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Hasil Pencarian

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Dewi Utari
"Latar belakang Kanker payudara merupakan salah satu kanker paling banyak dialami oleh perempuan di dunia. Data yang didapatkan di RSUPN Cipto Mangunkusumo Jakarta menunjukkan bahwa sebagian besar pasien datang pada stadium lanjut lokal. Penanganan kanker payudara pada tahap lanjut lokal meliputi pemberian kemoterapi neoadjuvan, mastektomi, serta rekonstruksi. Waktu pelaksanaan rekonstruksi payudara pascamastektomi terbaik masih mejadi perdebatan pada klinisi. Studi ini bertujuan untuk membandingkan luaran antara rekonstruksi payudara secara immediate dan delayed pada pasien kanker payudara lanjut lokal yang dilakukan mastektomi dan pemberian kemoterapi neoadjuvan.
Metode Penelitian ini merupakan sebuah studi tinjauan sistematik dengan pencarian literatur dari basis data elektronik Cochrane, Pubmed, dan ScienceDirect, tanpa membatasi waktu dan bahasa. Telaah kritis dilakukan dengan menggunakan panduan Critical Appraisal Skills Programme (CASP). Luaran yang dinilai dalam penelitian ini adalah mortalitas, rekurensi, komplikasi, dan kualitas hidup.
Hasil Ditemukan sebanyak empat artikel tentang perbandingan antara luaran rekonstruksi immediate dan delayed pada rekonstruksi kanker payudara stadium lanjut lokal pascakemoterapi neoadjuvan yang kemudian disaring hingga diperoleh dua artikel yang dinilai layak dikaji. Dari hasil kajian ini diketahui bahwa tidak terdapat perbedaan mortalitas dan rekurensi antar kelompok, didapatkan tingkat komplikasi yang lebih tinggi pada kelompok dengan rekonstruksi immediate, serta tidak didapatkan data mengenai kualitas hidup pada kedua kelompok.
Kesimpulan Didapatkan tingkat komplikasi yang lebih tinggi secara signifikan pada rekonstruksi payudara secara immediate, namun tidak didapatkan perbedaan luaran pada parameter lainnya antar kelompok

Background Breast cancer is one of the most common cancers among women in the world. Data from Cipto Mangunkusumo National General Hospital showed that most of the patients were in locally-advanced stage. The treatment of locally advanced breast cancer includes administration of neoadjuvant chemotherapy, mastectomy, and reconstruction. The ideal timing of post-mastectomy breast reconstruction is still a matter of debate for clinicians. This study aimed to compare the outcome between immediate and delayed breast reconstruction in locally advanced breast cancer after mastectomy and neoadjuvant chemotherapy.
Method This systematic review utilized Cochrane, Pubmed, and ScienceDirect as the databases. There was no limitation on the timing of publication, nor the language. The critical analysis was conducted using the Critical Appraisal Skills Program (CASP) guide. The outcomes assessed in this study were mortality, recurrences, complications, and quality of life.
Result There were four articles comparing immediate and delayed reconstruction outcomes in locally advanced breast cancer, after mastectomy and neoadjuvant chemotherapy. The articles were further screened to obtain two articles deemed suitable for this study. This study showed that there was no difference in mortality and recurrence between groups. However, there was a significant higher complication rate in the immediate reconstruction group. There was no data regarding the quality of life in the two groups.
Conclusion There was significantly higher rate of complications with immediate breast reconstruction, but there was no difference in outcome in other parameters between groups
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Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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UI - Tugas Akhir  Universitas Indonesia Library
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Arga Patrianagara
"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.

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.
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Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
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UI - Tugas Akhir  Universitas Indonesia Library
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Shintia Christina
"[ABSTRAK
Latar belakang : Kanker payudara lanjut lokal (KPLL) adalah kanker payudara stadium III.Modalitas terapi KPLL adalah pembedahan, kemoterapi, radioterapi, hormonal terapi dan terapi target. Respon kemoterapi neoadjuvan terdiri dari respon klinis dan respon patologi. Penilaian respon kemoterapi neoadjuvan penting untuk memprediksi angka ketahanan hidup dan dapat menjadi pedoman kemoterapi selanjutnya. Penilaian respon patologi selama ini bersifat kuantitatif dan sering tidak selaras dengan respon klinis. Perubahan jumlah selularitas dapat terlihat, tetapi kualitas sel tumor tersebut tidak dapat diketahui dengan pulasan Haematoxylin-eosin (HE) pada fase awal fragmentasi DNA, sehingga penilaian respon patologi perlu dilakukan secara kuantitatif dan kualitatif yaitu menilai selularitas sel tumor dan persentase apoptosis.
