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Yasser Jayawinata
Ki-67 sebagai Prediktor Respons Kemoterapi Neoajuvan pada Kanker Payudara Lanjut Lokal di RSCM = Ki-67 as a Predicting Factor of Neoadjuvant Chemotherapy Clinical Response for Local Advanced Breast Cancer in RSCM
"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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UI - Tesis Membership  Universitas Indonesia Library
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Sinta Chaira Maulanisa
Hubungan Ekspresi Limfosit T CD8+ Terhadap Respons Kemoterapi Neoadjuvan Pada Kanker Payudara Lanjut Lokal Berdasarkan Respons Patologis Miller Payne = Expression of CD8 Lymphocytes as a Predictor for Miller Payne's Pathological Response to Neoadjuvan Chemotherapy in Locally Advanced Breast Cancer
"Kanker payudara merupakan kanker paling umum pada wanita di seluruh dunia
dengan insiden lebih dari dua juta orang setiap tahunnya. Kanker payudara
stadium lanjut lokal adalah jenis kanker payudara invasif yang terbatas pada
payudara regional dan kelenjar getah bening. Salah satu terapi adalah kemoterapi
neoadjuvan (KN) yang efikasinya dapat dievaluasi secara respons patologis
dengan Miller Payne. Penting untuk mengidentifikasi biomarker sebagai prediktor
respons patologis setelah KN. Limfosit CD8+ diperiksa sebagai prediktor
keberhasilan KN lanjut lokal. Dengan menggunakan metode cross-sectional,
penelitian ini dilakukan di laboratorium patologi anatomi dan divisi bedah
onkologi RSUPN Dr. Cipto Mangunkusumo antara bulan Januari-Juni 2022.
Subjek penelitian ini adalah pasien kanker payudara stadium lanjut lokal yang
menjalani operasi pengangkatan payudara dengan terapi KN dari bulan September
2015- Februari 2022. Subjek penelitian ini didominasi luminal B, grade 2, ER+
dan kemoterapi berbasis antrasiklin. Ekspresi limfosit CD8+ tinggi dan tidak ada
hubungan dengan faktor klinikopatologi. Sebagian besar pasien memberikan
respon patologis positif terhadap kemoterapi dan terdapat hubungan yang
bermakna antara ekspresi limfosit T CD8+ dengan respon patologis Miller-Payne.
Diperlukan penelitian lebih lanjut mengenai ekspresi limfosit CD8+ sebagai faktor
prediktif dalam respon kemoterapi neoadjuvan.
Breast cancer is the most common cancer in women worldwide with an incidence
of more than two million people annually. Locally advanced breast cancer is a
type of invasive breast cancer limited to the regional breast and lymph nodes. One
of the treatments is neoadjuvant chemotherapy (NC) whose efficacy can be
evaluated by the Miller Payne method. It is important to identify biomarkers to
predict pathological responses after NC. CD8+ lymphocyte was examined as a
predictor of advanced local NC successfulness. Using cross-sectional method, this
research was done in the laboratory of anatomical pathology and division
surgical oncology RSUPN Dr. Cipto Mangunkusumo between January-June 2022.
