Faktor-faktor yang Berhubungan dengan Kesintasan Pasien Kanker Serviks yang Ditatalaksana dengan Histerektomi Radikal dan Limfadenektomi

• Main Authors: Sigit Purbadi, R.M. Ali Fadhly
• Format: Article
• Language: English
• Published: Universitas Indonesia 2019-04-01
• Series: Journal Kedokteran Indonesia
• Subjects: kanker serviks, kesintasan, histerektomi radikal, limfadenektomi
• Online Access: http://journal.ui.ac.id/index.php/eJKI/article/view/10763
• ISSN: 2338-1426; 2338-6037

<p class="MsoNormal" style="text-align: justify;"><span style="font-size: 9pt; line-height: 107%; font-family: Arial-ItalicMT;">Kanker serviks adalah penyakit keganasan ke-4 tersering di dunia dan kedua di Indonesia. Kesintasanpasien kanker serviks merupakan ukuran kualitas layanan. Penelitian ini bertujuan untuk mengetahui faktor-faktoryang berhubungan dengan kesintasan pasien kanker serviks yang ditatalaksana dengan histerektomi radikal danlimfadenektomi. Penelitian dengan desain kohort retrospektif ini dilakukan di RSUPN dr. Cipto Mangunkusumopada bulan Agustus 2015 - Agustus 2016. Subjek adalah pasien kanker serviks stadium awal yang dilakukanhisterektomi radikal dan limfadenektomi pada bulan Januari 2011-Desember 2013. Variabel yang diteliti adalahstadium, histopatologi, ukuran tumor, diferensiasi tumor, invasi stroma, limfovaskular dan parametrium, kelenjarlimfe pelvis, batas sayatan dan hubungannya dengan kesintasan. Data diolah dengan SPSS versi 20 dan dianalisisdengan uji chi square, uji regresi cox metode stepwise, dan Kaplan Meier. Diperoleh 123 subjek kanker serviksnamun data yang dapat dianalisis adalah 50 pasien. Proporsi kesintasan subjek dengan keganasan serviks dalam7 tahun 2 bulan masa observasi maksimum 75%; tahun pertama 90% dan tahun ketiga 88%. Stadium, ukuran dandiferensiasi tumor, histopatologi, kelenjar limfe pelvis, batas sayatan, invasi limfovaskular dan parametrium tidakberhubungan dengan kesintasan namun invasi stroma dan terapi radiasi berhubungan dengan kesintasan. Faktorfaktoryang berhubungan dengan kesintasan adalah invasi stroma &lt;2/3 bagian yang merepresentasikan ukurrantumor dan terapi radiasi yang diperlukan pada pasien risiko tinggi pasca bedah (memberikan kesintasan lebihbaik). Perlu dilakukan penelitian lebih lanjut untuk mengetahui faktor prognostik lain pada pasien kanker serviksstadium awal seperti ekspresi faktor stem cells (SOX4, NANOG dan OCT4).</span></p> <p class="MsoNormal" style="text-align: justify;"><strong><span style="font-size: 9.0pt; line-height: 107%; font-family: &quot;Arial-BoldItalicMT&quot;,sans-serif; mso-bidi-font-family: Arial-BoldItalicMT;">Kata kunci: </span></strong><span style="font-size: 9.0pt; line-height: 107%; font-family: Arial-ItalicMT; mso-bidi-font-family: Arial-ItalicMT;">kanker serviks, kesintasan, histerektomi radikal, limfadenektomi.</span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-size: 9.0pt; line-height: 107%; font-family: Arial-ItalicMT; mso-bidi-font-family: Arial-ItalicMT;">&nbsp;</span></p> <p class="MsoNormal" style="text-align: justify;"><strong><span style="font-size: 12.0pt; line-height: 107%; font-family: &quot;Arial-BoldMT&quot;,sans-serif; mso-bidi-font-family: Arial-BoldMT;">Factors Associated with Survival Rate of Cervical Cancer Patients Treatedby Radical Hysterectomy and Lymphadenectomy</span></strong><strong><span style="font-size: 9.0pt; line-height: 107%; font-family: &quot;Arial-BoldItalicMT&quot;,sans-serif; mso-bidi-font-family: Arial-BoldItalicMT;">Abstract</span></strong><span style="font-size: 9.0pt; line-height: 107%; font-family: Arial-ItalicMT; mso-bidi-font-family: Arial-ItalicMT;">Cervical cancer is the 4</span><span style="font-size: 5.0pt; line-height: 107%; font-family: Arial-ItalicMT; mso-bidi-font-family: Arial-ItalicMT;">th </span><span style="font-size: 9.0pt; line-height: 107%; font-family: Arial-ItalicMT; mso-bidi-font-family: Arial-ItalicMT;">most comkon cancer in the world and ranked 2</span><span style="font-size: 5.0pt; line-height: 107%; font-family: Arial-ItalicMT; mso-bidi-font-family: Arial-ItalicMT;">nd </span><span style="font-size: 9.0pt; line-height: 107%; font-family: Arial-ItalicMT; mso-bidi-font-family: Arial-ItalicMT;">in Indonesia. The survivalrate of cervical cancer patients is the parameter of quality of care. This study was intended to determinefactors associated with survival rate of cervical cancer patients treated by radical hysterectomy andlymphadenectomy. This retrospective cohort study was conducted in Cipto Mangunkusumo Hospital onAugust 2015 &ndash; August 2016. Subjects were early stage cervical cancer patients who underwent radicalhysterectomy and lymphadenectomy on January 2011 &ndash; December 2013. Analyzed variables were cancerstages, histopathology, tumour size, tumor differentiation, stromal invasion, lymphovascular and parametrium,pelvic lymph nodes, surgical margin, and its association with survival rate. Data were analyzed with SPSSversion 20 by using chi-square test, stepwise cox-regression test, and Kaplan-Meier test. Of all 123 subjectswith cervical cancer, only 50 subjects were eligible to be analyzed further. The survival rate of cervical cancerpatients within 7 years and 2 months with maximum observation were 75%; 1-year survival rate was 90%and 3-year survival rate 88%. Stages, size, and tumour differentiation, histopathology, pelvic lymph nodes,surgical margin, lymphovascular invasion and parametrium were not associated with survival rate. However,stromal invasion and radiotherapy were associated with survival rate. In conclusion, factors associatedwith survival rate are stromal invasion with less than two-third area which represents the tumour size andradiotherapy which is needed for high-risk patients post-surgery (better survival rate). Further studies areneeded to determine other prognostic factors in early stages cervical cancer patients such as the expressionof stem cell factors (SOX4, NANOG, and OCT 4).</span></p> <p class="MsoNormal" style="text-align: justify;"><strong><span style="font-size: 9.0pt; line-height: 107%; font-family: &quot;Arial-BoldItalicMT&quot;,sans-serif; mso-bidi-font-family: Arial-BoldItalicMT;">Keywords: </span></strong><span style="font-size: 9pt; line-height: 107%; font-family: Arial-ItalicMT;">cervical cancer, survival rate, radical hysterectomy, lymphadenectomy.</span></p> <!--EndFragment-->