Bahan dan cara : Dilakukan penelitian retrospektif analitik secara potong lintang pada kanker payudara lanjut lokal tahun 2010-2014 di Departemen Patologi Anatomi FKUI/RSCM dan divisi bedah onkologi RSCM. Sampel biopsi dan reseksi dibandingkan untuk mengevaluasi penurunan selularitas, kemudian diklasifikasikan ke derajat Miller- Payne (MP). Sampel reseksi dipulas dengan TUNEL dan dihitung persentase apoptosis. Penurunan selularitas antara biopsi dan mastektomi dengan TUNEL merupakan Modifikasi MP. Hasil : Perubahan respon patologi dengan Modifikasi MP menimbulkan peningkatan derajat pada 24 kasus. Tidak terdapat hubungan antara respon klinis dengan persentase apoptotis (p=0,108), respon klinis dengan MP (p=1,000) dan Modifikasi MP (p=0,655). Tidak didapatkan hubungan dan adanya korelasi yang lemah antara penyusutan massa tumor secara klinis dengan jumlah sel tumor yang mati dengan MP (p=0,177; r =0,212) dan Modifikasi MP (p=0,609; r = 0,081). Terdapat perbedaan signifikan antara jumlah sel mati yang dinilai dengan MP dan Modifikasi MP (p =0,000).
Kesimpulan : Persentase apoptosis tidak berhubungan dengan respon klinis. Modifikasi MP meningkatkan nilai derajat respon patologik, tetapi penilaian Modifikasi MP tetap tidak menunjukkan korelasi dengan respon klinik.ABSTRACT Background: Locally advanced breast cancer (LABC) is a stage III breast cancer. The management of LABC includes surgery, chemotherapy, radiotherapy, hormonal and targeted therapy. Responses to neoadjuvant (before surgery) chemotherapy consist of clinical and pathological responses. Evaluating chemotherapy response is essential to predict survival rate and it may become guidelines for the next chemotherapy in the future. Until now, the evaluation of pathological response only involves quantitative assessment and the clinical responses are often inconsistent with the pathological responses. Morphological changes of apoptotic cells can still be seen. However, the quality of the tumor cells is vague when the cells are stained with Hematoxylin-eosin (HE) during the first stage of DNA fragmentation. The evaluation of pathological responses; therefore, need to be performed by quantitative and qualitative methods, i.e. by evaluating the cellularity of tumor cells and the percentage of apoptosis.
Materials and method: A cross-sectional analytical retrospective study was conducted on the issue of locally advanced breast cancer between 2010 and 2014 at the Department of Anatomical Pathology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital and Division of Surgical Oncology, Cipto Mangunkusumo Hospital. Specimens of biopsy and resection were compared to evaluate reduction in cellularity, which were subsequently categorized into stages of Miller-Payne (MP) classification. The specimens of resection were stained with TUNEL and the percentage of apoptosis was calculated. Reduction in cellularity between biopsy and mastectomy specimens with TUNEL staining is a modified MP methods.
Results: The evaluation of pathological responses using the modified MP method has increased the value of MP grading in 24 cases. We found no association between clinical responses with percentage of apoptosis (p=0,108), MP pathological responses (p=1,000) and modified MP (p=0,655). There is no association and weak correlation between decreasing tumor mass with MP (p=0,177; r=0,212) and modified MP (p=0,609; r=0,081). There was a correlation between the dead cell evaluated by MP and by modified MP. (p=0.000)
Conclusion: Apoptosis percentage does not correlate with clinical responses. Modified MP increases the degree or grading of pathological responses, but it does not improve the correlation with clinical responses., Background: Locally advanced breast cancer (LABC) is a stage III breast cancer. The management of LABC includes surgery, chemotherapy, radiotherapy, hormonal and targeted therapy. Responses to neoadjuvant (before surgery) chemotherapy consist of clinical and pathological responses. Evaluating chemotherapy response is essential to predict survival rate and it may become guidelines for the next chemotherapy in the future. Until now, the evaluation of pathological response only involves quantitative assessment and the clinical responses are often inconsistent with the pathological responses. Morphological changes of apoptotic cells can still be seen. However, the quality of the tumor cells is vague when the cells are stained with Hematoxylin-eosin (HE) during the first stage of DNA fragmentation. The evaluation of pathological responses; therefore, need to be performed by quantitative and qualitative methods, i.e. by evaluating the cellularity of tumor cells and the percentage of apoptosis.
Materials and method: A cross-sectional analytical retrospective study was conducted on the issue of locally advanced breast cancer between 2010 and 2014 at the Department of Anatomical Pathology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital and Division of Surgical Oncology, Cipto Mangunkusumo Hospital. Specimens of biopsy and resection were compared to evaluate reduction in cellularity, which were subsequently categorized into stages of Miller-Payne (MP) classification. The specimens of resection were stained with TUNEL and the percentage of apoptosis was calculated. Reduction in cellularity between biopsy and mastectomy specimens with TUNEL staining is a modified MP methods.
