Tesis

Perbandingan Respon Terapi dan Luaran Pasca Radiasi pada Karsinoma Sel Skuamosa serviks Stadium IIIB dengan Pembesaran KGB dan Tanpa Pembesaran KGB = Comparisons of Outcomes from Radiotherapy treatment in Squamous Cell Carcinoma Stage IIIB with and without Lymph Node Enlargement.

Latar belakang: Kanker serviks menduduki peringkat kedua sebagai kanker tersering di seluruh dunia. Karsinoma sel skuamosa (KSS) adalah jenis histopatologi kanker serviks tersering. Prognosis terapi dan kesintasan KSS serviks menjadi informasi yang penting untuk pasien dan klinisi. Tujuan: 1.Memperbaiki prognosis dan respon terapi radiasi pasien KSS serviks; 2.Mengetahui respon pasca terapi radiasi pada pasien KSS serviks stadium IIIB; 3.Mengetahui prevalensi dan deskripsi sosiodemografi pasien KSS serviks stadium IIIB; 4.Mengetahui perbedaan klinikopatologik pasien KSS serviks stadium IIIB ditinjau dari: diameter massa serviks, derajat diferensiasi sel kanker, dan jenis histopatologi sel kanker; Mengetahui kesintasan 1 tahun setelah menjalani terapi radiasi. Metode: Dilakukan telaah historical kohort pada 76 pasien KSS serviks stadium IIIB di RSCM dari tahun 2016-2017. Pasien dikelompokkan menjadi KSS serviks stadium IIIB dengan pembesaran KGB dan tanpa pembesaran KGB. Dilakukan analisis univariat, bivariat, dan multivariat. Kesintasan 1 tahun dianalisis dengan menggunakan Kaplan-Meier. Hasil: Prevalensi terbagi menjadi 36 pasien (47,4%) dengan pembesaran KGB, dan 40 pasien (52,6%) tanpa pembesaran KGB. Respon terapi radiasi pada KSS serviks IIIB dengan pembesaran KGB lebih rendah, RR 4,26 (1,96 -9,27, IK 95%). Skor prediktor ≥2.1 sebagai titik potong untuk menentukan diagnosis respons negatif pada terapi radiasi (LR+ 2,31, sensitivitas 96,3%, spesifisitas 58,3%, dan akurasi 77,3%). Deskripsi sosiodemografi dan klinikopatologi sebanding antara kedua kelompok. Kesintasan 1 tahun KSS serviks stadium IIIB tanpa pembesaran KGB lebih baik (HR 9,57). Kesimpulan: Terdapat perbedaan bermakna terhadap respon terapi radiasi antara kelompok KSS serviks stadium IIIB dengan pembesaran KGB dan tanpa pembesaran KGB.
Kata kunci: KSS serviks stadium IIIB; Kelenjar Getah Bening; Terapi Radiasi; MRI


Background: Cervical cancer is second rank as the most common cancer worldwide. Squamous cell carcinoma (SCC) is the most common histopathology type for cervical cancers. The radiotherapy prognostic and survival rate of cervical SCC becomes important information for patients and clinicians. Objectives: (1)To improve prognostic and radiotherapy respond from SCC; (2)knowing the radiotherapy response in patients stage IIIB cervical SCC with lymph node enlargement (LNE) compared to without LNE; (3)knowing the prevalence and description of sociodemographic; (4)knowing clinicopathologic differences in stage IIIB cervical SCC patients in terms of: cervical mass diameter, differentiated grade of cancer cells, and histopathologic type of cancer cells. (5)Knowing 1 year survival rate after radiotherapy. Method: A historical cohort study was undertaken in 76 patients with stage IIIB cervical SCC in RSCM from 2016-2017. Patients are grouped into stage IIIB cervical SCC with LNE and without LNE. Univariate, bivariate, and multivariate analyzes were performed. The 1-year survival was analyzed using Kaplan-Meier. Results: Prevalence was divided into 36 patients(47.4%) with LNE, and 40 patients(52.6%) without LNE. The radiotherapy respon for stage IIIB cervical SCC with LNE is worst than without LNE, RR 4.26(1.96-9.27, 95% IK). Predictor score ≥2.1 as the cutoff point to determine negative response on radiotherapy (LR+ 2.31, sensitivity 96.3%, specificity 58.3%, and accuracy 77.3%). Sociodemographic and clinicopathologic descriptions were comparable between the two groups. The 1year survival of stage IIIB cervical SCC without LNE better than with LNE, HR 9.57 (3.28–27.88 95% IK). Conclusion: There was a significant difference to radiotherapy response between the stage IIIB cervical SCC with LNE and without LNE.
Keyword: stage IIIB SCC, Lymph node enlargement, Radiotherapy, MRI.