Tesis

Perbedaan Ekspresi Chromogranin A pada Adenokarsinoma Prostat Berdiferensiasi Baik, Sedang dan Buruk = Difference Expression of Chromogranin A in Prostate Adenocarcinoma Well, Moderately and Poor differentiated.

Latar belakang: Kanker prostat merupakan tumor ganas terbanyak ketiga pria di dunia. Penyebabnya dipengaruhi faktor usia, genetik, ras, hormonal, diet dan lingkungan. Kanker prostat dapat mengalami Neuroendocrine Differentiation (NED), meningkat pada kanker prostat berdiferensiasi buruk terutama yang tidak merespon baik terhadap terapi hormonal. NED akan menentukan prognosis dan pemilihan alternatif terapi. Tujuan: Mengetahui perbedaan ekspresi Chromogranin A (CgA) pada adenokarsinoma prostat berdiferensiasi baik, sedang dan buruk serta kaitannya dengan derajat keganasan berdasarkan grading tumor yang diharapkan dapat menentukan prognosis dan pemilihan alternatif terapi. Metode: Studi potong lintang terhadap jaringan biopsi yang difiksasi formalin, diletakkan dalam parafin dari pasien dengan adenokarsinoma prostat berdiferensiasi baik, sedang dan buruk. Sampel penelitian dipulas dengan pewarnaan imunohistokimia CgA, diidentifikasi dan dianalisa hubungan ekspresi CgA berdasarkan usia, diagnosis histopatologik, grade groups, skor Gleason dan kadar PSA. Hasil: Ekspresi CgA positif dengan median 40 (0,4-100) banyak terjadi pada kelompok usia < 70 tahun. Ekspresi CgA positif dengan median 56,2 (0,4-100) banyak terjadi pada kasus adenokarsinoma prostat berdiferensiasi buruk, grade tinggi dan skor Gleason > 7. Ekspresi CgA positif dengan median 35,4 (0,4-88,6) banyak terjadi dengan kadar PSA > 52,4 µg/ml. Didapatkan hubungan bermakna antara ekspresi CgA dengan diagnosis histopatologik, grade groups dan skor Gleason (p = 0, 006;p = 0,021;p = 0,006). Tidak didapatkan hubungan bermakna antara ekspresi CgA dengan usia dan kadar PSA (p = 0,412;p = 0.969). Kesimpulan: Terdapat kecenderungan positivitas ekspresi CgA lebih banyak terjadi pada kasus adenokarsinoma prostat berdiferensiasi buruk dengan grade tinggi, yang dapat mempengaruhi prognosis dan pemilihan alternatif terapi.
Kata kunci: Ekspresi Chromogranin A, adenokarsinoma prostat, grade groups, skor Gleason.


Background: Prostate cancer is the third most common malignant tumor in men worldwide. Predisposing factors of prostate cancer are influenced by age, genetics, race, hormonal, diet and environment. Prostate cancer may undergo Neuroendocrine Differentiation (NED), and it found to be increase in poorly differentiated type of prostate cancer, especially who do not respond well to hormonal therapy. NED will determine the prognosis and selection of therapeutic alternatives. Objective: To determine differences in expression of Chromogranin A (CgA) in prostate adenocarcinoma well, moderately and poor differentiated and its relationship to the tumour grading, and its effect on determining prognosis and selecting therapeutic alternatives. Methods: A cross-sectional study conducted to formalin fixed paraffin embedded biopsy tissue that are taken from a patient with prostate adenocarcinoma well, moderately and poor differentiated. The sample are immunohistochemical stained with CgA, identified and analyzed. The reviewed and analized it’s relationship to the parameter; on age, histopathological diagnosis, grade groups, Gleason score and PSA level. Results: Chromogranin A positive expression with median 40 (0.4-100) was found in the age < 70 years. CgA positive expression with median 56.2 (0.4-100) was found in poorly differentiated, high grade and Gleason score > 7 of prostate adenocarcinoma. CgA positive expression with median 35.4 (0.4-88, 6) was found with PSA level > 52.4 µg/ml. There were a significant difference between CgA expression with histopathological diagnosis, grade groups and Gleason score (p = 0, 006;p = 0.021;p = 0.006). There were no significant difference between CgA expression with age and PSA level (p = 0.412;p = 0969). Conclusion: There is a statistically significant difference of CgA expression with histopathologycal diagnosis and grade groups of prostate adenocarcinoma that reflect a worse prognosis in CgA positive group among prostate adenocarcinoma, which will need alternative therapies beside widely used-hormonal therapy.
Keywords: Expression Chromogranin A, prostate adenocarcinoma, grade groups, Gleason score.