Results: The evaluation of pathological responses using the modified MP method has increased the value of MP grading in 24 cases. We found no association between clinical responses with percentage of apoptosis (p=0,108), MP pathological responses (p=1,000) and modified MP (p=0,655). There is no association and weak correlation between decreasing tumor mass with MP (p=0,177; r=0,212) and modified MP (p=0,609; r=0,081). There was a correlation between the dead cell evaluated by MP and by modified MP. (p=0.000)
Conclusion: Apoptosis percentage does not correlate with clinical responses. Modified MP increases the degree or grading of pathological responses, but it does not improve the correlation with clinical responses.]"
Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tugas Akhir  Universitas Indonesia Library
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Syarifah Dewi
"ABSTRAK
Latar Belakang: Keberadaan sel punca kanker payudara diduga berkontribusi dalam timbulnya resistensi terapi. Beberapa mekanisme yang mempengaruhi respons terapi pada kanker yaitu aktifnya jalur sinyal embrionik, hambatan apoptosis dan tingginya perbaikan DNA serta adaptasi sel punca kanker terhadap hipoksia dan stres oksidatif.Tujuan: Menganalisis profil ekspresi gen kepuncaan pada kanker payudara setelah terapi neoajuvan hormonal dan kemoterapi dilihat hubungannya dengan jalur apoptosis p53, jalur stres oksidatif NFkB dan penanda hipoksia HIF- serta respons terapi.Metode: Penelitian ini menggunakan sampel jaringan kanker payudara stadium IIIB dan IV sebelum terapi neoajuvan 46 sampel pre dan setelah terapi neoajuvan 46 sampel post . Total RNA diekstraksi kemudian dilakukan pengukuran ekspresi dengan menggunakan teknik Next Generation Sequencing Truseq targeted RNA expression Illumina dengan menggunakan panel sel punca, p53 dan NFkB. Selain itu juga ekspresi HIF-1 dan HIF-2 diukur dengan menggunakan qRT-PCR.Hasil: Setelah terapi neoajuvan, profil ekspresi gen kanker payudara yang memiliki respons molekuler yang baik pada jalur kepuncaan adalah CCNE1, CDC42, CTNNB1, HDAC2, PSEN1, PSENEN, pada jalur apoptosis adalah BIRC5, CASP8, CASP9, CDK1 dan PCNA, pada jalur stres oksidatif adalah SOD2, STAT1 dan TBK1, serta pada jalur hipoksia yaitu HIF-1 dan HIF-2 . Profil ekspresi gen dengan respons molekuler yang buruk pada jalur kepuncaan adalah ALDH1A1, ALDH2, CCND2, CXCL12, FZD7, IGF1, sedangkan pada jalur apoptosis adalah ATM dan BID. Respons histopatologis Miller Payne berkorelasi positif bermakna dengan ekspresi gen jalur apoptosis dengan respons molekuler yang baik BIRC5, CASP8, CDK1 , namun berkorelasi negatif bermakna dengan ekspresi gen ALDH1A1. Survival pasien kanker payudara berkorelasi negatif bermakna dengan ekspresi ALDH1A1 dan SOD2.Kesimpulan: Ekspresi gen ALDH1A1 dan SOD2 merupakan faktor penting untuk prediksi prognosis terapi neoajuvan sistemik pada pasien kanker payudara stadium lanjut.

