Tesis

Proporsi Ekspresi Protein p16INK4a Pada Kasus Karsinoma Laring di Departemen THT-KL RSUPN Cipto Mangunkusumo (Sebagai Potensi Penanda Infeksi Human Papillomavirus)= The Proportion of Protein p16INK4a Expression In Laryngeal Carcinoma in the Department of Otolaryngology Head & Neck Surgery Cipto Mangunkusumo Hospital (As a Potencial Marker of Human Papillomavirus Infection).

Karsinoma laring termasuk penyakit keganasan kepala leher dengan prevalensi, morbiditas dan mortalitas tinggi. Selama ini merokok dan alkohol diketahui sebagai faktor risiko utama, suatu studi epidemiologi melaporkan 15-20% kasus karsinoma laring terjadi pada orang tidak merokok dan minum alkohol. Hal ini menimbulkan dugaan faktor risiko lain, salah satunya yaitu riwayat infeksi Human papillomavirus (HPV). Infeksi HPV selain sebagai faktor risiko juga dilaporkan sebagai faktor prognostik baik karena respon terapi pasien dengan HPV positif dikatakan lebih baik daripada HPV negatif. Penelitian ini bertujuan untuk mengetahui proporsi karsinoma laring positif terhadap ekspresi protein p16INK4a sebagai surrogate marker HPV di Departemen THT-KL RSCM. Penelitian potong lintang dilakukan bulan Maret-Juni 2015 menggunakan data retrospektif 77 pasien karsinoma laring yang dioperasi Laringektomi Total (LT) dari tahun 2006-2013. Ekspresi protein p16INK4a diperiksa secara imunohistokimia dan dinilai secara semikuantitatif yang dihubungkan dengan karakteristik klinis dan kesintasan subjek. Sebanyak 17 subjek (22%) positif terhadap p16INK4a, termasuk 3 subjek yang tidak merokok dan minum alkohol. Berdasarkan uji kesintasan Kaplan Meier terlihat kecenderungan kesintasan lebih baik pada subjek p16INK4a positif daripada yang negatif. Hubungan infeksi HPV sebagai faktor risiko karsinoma laring masih membutuhkan penelitian lanjut yang diharapkan dapat memberi pencegahan dan tatalaksana karsinoma laring lebih baik
Kata kunci: Karsinoma laring, infeksi HPV, p16INK4a, imunohistokimia



Laryngeal carcinoma is one of head and neck carcinoma with high prevalence, morbidity, and mortality. Smoking and alcohol are known as major risk factor, other epidemiology study reported 15-20% of cases without history of smoking and drinking alcohol. It raises the suspected other risk factor, one of which is the history of Human papillomavirus (HPV) infection. Besides HPV infection as a risk factor also reported as a good prognostic factor, response to therapy of patients with positive HPV is said to be better than the HPV-negative. The purpose of this study is knowing the proportion of laryngeal carcinoma with p16INK4a protein expression positive as a surrogate marker of HPV in the Department of Otolaryngology Head & Neck Surgery Cipto Mangunkusumo Hospital. This is a cross-sectional study during March-June 2015 using retrospective data from 77 patients laryngeal carcinoma were underwent Total Laryngectomy from 2006 to 2013. P16INK4a protein expression examined by immunohistochemistry method and assessed semiquantitatively. The results were analyzed its relation with clinical characteristics and survival of the subject. A total of 17 subjects (22%) positive for p16INK4a, including 3 subjects who did not smoke and drink alcohol. Based on Kaplan-Meier's method looks tendency better survival on the subject of p16INK4a positive than negative. The role of HPV infection as a risk factor for laryngeal carcinoma still need more research which expected could provide better prevention and management of laryngeal carcinoma.
Keywords: Laryngeal carcinoma, HPV infection, p16INK4a, immunohistochemistry