The subjects were locally advanced breast cancer patients who received
neoadjuvant breast removal surgery from September 2016- February 2022. 35 out
of 40 subjects had clinical stage T4 mostly NST, luminal B, grade 2, ER+ and
anthracycline-based chemotherapy. The expression of CD8+ lymphocytes was
high and there was no association with clinicopathological factors. Most of the
patients respond positively to chemotherapy and there is a significant relationship
between the expression of CD8+ T lymphocytes with Miller Payne pathological
response. Further research on CD8+ lymphocyte expression"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
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UI - Tesis Membership  Universitas Indonesia Library
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Lili Dwiyani
Peran rehabilitasi preventif terhadap kapasitas fungsional dan kualitas hidup pasien kanker payudara stadium II-III yang menjalani kemoterapi = Effect of preventive rehabilitation on functional capacity and quality of life amongst patients stage II-III breast cancer receiving chemotherapy
"Kanker payudara merupakan jenis keganasan tersering pada wanita di Indonesia. Kemoterapi dan inaktivitas fisik selama pengobatan kanker menyebabkan penurunan kapasitas fungsional dan kualitas hidup. Rehabilitasi preventif dengan latihan aerobik terbukti bermanfaat meningkatkan kapasitas fungsional dan kualitas hidup pada populasi ini, namun studi mengenai aktivitas berjalan kaki terukur pedometer masih belum diteliti di Indonesia. Studi ini bertujuan menilai efek aktivitas berjalan kaki harian 4000 langkah selama 8 minggu terhadap kapasitas fungsional dan kualitas hidup pasien kanker payudara stadium II-III yang menjalani kemoterapi. Studi ini adalah one group pre and post test design, dilakukan pada 15 subjek, berusia 25-59 tahun, di poliklinik Rumah Sakit Kanker Dharmais. Kapasitas fungsional ditentukan dari jarak tempuh uji jalan enam menit protokol Nury dan kualitas hidup dengan EORTC-QLQ-C30 versi Bahasa Indonesia, yang dinilai sebelum dan setelah rehabilitasi preventif. Rerata capaian jumlah langkah harian adalah 5005,26+1574 langkah. Tidak ditemukan perbedaan kapasitas fungsional sebelum dan setelah rehabilitasi (436,84±47,87 dan 449,64±51,84, p=0,0143). Terjadi peningkatan kualitas hidup global EORTC QLQ-C30 setelah penerapan aktivitas berjalan kaki terukur (63,89±30,97 dan 82,78±14,24, p=0,011). Aktivitas berjalan kaki terukur pedometer selama 8 minggu mempertahankan kapasitas fungsional dan meningkatkan kualitas hidup pada pasien kanker payudara stadium II-III yang menjalani kemoterapi.
Breast cancer is the most common cancer amongst Indonesian women. Chemotherapy and physical inactivity during cancer treatment lead to decreased functional capacity and quality of life, which could be prevented by doing aerobic exercise. However, studies on pedometer-based walking activity programs have not been studied in Indonesia. This study aimed to assess the effects of eight weeks of 4000-steps of the pedometer-based walking activity program on functional capacity and quality of life in stage II-III breast cancer patients receiving chemotherapy. This study was a one-group pre-and post-test design with 15 subjects, aged 25-59 years, in the outpatient of Rumah Sakit Kanker Dharmais. The functional capacity was determined from the six-minute walk test distances of the Nury's protocol and quality of life with the EORTC-QLQ-C30 Indonesian version, which were assessed before and after rehabilitation. The average daily step count was 5005.26+1574 steps. There was no difference in functional capacity before and after rehabilitation (436.84±47.87 and 449.64±51.84, p=0.0143). There was an increase in the global quality of life of the EORTC QLQ-C30 after the implementation of measured walking activities (63.89±30.97 and 82.78±14.24, p=0.011). Eight weeks of pedometer-based walking activity program maintains functional capacity and improves the quality of life in stage II-III breast cancer patients receiving chemotherapy."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
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UI - Tesis Membership  Universitas Indonesia Library
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Endang Setiawati
Pengaruh Usia Menarche Pada Perempuan Dengan Kejadian Kanker Payudara Di Daerah Perkotaan Indonesia (Analisis Data Riset Penyakit Tidak Menular Tahun 2016). = The Effect of Menarche Age on Women with Breast Cancer Incidence in Urban Areas of Indonesia (Analysis of Non-Communicable Diseases Research Data, 2016)