ABSTRACT
Introduction: The presence of breast cancer stem cells is considered to contribute to therapeutic resistance. There are some mechanisms affected therapy response in the cancer, such as active embryonic signaling pathways, inhibition of apoptosis and high DNA repair, adaptation to hypoxia and oxidative stress.Aim: to analyse the stemness gene expression profile in breast cancer after neoadjuvant chemotherapy and hormonal therapy correlated with apoptotic p53 , oxidative stress NFkB and hypoxia HIF- signaling pathways and also therapeutic responses.Methods: This study used breast tissue samples IIIB and IV before neoadjuvant therapy 46 pre samples and after neoadjuvant therapy 46 post samples . Total RNA was measured the expression profile using Next Generation Sequencing Truseq targeted RNA expression Illumina with stem cell, p53 and NFkB panels. In addition, HIF-1 and HIF-2 expression were measured using qRT-PCR. Results: After neoadjuvant therapy, the expression profiles of breast cancer genes that have good molecular responses in stem cells pathway are CCNE1, CDC42, CTNNB1, HDAC2, PSEN1, PSENEN, in apoptotic pathway are BIRC5, CASP8, CASP9, CDK1 and PCNA, in oxidative stress pathway are SOD2, STAT1 and TBK1, as well as in the hypoxic pathway HIF-1 and HIF-2 . Expression profiles with poor molecular responses in stem cells pathway are ALDH1A1, ALDH2, CCND2, CXCL12, FZD7, IGF1, while in apoptotic pathway are ATM and BID. Histopathologic response Miller Payne was significantly positively correlated with apoptotic pathway gene expression with good molecular response BIRC5, CASP8, CDK1 , but negatively significant correlated with ALDH1A1 gene expression. Survival of breast cancer patients significantly negatively correlated with ALDH1A1 and SOD2 expression. Conclusion: ALDH1A1 and SOD2 gene expression is an important factor for predicting the prognosis of systemic neoajuvan therapy in patients with advanced breast cancer."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2018
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UI - Disertasi Membership  Universitas Indonesia Library
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Filipus Dasawala
"Kemoterapi neoajuvan (KNA) merupakan salah satu modalitas terapi pada kanker payudara lanjut lokal (KPD-LL). Beberapa studi telah menunjukkan KNA dapat meningkatan kesintasan keseluruhan bila didapatkan respons patologis komplet, namun efektifitasnya dihambat oleh kemoresistensi yang dapat dimediasi oleh P-glycoprotein (Pgp). Tujuan dari studi ini adalah untuk mengkaji hubungan antara ekspresi Pgp dengan respons terhadap KNA pada pasien KPD-LL. Studi kohort prospektif multisentra dilakukan di RSUPN Dr. Cipto Mangunkusumo dan RSUD Koja pada periode September 2018 sampai Mei 2019. Analisis imunohistokimia dilakukan pada sampel biopsi untuk menilai ekspresi Pgp secara semikuantitatif. Respons klinis dinilai pascakemoterapi tiga siklus dengan menggunakan kriteria WHO. Subjek yang dinilai operabel pascaKNA menjalani operasi mastektomi radikal modifikasi. Respons patologis dinilai pada spesimen bedah dengan menggunakan kriteria Miller-Payne. Pgp didapatkan positif pada 21/27 subjek (77,8%) dan lemah/negatif pada 6/27 subjek (22,2%). Respons patologis komplet hanya didapatkan pada satu pasien dengan Pgp negatif. Tidak ada perbedaan secara statistik antara subjek dengan Pgp positif dan Pgp negatif dalam hal respons klinis maupun respons patologis. Hasil studi ini menunjukkan bahwa mayoritas pasien KPD-LL mengekspresikan Pgp, namun Pgp tidak dapat digunakan sebagai prediktor respons terhadap KNA, baik klinis maupun patologis.

Neoadjuvant chemotherapy (NACT) is one of the modalities used to treat locally advanced breast cancer (LABC). Studies have shown that it can improve overall survival if pathological complete response is achieved, but it is impeded by chemoresistance of which can be mediated by P-glycoprotein (Pgp). The aim of this study is to explore the association between Pgp expression and response to NACT. A multicenter prospective cohort study was carried out in Dr. Cipto Mangunkusumo General Hospital and Koja General Hospital from September 2018 to May 2019. Immunohistochemical analyses of the biopsy samples were done to semiquantitatively measure Pgp expression. Clinical response was evaluated after three cycles NACT using WHO response criteria. Subjects, who were deemed operable post-NACT, underwent modified radical mastectomy. Afterwards, the surgical specimens were evaluated for pathological response following Miller-Payne criteria. Pgp was strongly expressed in 21/27 subjects (77.8%) and weak/negative in 6/27 subjects (22.2%). pCR was seen only in one Pgp negative subject. There was no difference between Pgp positive and negative subjects in terms of clinical response and pathological response. The results show, Pgp is expressed in the majority of LABC patients, but it cannot be used as a predictor of response to NACT, either clinically or pathologically.
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Jakarta: Fakultas Kedokteran Universitas Indonesia, 2021
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UI - Tugas Akhir  Universitas Indonesia Library
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Annisa Syafitri
"Latar belakang: CTC sebagai bagian dari liquid biopsy berperan dalam melakukan monitoring pasien kanker payudara yang menjalani terapi. Adanya CTC menjadi pertanda resistensi terapi dan memengaruhi prognosis pasien. Penelitian ini bertujuan melihat adakah perubahan nilai CTC pada pasien kanker payudara stadium lokal lanjut atau lanjut yang mendapatkan kemoterapi serta melihat perubahan nilai CTC tersebut apakah dipengaruhi oleh usia, status menopause, subtipe, metastasis, dan grade.
