanjutan untuk menganalisis kemungkinan peran p73 dalam menggantikan fungsi p53 pada kanker mulut selanjutnya diperlukan.

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Genetic alteration on p53 allows cellular immortalization and predisposes cells to neoplastic transformation. This immortalization is related to telomere length maintenance by telomerase. Human TERT is a key component of telomerase, which activity is suppressed by p53. The p73, the homolog of p53, has a similar ability in tumor suppression. The P73 is expressed at a different level in various cancer cells and normal tissues. Profile of human TERT and P73 in mutant p53 OSCC cell line and normal human oral mucosa have not been known.Objective: To observe human TERT and P73 profile in mutant p53 OSCC cell lines and normal human oral mucosa. Methods: The extracted protein of HSC-3 and HSC-4 cell lines and normal mucosal tissues were analyzed with SDS PAGE to detect human TERT and p73 expression based on the molecular weight. Results: The HSC-3 cell line showed thicker band density of P73 compared to its density of HSC-4. Only 50% of normal oral mucosa tissue showed thick P73 band density. The human TERT band was clearly shown in HSC-3 and HSC-4 cell lines but not in normal oral mucosa. Conclusion: Different profile of human TERT and P73 in OSCC cell lines and normal oral mucosa might be cell-type specific and influenced by the status of p53. Analysis of the role of p73 in these cancers might need further research to determine possible p73 substitution for p53 function."

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Pendahuluan: Karsinoma rongga mulut adalah keganasan tersering ke-6 di Asia. Mayoritas pasien karsinoma sel skuamosa rongga mulut (KSSRM) di RSCM datang dalam kondisi lanjut. Namun belum ada studi yang meneliti mengenai kesintasan penyakit ini di Indonesia. Penelitian ini bertujuan untuk menilai kesintasan KSSRM di RSCM berdasarkan stadium klinis AJCC ke-8.

Metode: dilakukan studi analisis kesintasan secara retrospektif dengan menggunakan data pasien KSSRM yang didiagnosis di Divisi Bedah Onkologi RSCM pada tahun 2014-2018. Luaran pasien didapatkan dari rekam medis dan menghubungi pasien via telepon. Data dianalisis menggunakan metode Kaplan-Meier.

Hasil: Mayoritas pasien adalah laki-laki (perbandingan laki-laki:perempuan adalah 1,03:1) dengan rerata usia  51,12±13,821 tahun. Tumor ditemukan paling banyak di daerah lidah (72,8%) dan kebanyakan pasien didiagnosis pertama kali pada stadium IV (83,4%). Kesintasan keseluruhan satu dan dua tahun adalah 58,6% dan 43,1%, dengan kesintasan spesifik-penyakit adalah 66,9%. Kesintasan satu dan dua tahun terendah adalah pada kelompok stadium IV (53,5% dan 36,1% secara berurutan). Namun tidak terdapat hubungan yang bermakna secara statistik antara kesintasan dan stadium klinis pada studi ini.

Simpulan:  Kesintasan KSSRM yang rendah di RSCM menunjukan tingginya patient delay. Penapisan dan edukasi mengenai penyakit ini dibutuhkan untuk meningkatkan angka kesintasan.

 

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Introduction: Oral cancer carcinoma is the 6^th most frequent malignancy in Asia. In Cipto Mangunkusumo Hospital, most patient comes in late stage. Yet, there is no survival study available for this disease in our country.

Objectives: This study aims on revealing the survival rate oral squamous cell carcinoma (OSCC) patients in Cipto Mangunkusumo based on the 8^th AJCC staging.

Methods: We performed a retrospective survival analysis study from a database of OSCC patients diagnosed at Cipto Mangunkusumo Hospital in 2014-2018. Follow-up details were updated from medical record and by phone calls. Data was analysed using the Kaplan-Meier method.

Results: Majority of the patients were male (male-to-female ratio was 1.03:1) with the mean age was 51,12±13,821 years old. Tumors occurred mostly in the tongue (72,8%), and most patients were initially diagnosed as stage IV (83,4%). The one and two year overall survival rate were 58,6% and 43,1%, with a disease-specific survival rate was 66,9%. The worst one and two year survival rate was found constantly in the stage IV group (53,5% and 36,1%, consecutively). Though there was no statistically significant association between overall survival and clinical staging in this study (p>0,05).