"Kanker payudara adalah adalah tumor ganas yang terbentuk dari sel-sel payudara
yang tumbuh dan berkembang tanpa terkendali sehingga dapat menyebar diantara
jaringan atau organ di dekat payudara atau ke bagian tubuh lainnya. Tujuan penelitian ini adalah untuk mengetahui hubungan usia menarche pada perempuan dengan kejadian kanker payudara di daerah perkotaan Indonesia dengan menganalisis data riset PTM tahun 2016. Desain yang digunakan dalam penelitian ini adalah cross sectional dengan sampel 34.635, sample diambil berdasarkan total sampling data yang masuk dalam kriteria inklusi dan eksklusi penelitian. Analis bivariat menggunakan chi-Square dan analisis multivariat menggunakan regresi logistik. Hasil penelitian ini menunjukkan bahwa proporsi kanker payudara pada perempuan di daerah perkotaan Indonesia berdasarkan data riset PTM tahun 2016 sebesar 7,9%. Hasil analisis multivariate hubungan usia menarche dengan kejadian kanker payudara memiliki P value 0,539 OR 1,051 (0,897-1,232) yang berarti P value >0,05. Kesimpulannya, tidak ada hubungan antara usia menarche dengan kejadian kanker payudara berdasarkan data riset PTM tahun 2016 setelah di kontrol dengan variabel pendidikan, pekerjaan, riwayat kanker pada keluarga dan pola kebiasaan makan
Breast cancer is a malignant tumor that was formed from breast cells that grow
out of control so that it can spread between tissues or organs near the breast or to other parts of the body. This study aims to know the correlation between the age of menarche in women and the incidence of breast cancer in urban areas of Indonesia by analyzing data from the 2016 Non-Communicable Diseases research. Design of this research used cross sectional study, sample which suitable from inclusion and exclusion criteria was 34.635 respondens. Bivariate analysis used chi-square and multivariate analysis used logistic regression. The results showed the proportion of breast cancer in women in urban areas of Indonesia based on research data on Non-Communicable Diseases in 2016 was 7.9%. Multivariate analysis showed that relationship between the age of menarche and
the incidence of breast cancer P value 0.539 OR 1.051 (0.897-1.232) which means P value > 0.05. The conclusion, there was not a significant relationship between the age of menarche in women and the incidence of breast cancer in urban areas of Indonesia by analyzing data from the 2016 Non-Communicable Diseases research after being controlled with variables of education, occupation, family history of cancer and dietaryhabits."
Depok: Fakultas Kesehatan Masyarakat Universitas Indonesia, 2021
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UI - Tesis Membership  Universitas Indonesia Library
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Naura Syafira
Fitokimia, aktivitas antioksidan, dan sitotoksisitas dari ekstrak Lentinula edodes terhadap sel kanker payudara T47D = Phytochemistry, Antioxidant Activity, and Cytotoxicity of Lentinula edodes Extract toward T47D Breast Cancer
"Latar belakang: Kanker payudara sebagai kanker nomor satu pada wanita merupakan sebuah ancaman. Kanker payudara merupakan kanker dengan sebab non-infeksius. Secara umum, kanker merupakan penyakit multifaktorial. Faktor genetik, lingkungan, dan gaya hidup memiliki peran dalam perkembangan kanker. Manusia secara konstan selalu terpapar radikal bebas baik dari internal maupun eksternal. Ketidakseimbangan antara radikal bebas dan antioksidan dapat menyebabkan radikal bebas yang tidak terkontrol dan berlebihan. Hal ini dapat mengakibatkan kerusakan sel dan berakhir dengan pertumbuhan sel yang tidak terkontrol. Jamur shiitake (Lentinula edodes) merupakan salah satu jamur yang telah dipelajari secara ekstensif tentang manfaatnya. Telah diketahui bahwa L. edodes memiliki efek antioksidan dan sitotoksik terhadap sel kanker. Studi ini bertujuan untuk mengetahui konstituen fitokimia, aktivitas antioksidan, dan aktivitas sitotoksik dari L. edodes terhadap sel kanker payudara T47D.
Metode: L. edodes yang sudah berupa serbuk kering dimaserasi dengan n-heksan, etil asetat, dan etanol secara berurutan, menghasilkan ekstrak n-heksana, ekstrak etil asetat dan ekstrak etanol L. edodes. Setiap ekstrak kemudian dievaluasi kandungan konstituen fitokimia, aktivitas antioksidan, dan aktivitas sitotoksiknya melalui uji fitokimia, analisis kromatografi lapis tipis (KLT), uji DPPH, dan uji MTT terhadap sel kanker T47D.