Metode: Didapatkan 30 sampel pasien kanker payudara stadium lokal lanjut atau lanjut yang akan mendapatkan kemoterapi berbasis Anthracycline dan Taxan. Pre kemoterapi pasien diambil darah perifer dan dilakukan pemeriksaan CTC menggunakan flowcytometry dengan antibodi EpCAM. Pasien lalu menjalani siklus kemoterapi hingga lengkap. Setelah itu pasien kembali diambil darah perifer dan diperiksa nilai CTC post kemoterapi.
Hasil: Dari ke 30 sampel, didapatkan mean usia 47,93+7.30. Sebanyak 56,7 (n=17) belum menopause, 43,3% status tumor T3 dan T4, status kelenjar getah bening terbanyak adalah N0 dan N1 (43,3%). Hanya 2 pasien yang ditemukan ada metastasis. 56,7% pasien dengan grade 3, dan subtipe terbanyak adalah luminal B ( 63,4%, n=19). Terdapat 22 pasien (73,3%) dengan ER positif, 14 pasien (46,7%) dengan PR positif. Terdapat 11 pasien (36,7%) dengan Her2 positif dan 21 pasien (70%) dengan Ki67 high proliferation. Hasil CTC pre kemoterapi didapatkan nilai median 1460,50 sedangkan CTC post kemoterapi didapatkan nilai median 415,50 dilakukan uji Wilcoxon dan perbedaan bermakna dengan nilai p=0,002. Analisis multivariat regresi linier dihubungkan antara penurunan nilai CTC terhadap usia, status menopause, subtipe, metastasis, dan grading didapatkan status menopause berhubungan bermakna terhadap perubahan nilai CTC (p<0,05).
Kesimpulan: CTC pada pasien kanker payudara stadium lokal lanjut dan lanjut setelah kemoterapi lebih rendah bermakna dibandingkan sebelum kemoterapi. Status menopause memiliki hubungan bermakna terhadap penurunan jumlah CTC setelah kemoterapi pada kanker payudara stadium lokal lanjut dan lanjut
.
Background: As part of liquid biopsy, CTCs play a role in monitoring breast cancer patients undergoing therapy. The existence of CTCs is a sign of therapy resistance and affects patient prognosis. This study aims to examine whether there are changes in CTC values in patients with locally advanced or advanced breast cancer, who receive chemotherapy and are influenced by age, menopause status, subtype, metastasis, and grade.
Method: Of the 30 samples of locally advanced or advanced breast cancer patients receiving Anthracycline and Taxan-based chemotherapy were obtained. Pre-chemotherapy, peripheral blood, was drawn and CTCs were examined using flow cytometry with EpCAM antibody. Patients then undergo a complete chemotherapy cycle. After that, the patients were again taken peripheral blood and examined for post-chemotherapy CTC values.
Result: The study was conducted at Cipto Mangunkusumo Hospital, started from December 2022 to December 2023. Of the 30 samples with the mean age was 47,93+7,30. A total of 56,7 (n=17) were not menopause, 43,3% of tumor status with the T3 and T4, and the most common lymph node status with the N0 and N1 (43,3%). Only two patients were found to have metastasis. Then, 56,7% of patients had grade 3, and the most common subtype was luminal B (63,4%, n=19). There were 22 patients (73,3%) with ER positive, 14 patients (46,7%) with PR positive, 11 patients (36,7%) with Her2 positive, and 21 patients (70%) with Ki67 high proliferation. Pre-chemotherapy CTC results obtained a median value of 1460.50, Meanwhile, post-chemotherapy CTC obtained a median value of 415,50. Wilcoxon test was performed and the difference was significant with a value of p = 0,002. Multivariate linear regression analysis was correlated between the decrease in CTC values with age, menopause status, subtype, metastasis, and grading. The menopausal status has a significant association with decrease CTC values (p<0,05).
Conclusion: CTC in locally advanced and advanced breast cancer patients after chemotherapy was significantly lower than before chemotherapy. menopause status has a significant association with decreased CTC values after chemotherapy in locally advanced and advanced breast cancer.
