Tesis

Perbanding Profil Koagulasi Tumor Otak Primer dan Tumor Otak Sekunder = Coagulation Profile Comparison Between Primary Brain Tumor and Secondary Brain Tumor.

Latar Belakang: Tumor otak sekunder seringkali didiagnosis dengan riwayat keganasan sebelumnya, namun pada beberapa studi, hampir separuh kasus didiagnosis tanpa riwayat keganasan sebelumnya. Dengan demikian, tumor otak sekunder harus selalu menjadi diagnosis banding pada kasus tumor otak. Tumor otak primer dan sekunder dapat menyebabkan gangguan koagulasi melalui mekanisme yang berbeda. Tujuan dari penelitian ini adalah untuk melihat potensi profil koagulasi dalam penegakan diagnosis tumor otak primer dan sekunder Metode Penelitian: Penelitian ini menggunakan desain potong lintang, dengan menggunakan rekam medis pasien tumor otak di RS Cipto Mangunkusumo, Jakarta, sejak Januari 2009 hingga Mei 2016. Tumor otak didiagnosis berdasarkan riwayat perjalanan penyakit, CT scan/MRI kepala, dan histopatologis dari jaringan otak atau organ primer lain. Pemerksaan profil koagulasi mencakup prothrombine time (PT), activated partial thromboplastin time (APTT), fibrinogen dan D-dimer serum. Data komplikasi dicatat dari rekam medis. Hasil: Didapatkan 135 subjek dengan median usia 48 (18-68) tahun. Tumor otak primer sedikit lebih banyak dibandingkan dengan tumor otak sekunder (52,6% vs 47,4%), dimana astrositoma merupakan tumor tersering (46,5%). Tumor paru memiliki insidens tertinggi pada tumor otak sekunder (39,1%) dan merupakan tumor primer dengan kadar fibrinogen tertinggi (424,70 (239,0-900,0; p 0,016). Kada median atau rerata PT, APTT dan fibrinogen lebih tinggi pada tumor otak sekunder. Analisis multivariat membuktikan bahwa jenis tumor memiliki korelasi terkuat dengan kadar median fibrinogen. Dari seluruh faktor penyulit, sepsis berhubungan dengan peningkatan kadar rerata APTT dan kadar median fibrinogen (p 0,009 and 0,002). Kesimpulan: koagulopati ditemukan pada 79,4% subjek. Kadar rerata atau median PT, APTT dan fibrinogen lebih tinggi pada tumor otak sekunder dibandingkan dengan tumor otak primer. Pada tumor otak sekunder, subjek yang berasal dari tumor paru memiliki kadar median fibrinogen yang lebih tinggi secara bermakna dibandingkan dengan tumor primer lain. Sepsis merupakan satusatunya penyulit yang berhubungan secara bermakna dengan kadar rerata APTT dan kadar median D-dimer.
Kata Kunci: tumor otak primer, tumor otak sekunder, profil koagulasi, PT, APTT, fibrinogen, D-dimer



Background: Secondary brain tumor was often diagnosed with previous history of cancer, but in several studies, half of the case was diagnosed without any history of cancer. Therefore, secondary brain tumor should always be one of the differential diagnosis in brain tumor patients. Primary and secondary brain tumor could cause coagulation disorder with different mechanism. The aim of this study is to see the potential of coagulation profile in diagnostic process of primary and secondary brain tumor. Materials and Method: This is a cross sectional study from medical records of adult brain tumor patients in Cipto Mangunkusumo Hospital, Jakarta, from January 2009 - May 2016. Brain tumor was diagnosed based on clinical history, head CT scan/MRI, and histopathology of the brain or any other primary organs. Coagulation profile measurements include prothrombine time (PT), activated partial thromboplastin time (APTT), fibrinogen and D-dimer serum. Data regarding complications were obtained from patient’s medial records. Results: The study recruited 135 patients, with median age of 48 (18-68) years old. Primary brain tumor was slightly predominant than the secondary (52,6% vs 47,4%), among which astrocytoma was the most frequent (46,5%). Lung cancer had highest incidence in the secondary brain tumor group (39,1%) and was the primary tumor with the highest fibrinogen level (424,70 (239,0-900,0; p 0,016). Median or mean PT, APTT and fibrinogen levels are higher in the secondary brain tumor group. Multivariate analysis proved that tumor type had strongest correlation with median fibrinogen levels. Among the confounding factors, sepsis significantly influenced the increase of APTT and fibrinogen levels (p 0,009 and 0,002). Conclusions:Coagulopathy was found in 79,4% subjects. Mean or median PT, APTT and fibrinogen was higher in secondary brain tumor than primary brain tumor. In the secondary brain tumor, subjects with lung cancer origin had a significant higher median fibrinogen levels compared to other primary tumor. Sepsis was the only complications that had a significant correlation with mean APTT levels and median D-dimer levels.
Keywords: primary brain tumor, secondary brain tumor, coagulation profile, PT, APTT, fibrinogen, D-dimer