Hasil: Skrining uji fitokimia dari ekstrak L. edodes menunjukkan adanya alkaloid, glikosida, flavonoid, dan triterpenoid. Analisis KLT menunjukan bahwa L. edodes mengandung lima belas komponen senyawa kimia. Uji DPPH memperlihatkan bahwa ekstrak etanol L. edodes memiliki aktivitas antioksidan yang sangat kuat terhadap radikal bebas DPPH. Berdasarkan uji MTT, ketiga jenis ekstrak L. edodes menunjukkan aktivitas sitotoksik yang sangat kuat terhadap sel kanker payudara T47D.
Kesimpulan: Senyawa kimia yang terkandung pada L. edodes menunjukan aktivitas antioxidant dan sitotoksi terhadap sel kanker payudara T47D melalui Analisa DPPH dan MTT.
Background: Breast cancer is a major threat as it is the number one cancer affecting women. It is a non-communicable disease with non-infectious etiology. In general, cancer is a multifactorial disease. Factors such as genetics, environment, and lifestyle play a role. Humans are constantly exposed to free radicals from internal or external sources. An imbalance between free radicals and antioxidants will cause uncontrollable and excessive free radicals. This can cause cell damage which leads to uncontrollable cell growth. Shiitake mushroom (Lentinula edodes) is one of fungi that has been studied extensively on its health benefits. It is known to contain substances that can exert antioxidant and cytotoxicity towards cancer cells. The study aims to investigate phytochemical constituent, antioxidant activity, and cytotoxic activity of Lentinula edodes towards T47D breast cancer cells.
Method: Dry powder L. edodes was macerated in multi-level manner with n-hexane, ethyl acetate, and ethanol as solvent sequentially producing n-hexane extract, ethyl acetate extract, and ethanol extract of L. edodes. Each extract is evaluated for its phytochemical constituents composition, antioxidant activity, and cytotoxic activity using phytochemical test, thin layer chromatography, DPPH assay, and MTT assay towards T47D breast cancer cell line.
Results: Preliminary phytochemical screening of L. edodes extract showed that it contains alkaloid, glycoside, flavonoid, and triterpenoid. TLC resulted in fifteen chemical compounds. DPPH assay resulted in very active antioxidant activity of L. edodes ethanol extract towards DPPH free radicals. Based on MTT assay, the three L. edodes extracts resulted in very active cytotoxic activity towards the T47D breast cancer cell line.
Conclusion: Chemical constituents of L. edodes showed antioxidant activity and cytotoxic activity toward T47D breast cancer line through DPPH assay and MTT assay respectively."
Depok: Fakultas Kedokteran Universitas Indonesia, 2020
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UI - Skripsi Membership  Universitas Indonesia Library
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Filipus Dasawala
Ekspresi P-glycoprotein dan respons terhadap kemoterapi neoajuvan pada kanker payudara lanjut lokal: studi kohort prospektif multisentra = P-glycoprotein expression and response to neoadjuvant chemotherapy in locally advanced breast cancer: multicenter prospective cohort study
"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."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2021
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UI - Tugas Akhir  Universitas Indonesia Library
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Arga Patrianagara
Hubungan Rasio Neutrofil Dan Platelet Terhadap Limfosit Dan Rasio Limfosit Terhadap Monosit Dengan Respons Klinis Pada Kanker Payudara Lokal Lanjut Yang Mendapat Kemoterapi Neoadjuvan = The Association between Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio, and Monocyte-Lymphocyte Ratio with Clinical Response in Locally Advanced Breast Cancer after Neoadjuvant Chemotherapy
"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."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
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UI - Tugas Akhir  Universitas Indonesia Library
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Laila Rose Foresta
Korelasi perubahan kurva kinetik pada magnetic resonance imaging dengan perubahan ukuran tumor sebagai penanda respons tumor pasca kemoterapi neoajuvan pasien kanker payudara = correlation of kinetic curve gradient degree changes and tumor size changes in magnetic resonance imaging as a tumor response marker for neoadjuvant chemotherapy in breast cancer patients
"Penelitian ini bertujuan mencari penanda respons tumor yang lebih dini untuk kemoterapi neoajuvan pada kasus kanker payudara stadium lanjut, yaitu dengan mengkorelasikan derajat kemiringan washout fase delay kurva kinetik pada pemeriksaan DCE-MRI dengan perubahan ukuran tumor kanker payudara. Perubahan neovaskularisasi sudah dapat dinilai sejak 24 jam pertama setelah pemberian kemoterapi siklus pertama, sedangkan pengukuran tumor umumnya paling baik dinilai setelah kemoterapi neoajuvan siklus ketiga.