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Jakarta: Fakultas Kedokteran Universitas Indonesia, 2024
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UI - Tugas Akhir  Universitas Indonesia Library
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Yuki Andrianto
"Tujuan: PD-L1 merupakan protein yang berperan dalam pengaturan respon imun terhadap tumor. Peningkatan ekspresi PD-L1 mengakibatkan antigen atau sel kanker dapat terhindar dari sistem imun. Hubungan ekspresi PD-L1 dengan penggunaan imunoterapi dan radioterapi secara bersamaan telah banyak dilakukan. Akan tetapi, saat ini masih belum diketahui hubungan antara ekspresi tersebut dengan toksisitas akut radiasi. Untuk itu, penelitian ini dilakukan untuk mengevaluasi hubungan antara ekspresi PD-L1 dengan toksisitas akut selama radiasi dan 2 bulan paska radiasi. Metoda: 30 pasien kanker serviks lanjut local yang mendapatkan terapi radiasi di Departemen radioterapi RSCM. Pasien dilakukan biopsy 2 kali yaitu pra radiasi eksterna dan paska radiasi eksterna untuk dilakukan pemeriksaan ELISA & IHK PD-L1. Selama menjalani radiasi eksterna dan 2 bulan paska radiasi, pasien dievaluasi toksisitas akut dengan kirteria CTCAE versi 5. Hasil: Ekspresi PD-L1 pada kanker serviks lanjut lokal yang mendapatkan radiasi tidak memengaruhi pada toksisitas akut selama radiasi eksterna dan 2 bulan paska radiasi (p>0,05). Akan tetapi, IHK PD-L1 dengan intesitas ≥ 2 dan ELISA PD-L1 yang mengalami penurunan dari pra radiasi ke paska radiasi, menunjukkan ada kecenderungan memiliki toksisitas yang lebih rendah yaitu ≤ Grade 1. Kesimpulan: Ekspresi PD-L1 tidak menurunkan toksisitas akut radiasi selama radiasi dan 2 bulan paska terapi pada pasien kanker serviks stadium lanjut lokal. Akan tetapi, pada toksisitas akut 2 bulan paska terapi menunjukkan kecenderungan mendapatkan toksisitas radiasi yang lebih rendah pada pasien yang memiliki ekspresi PD-L1.

Objectives: PD-L1 is a protein that controls the immune response to tumors. Increased PD-L1 expression results in immune system not detecting cancer cells. There was a correlation between the expression of PD-L1 and the combined use of immunotherapy and radiotherapy. At this time, however, there is no established association between these expression and radiation acute toxicity. Methods: Totally 30 locally advanced cervical cancer patients receiving radiation therapy in the Department of Radiotherapy of RSCM. Biopsy was performed twice, pre-external radiation and post-external radiation for PD-L1 ELISA & IHC tests. The patient was evaluated for radiation of acute toxicity with CTCAE version 5 during external radiation and 2 months post-radiation. Results: The expression of PD-L1 in local advanced cervical cancer which received radiation did not affect acute toxicity during external radiation and 2 months post radiation (p > 0.05). However, PD-L1 CPI with intensity ≥ 2 and PD-L1 ELISA which decreased from pre-radiation to post-radiation, showed a tendency to have lower toxicity, namely ≤ Grade 1. Conclusion: PD-L1 expression in local advanced cervical cancer patients did not reduce the acute toxicity of radiation during external radiation and 2 months post-treatment. Nonetheless, 2 months post-therapy, acute toxicity showed a propensity to lower toxicity in patients with expression of PD-L1."
Depok: Fakultas Kedokteran Universitas Indonesia, 2019
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UI - Tesis Membership  Universitas Indonesia Library
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Yuki Andrianto
"Tujuan: PD-L1 merupakan protein yang berperan dalam pengaturan respon imun terhadap tumor. Peningkatan ekspresi PD-L1 mengakibatkan antigen atau sel kanker dapat terhindar dari sistem imun. Hubungan ekspresi PD-L1 dengan penggunaan imunoterapi dan radioterapi secara bersamaan telah banyak dilakukan. Akan tetapi, saat ini masih belum diketahui hubungan antara ekspresi tersebut dengan toksisitas akut radiasi. Untuk itu, penelitian ini dilakukan untuk mengevaluasi hubungan antara ekspresi PD-L1 dengan toksisitas akut selama radiasi dan 2 bulan paska radiasi. Metoda: 30 pasien kanker serviks lanjut local yang mendapatkan terapi radiasi di Departemen radioterapi RSCM. Pasien dilakukan biopsy 2 kali yaitu pra radiasi eksterna dan paska radiasi eksterna untuk dilakukan pemeriksaan ELISA & IHK PD-L1. Selama menjalani radiasi eksterna dan 2 bulan paska radiasi, pasien dievaluasi toksisitas akut dengan kirteria CTCAE versi 5. Hasil: Ekspresi PD-L1 pada kanker serviks lanjut lokal yang mendapatkan radiasi tidak memengaruhi pada toksisitas akut selama radiasi eksterna dan 2 bulan paska radiasi (p>0,05). Akan tetapi, IHK PD-L1 dengan intesitas ≥ 2 dan ELISA PD-L1 yang mengalami penurunan dari pra radiasi ke paska radiasi, menunjukkan ada kecenderungan memiliki toksisitas yang lebih rendah yaitu ≤ Grade 1. Kesimpulan: Ekspresi PD-L1 tidak menurunkan toksisitas akut radiasi selama radiasi dan 2 bulan paska terapi pada pasien kanker serviks stadium lanjut lokal. Akan tetapi, pada toksisitas akut 2 bulan paska terapi menunjukkan kecenderungan mendapatkan toksisitas radiasi yang lebih rendah pada pasien yang memiliki ekspresi PD-L1.