Conclusion: The low OSCC survival rate in Cipto Mangunkusumo Hospital indicated a high level of patient delay. Screening and education regarding this disease are needed to increase the survival rate.

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"Pendahuluan: Insidensi Infeksi HPV pada Karsinoma Sel Skuamosa Oral dan Hubungannya dengan Mutasi p53 dan c-myc: Penelitian Kasus Kontrol pada Rumah Sakit Muwardi. Rata-rata angka kejadian kanker rongga mulut dan pharyng di negara berkembang per tahun diperkirakan pada kisaran 25 kasus per 100.000 penduduk. Saatini patogenesis kanker telah diketahui berhubungan dengan virus Human papilloma (HPV). Catatan lain bahwa mutasi pada gena p53 dan c-myc ditemukan pada 50% dari seluruh kejadian kanker. Tujuan: Tujuan penelitian ini adalah untuk mengetahui kejadian pasien Kanker Sel Skuamous Rongga Mulut (KSSRM) dengan infeksi HPV tanpa mutasigena p53 dan c-myc. Bahan dan Cara: Jaringan biopsi frozen sections dari pasien Sel Skuamous Rongga Mulut Jinak (SSRMJ) dan Kanker Sel Skuamous Rongga Mulut (KSSRM) yang dikumpulkan dari Bagian Penyakit Gigi dan Mulut RSUD dr Muwardi Surakarta mulai Januari 2007 hingga Januari 2008. Amplifikasi gena L1-HPV untuk mengetahuikeberadaan stressor HPV. Amplifikasi gena-gena p53 dan c-myc, dilanjutkan analisis Single Strand Comformational Polymorphisme (SSCP) dan diikuti pengukuran menggunakan densitometer untuk melihat keberadaan mutasi. Data yang terkumpul dianalisa menggunakan Uji Chi Square. Hasil: Pasien SSRMJ teridentifikasi 23% terinfeksi HPV dan pasien KSSRM teridentifikasi 73% terinfeksi HPV. Seratus persen pasien SSRMJ yang terinfeksi HPV tercatat tanpa mutasi pada gena p53 dan c-myc, 81% pasien KSSRM yang terinfeksi HPV tercatat tanpa mutasi gena p53 dan 91 % pasien KSSRM yang terinfeksi HPV tercatat tanpa mutasi gena c-myc. Analisis uji Chi Square menunjukkan perbedaan yang signifikan antara pasien SSRMJ dan KSSRM pada infeksi HPV tanpa mutasi gena p53 dan c-myc. Kesimpulan: HPV merupakan faktor untuk kejadian KSSRM.

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Introduction: Annual incidence rates for oral and pharyngeal cancer are estimated at 25 cases per 100,000 in developing countries. Human papilloma virus (HPV) was implicated in pathogenesis of Cancer. The mutations of p53 and c-myc are found 50% in cancer. Objective: Aims of this research were to know the incidence of OSSC patient which realized HPV infection without p53 and c-myc gene mutation. Materials and Methods: Tissue biopsy frozen sections were taken from BOSC (Benign Oral Squamous Cell) and OSCC (Oral Squamous Cell Carcinoma) patients collected from Oral and Dental Departement of dr Muwardi Distric Hospital in Surakarta from January 2007 to January 2008. Toamplify L1-HPV gene for fixed the HPV stressor. To amplify p53 and c-myc genes, continued with SSCP (Single Strand Conformational Polymorphisme) analysis and followed with measurement using densitometer, to see mutation existence. The collected data were analyzed with Chi Square. Results: BOSC patient identified 23% with HPV infections and OSCC patient identified 73% with HPV infections. Hundred percent BOSC patient with HPV infection without mutation in p53 gene and c-myc gene, 81% OSCC patient with HPV infection without mutation in p53 gene and 91 % OSCC patient with HPV infection without mutation in c-myc gene. Chi Square analysis showed significant difference between BOSC and OSCC patients with HPV infection without mutation in p53 and c-myc gene. Conclusion: HPV is a factor for pathogenesis of OSCC."