Penelitian ini merupakan studi deskriptif analitik dari data sekunder MRI payudara mulai Agustus 2011 hingga April 2013. Analisa korelasi perubahan derajat kemiringan washout fase delay kurva kinetik DCE-MRI dengan perubahan ukuran tumor sebelum dan sesudah pemberian kemoterapi neoajuvan awal, dilakukan dengan uji korelasi Pearson.
Hasil analisa menunjukkan tidak ada korelasi yang bermakna (r=0,151, p=0,622) antara perubahan sudut kemiringan washout fase delay kurva kinetik dengan perubahan ukuran tumor sebelum dan setelah pemberian kemoterapi neoajuvan, sehingga dapat disimpulkan bahwa parameter perubahan sudut kemiringan washout secara tunggal tidak dapat berfungsi sebagai penanda respons tumor kemoterapi neoajuvan. Hal ini dikarenakan respons tumor merupakan proses yang mutifaktorial sehingga perubahan sudut gradien washout saja secara langsung tidak dapat menunjukkan respons yang terjadi pasca kemoterapi neoajuvan.
This study assessed the possibility of a faster tumor response marker for neoadjuvant chemotherapy (NAC) by correlating the changes in kinetic curve washout gradient degree on the delayed phase of DCE-MRI after the first cycle, with changes in tumor size after the third cycle, as well as their roles in assessing tumor response for NAC. Studies show that changes in tumor size after the third NAC can be used to detect tumor response, whereas neovascularization changes with DCE-MRI can be detected as fast as 24 hours after the first cycle of chemotherapy.
This is an analytic study using breast MR data obtained between August 2011 until April 2013. Analysis of the correlation between changes in kinetic curve washout gradient with changes in tumor size before and after NAC was performed using the Pearson correlation test.
Based on the correlation analysis results, there is no significant correlation (r=0,151, p=0.622) btween the change in the angle of the washout kinetic curve gradient with the changes in tumor size before and after NAC. This concludes that changes in the degree of the washout angle alone cannot serve as a marker of tumor response to NAC, due of the multifactorial variables that take part in the process, and the kinetic curve alone is not sufficient to directly evaluate response."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013
T58662
UI - Tesis Membership  Universitas Indonesia Library
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Shintia Christina
Penilaian respon terapi neoadjuvan pada kanker payudara lanjut lokal dengan sistem Miller-Payne dan penanda apoptosis TUNEL = Pathological response assessment of neoadjuvant chemotherapy in locally advanced breast cancer with MP system and TUNEL
"[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
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
cover
Devi Felicia
Intensitas stromal tumor infiltrating lymphocytes (sTIL) dan ekspresi programmed death ligand 1 (PD-L1) sebagai prediktor respons patologis kanker payudara terhadap terapi neoadjuvan di RSCM = Stromal tumor infiltrating lymphocytes (sTIL) intensity and programmed death ligand 1 (PD-L1) expression as pathological predictors of breast cancer response to neoadjuvant therapy in RSCM
"Latar Belakang: Respons patologis kanker payudara terhadap terapi neoadjuvan masih relatif rendah, khususnya di RSCM. Intensitas sTIL dan ekspresi PD-L1 telah diteliti sebagai prediktor respons terapi neoadjuvan. Penelitian ini menilai peran intensitas sTIL dan ekspresi PD-L1 terhadap repons terapi neoadjuvan kanker payudara. Data tersebut dapat dimanfaatkan sebagai data awal di Indonesia, untuk perencanaan terapi pasien kanker payudara yang lebih baik, terlebih dengan sudah tersedianya imunoterapi anti-PD-1/PD-L1.
Tujuan: Mengetahui intensitas sTIL dan ekspresi PD-L1 sebagai prediktor respons patologis kanker payudara terhadap terapi neoadjuvan di RSCM.