Objectives: PD-L1 is a protein that controls the immune response to tumors. Increased PD-L1 expression results in immune system not detecting cancer cells. There was a correlation between the expression of PD-L1 and the combined use of immunotherapy and radiotherapy. At this time, however, there is no established association between these expression and radiation acute toxicity.
Methods: Totally 30 locally advanced cervical cancer patients receiving radiation therapy in the Department of Radiotherapy of RSCM. Biopsy was performed twice, pre-external radiation and post-external radiation for PD-L1 ELISA & IHC tests. The patient was evaluated for radiation of acute toxicity with CTCAE version 5 during external radiation and 2 months post-radiation.
Results: The expression of PD-L1 in local advanced cervical cancer which received radiation did not affect acute toxicity during external radiation and 2 months post radiation (p > 0.05). However, PD-L1 CPI with intensity ≥ 2 and PD-L1 ELISA which decreased from pre-radiation to post-radiation, showed a tendency to have lower toxicity, namely ≤ Grade 1. Conclusion: PD-L1 expression in local advanced cervical cancer patients did not reduce the acute toxicity of radiation during external radiation and 2 months post-treatment. Nonetheless, 2 months post-therapy, acute toxicity showed a propensity to lower toxicity in patients with expression of PD-L1.
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Depok: Fakultas Kedokteran Universitas Indonesia, 2019
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Nuraini Oktaviani
"Latar belakang: Salah satu modalitas terapi yang digunakan untuk meningkatkan angka kesintasan hidup pasien kanker payudara adalah dengan pemberian kemoterapi neoadjuvan. Pada umumnya kemoterapi neoajuvan kanker payudara stadium lanjut lokal di RSCM menggunakan regimen doxorubicin based. Namun belum ada penelitian lebih lanjut mengenai perbandingan kesintasan hidup lima tahun pasien kanker payudara lanjut lokal yang mendapatkan kemoterapi neoadjuvan doxorubicin based dengan non-doxorubicin based di RSCM.
Tujuan: Mengetahui angka kesintasan hidup lima tahun penderita kanker payudara stadium lanjut lokal yang diberikan kemoterapi neoadjuvan doxorubicin based dan non-doxorubicin based di RSCM tahun 2011 ndash; 2016.
Metode: Sebanyak 236 pasien kanker payudara stadium lanjut lokal yang mendapatkan kemoterapi neoadjuvan di RSCM tahun 2011-2016 menjadi sampel dalam penelitian ini. Analisis data dilakukan dengan metode Kapplan Meier, uji Log Rank dan Cox Regreession.
Hasil penelitian: Angka kesintasan hidup lima tahun pasien kanker payudara stadium lanjut lokal yang diberi kemoterapi neoadjuvan doxorubicin based sebesar 37 dan non-doxorubicin based sebesar 48,9 . Pasien kanker payudara stadium lanjut lokal yang mendapatkan kemoterapi neoadjuvan doxorubicin based memiliki probabilitas 1,38 kali lebih cepat terjadinya kematian 95 CI 0,946 ndash; 2,026 setelah dikontrol dengan variabel invasi pembuluh limfatik, respon klinis, stadium, radiasi, jenis histopatologi, grade, dan status menopause. Invasi pembuluh limfatik merupakan variabel dengan hazard ratio terbesar yaitu 4,74 95 CI 3,213 ndash; 7,284.
Kesimpulan: Kemoterapi neoadjuvan non-doxorubicin based menunjukkan kesintasan hidup yang lebih tinggi dibandingkan kemoterapi neoadjuvan doxorubicin based.

Background: One of the therapeutic modalities used to increase survival rates of breast cancer patients with neoadjuvan chemotherapy. In general, neoajuvan chemotherapy for locally advanced breast cancer at RSCM used a doxorubicin based regimen. But there has been no further study on the survival comparison of five years of locally advanced breast cancer patients who are neoadjuvan chemotherapy doxorubicin based or non doxorubicin based at RSCM.
Objectives: This study is conducted for determine 5 years survival rate of locally advanced breast cancer who were given neoadjuvan chemotherapy doxorubicin based and non doxorubicin based at RSCM in 2011 2016.
Methods: A total of 236 patients with locally advanced stage breast cancer who received neoadjuvan chemotherapy at RSCM in 2011 2016 were sampled in the study. Data analysis was perfomed by Kapplan Meier method, Log Rank and Cox Regreession analysis.
Results: 5 years survival rate of locally advanced breast cancer patients given neoadjuvan doxorubicin based chemotherapy is 37 and non doxorubicin based is 48.9. Locally advanced breast cancer patients receiving neoadjuvan doxorubicin based chemotherapy had a 1.38 times faster probability of death 95 CI 0.946 2.026 after controlled by invasive variation of lymphatic vein, clinical response, stage, radiation, histopathology, grade, And menopausal status. Invasion of lymphatic vessels is the variable with the largest hazard ratio of 4.74 95 CI 3,213 7,284.
Conclusions Neoadjuvan chemotherapy non doxorubicin based showed a higher survival than doxorubicin based for locally advanced breast cancer.
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Depok: Fakultas Kesehatan Masyarakat Universitas Indonesia, 2017
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Yasser Jayawinata
"Kanker payudara merupakan salah satu masalah kesehatan terbesar di Indonesia di mana sekitar 42,7% datang pada stadium lanjut lokal. Pemberian kemoterapi neoajuvan pada stadium lanjut lokal bertujuan mengecilkan ukuran tumor sehingga dapat dilakukan operasi dan menurunkan mortalitas. Salah satu prediktor untuk mengetahui keberhasilan kemoterapi neoajuvan adalah Ki-67, yaitu protein non-histone yang ekspresinya tinggi saat proliferasi sementara obat-obatan kemoterapi bekerja efektif pada fase proliferasi. Tujuan penelitian ini adalah untuk mengetahui peran Ki-67 sebagai faktor prediktor terhadap respons kemoterapi neoajuvan pada pasien KPDLL. Metode: Penelitian ini merupakan studi kohort retrospektif dengan kriteria inklusi adalah pasien dengan diagnosis kanker payudara stadium lanjut lokal dan mendapatkan kemoterapi neoajuvan di Rumah Sakit Cipto Mangunkusumo (RSCM) sejak 1 Januari 2014- 31Desember 2019. Cut-off ekspresi Ki-67 adalah 20%. Respons klinis kemoterapi neoajuvan dinilai berdasarkan kriteria WHO yang diukur setelah pemberian kemoterapi ketiga. Respons kemoterapi ini dikelompokkan menjadi respons baik (complete response dan partial response) dan respons buruk (stable disease dan progresive response). Hasil: Pasien kanker payudara lanjut lokal rata-rata berusia 50 tahun, ukuran tumor terbanyak T4 (90,4%), keterlibatan kelenjar getah bening N1 (52,1%), jenis histopatologi NST (71,3%), grade 2 (54,4%), ER positif (78,7%), PR positif (70,2%), HER2negatif (58,5%), Ki67 tinggi (70,2%), dan luminal B (56,4%). Lima puluh dua koma satu persen subjek memiliki respons kemoterapi buruk. Tidak terdapat perbedaan bermakna secara statistik antara ekspresi Ki-67 dengan respons kemoterapi (p= 1). Bila dihitung presentase sisa tumor, pasien dengan ekspresi Ki-67 tinggi memiliki persentase sisa tumor 74,6%, pasien dengan ekspresi Ki-67 rendah rata-rata tidak mengalami penurunan ukuran tumor dengan sisa tumor 103,8% (p= 0,977). Simpulan: Tidak terdapat perbedaan bermakna secara statistik antara ekspresi Ki-67 dan respons kemoterapi neoajuvan pada kanker payudara stadium lanjut lokal di RSCM.

Breast cancer is one of the most common health problems in Indonesia where 42.7% of patients have been diagnosed with Locally Advanced Breast Cancer (LABC). Neoadjuvant chemotherapy (NAC) is aimed to decrease the tumor size to be operable and decrease mortality. Ki-67 is highly expressed in the cell proliferation phase, while chemotherapy agents work effectively by targeting this proliferation. This study evaluates the utility of Ki-67 in LABC patients of the Asian-Indonesian population. Methods: This is a retrospective cohort study. Ki-67 data was from the medical record based on the immunohistochemistry staining with >20% cut off point. Clinical response was measured based on the WHO criteria after the third chemotherapy cycle, classified as good response (complete response and partial response) and poor response (stable disease and progresive response). Result: The majority of subjects in this study were 50 years old, with T4 tumor size (90.4%), N1 lymph node involvement (52.1%), NST histopathological type (71.3%), grade 2 (54.4%), ER-positive (78.7%), PR-positive (70.2%), HER2-negative (58.5%), high Ki67 expression (70.2%), and luminal B subtype (56.4%). 52.1% of all subjects showed ‘poor’ clinical responses to NAC. There was no significant association between subjects’ characteristics and the NAC Clinical response. Moreover, there was no significant association between Ki-67 and chemotherapy clinical response (p=1). Residual tumor size was 74.6% in high Ki-67 group and 103.8% in low Ki-67 group (p= 0.977). Conclusion: There is no statistically significant association between Ki-67 expression and NAC clinical response of LABC patients in Indonesia."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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