Metode: Penelitian berdesain kohort retrospektif, analitik observasional, pada kasus kanker payudara yang mendapatkan terapi neoadjuvan dan mastektomi di RSCM periode Januari 2014-Desember 2021. Dilakukan total sampling sebanyak 60 kasus. Ekspresi PD-L1 (imunohistokimia, klon 22C3) dan intensitas sTIL (histopatologi) diperiksa pada spesimen biopsi. Dilakukan analisis multivariat regresi linear untuk mendapatkan prediktor independen respons terapi neoadjuvan.
Hasil: Didapatkan 60 pasien perempuan, median usia 46 tahun, 91,7% karsinoma invasif no special type. Median intensitas sTIL 10% (1%-70%). Intensitas sTIL rendah (≤10%) pada 58,3% sampel. Ekspresi PD-L1 positif (CPS ≥1) pada 28,3% sampel. Hanya 8,3% sampel mencapai pCR, 90% tergolong RCB kelas II-III. Didapatkan prediktor independen skor RCB: Setiap peningkatan 1% intensitas sTIL, tidak adanya invasi limfovaskular, dan pemberian kemoterapi berbasis taksan diprediksi menurunkan skor RCB sebanyak 0,058 (0,039-0,078), 0,781 (0,241-1,321), dan 0,594 (0,037-1,152). Ekspresi PD-L1 yang positif berhubungan dengan tercapainya pCR-RCB kelas I (p=0,048), tetapi skor CPS bukan merupakan prediktor skor RCB pada analisis multivariat regresi linear.
Kesimpulan: Intensitas sTIL merupakan prediktor respons patologis kanker payudara terhadap terapi neoadjuvan di RSCM. Ekspresi PD-L1 berhubungan dengan tercapainya pCR-RCB kelas I, tetapi skor CPS bukan prediktor skor RCB.
Kata kunci: PD-L1, programmed-death ligand 1, sTIL, stromal tumour infiltrating lymphocyte, kanker payudara, kemoterapi neoadjuvan, respons patologis
Background: Pathological responses to neoadjuvant therapy were still relatively poor, especially in RSCM. Studies had been done to search for predictors of response such as sTIL intensity and PD-L1 expression, which is known to block sTIL action in killing cancer cells. This research assessed sTIL intensity and PD-L1 expression as predictors of response to neoadjuvant therapy in breast cancer. The preliminary data might be used to better tailored breast cancer patient therapy, considering the availability of anti-PD-1/PD-L1 immunotherapy nowadays.
Objective: To assess TIL intensity, PD-L1 expressions, and their roles as pathological predictors of breast cancer reponse to neoadjuvant therapy in RSCM.
Method: This was an observational analytic retrospective cohort study on breast cancer patients receiving neoadjuvant therapy and mastectomy in RSCM from January 2014 to December 2021. Total sampling was done. PD-L1 expression (immunohistochemistry, clone 22C3) and sTIL intensity (histopathology) was examined in the biopsy specimen. Linear regression analysis was done to determine the independent predictors of neoadjuvant therapy response (evaluated in the mastectomy specimen with residual cancer burden/RCB score).
Results: There were 60 female patients, median age 46 years old. 91,7% had invasive carcinoma of no special type. Median sTIL intensity was 10% (1%-70%). 58,3% patients had low sTIL intensity (≤10%). 28,3% patients had positive PD-L1 expression (CPS ≥1). Only 8,3% patients had pCR, while 90% patients had RCB class II-III. Every 1% increase in sTIL intensity, no lymphovascular invasion, and taxane chemotherapy were predicted to lower RCB score by 0,058, 0,781, dan 0,594, respectively. PD-L1 expression associated with pCR-RCB class I (p=0,048), but CPS score was not a predictor of RCB score in linear regression analysis.
Conslusion: sTIL intensity was an independent predictor of breast cancer response to neoadjuvant therapy in RSCM. PD-L1 expression associated with pCR-RCB class I, but CPS score was not a predictor of RCB score.
Keywords: PD-L1, programmed death ligand 1, sTIL, stromal tumour infltrating lymphocyte, breast cancer, neoadjuvant therapy, pathological response"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
T-pdf
UI - Tesis Membership  Universitas Indonesia Library
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