Tesis

Prevalens Penyakit Paru Obstruksi Kronik (PPOK) dan Emfisema Berdasarkan Pemeriksaan Spirometri dan Computed Tomography Scanning (CT-scan) Toraks Pada Pasien Kanker Paru di Rumah Sakit Umum Pusat Persahabatan = Prevalence of Chronic Obstructive Pulmonary Disease and Emphysema Based on Spirometry and Thorax CT-scan among Lung Cancer Patients Treated at Persahabatan Hospital Jakarta, Indonesia.

Latar Belakang: Merokok masih merupakan masalah kesehatan utama di Indonesia. Merokok menjadi faktor risiko bagi penyakit kanker paru dan PPOK. Hubungan antara kanker paru dan PPOK masih terus dikaji. Komorbiditas PPOK pada kanker paru dapat mempengaruhi proses diagnostik, tatalaksana serta managemen akhir kehidupan pasien kanker paru. Metode: Penelitian ini adalah studi potong lintang analitik yang dilakukan di poliklinik onkologi paru RSUP Persahabatan selama periode Agustus 2018 sampai dengan April 2019 terhadap pasien kanker paru kasus baru yang telah memenuhi kriteria inklusi dan eksklusi. Hasil: Terdapat 52 subjek yang diteliti dan didapatkan 76,9% adalah laki-laki dan perokok (71,2%), jenis kanker paru yang paling banyak ditemukan ialah kanker paru karsinoma bukan sel kecil (98,1%), sebagian besar stage 4 (88%) dan tampilan klinis 1 (50%). Prevalens PPOK berdasarkan pemeriksaan spirometri menurut kriteria PNEUMOBILE ialah 46,2% dan prevalens emfisema berdasarkan pemeriksaan CT-scan toraks ialah 30,8%. Subjek kanker paru yang menderita PPOK 91,7% termasuk kedalam obstruksi derajat sedang (GOLD 2) serta memiliki kelainan faal paru campuran obstruksi dan restriksi ( 70,8%). Subjek yang menderita emfisema terbanyak menderita emfisema jenis sentrilobular (43,7%). Terdapat hubungan antara letak lesi sentral terhadap beratnya obstruksi yang diukur melalui nilai VEP1 pada subjek PPOK dan emfisema. Kesimpulan: PPOK pada kanker paru terutama ditemukan pada laki-laki, perokok serta jenis kanker yang paling banyak diderita ialah kanker paru karsinoma bukan sel kecil. Emfisema yang paling banyak diderita ialah jenis sentrilobular yang secara umum banyak didapatkan pada perokok.
Kata kunci : PPOK pada kanker paru, emfisema pada kanker paru, PNEUMOBILE pada kanker paru, Faal paru pada kanker paru karsinoma bukan sel kecil.


Background: Smoking is one of risk factors in both of lung cancer and chronic obstructive pulmonary disease (COPD). Comorbidity of COPD among lung cancer patients generally influenced outcome of their quality of life, diagnostic procedures, treatments, and end of life managements. Methods: This analytical cross-sectional study involved newly diagnosed lung cancer cases admitted to the oncology clinics of Persahabatan Hospital Jakarta, Indonesia between August 2018 and April 2019. Patients who met the study criteria were consecutively included. Spirometric evaluation of airway obstruction and COPD was based on PNEUMOBILE and GOLD criteria. Radiological evaluation of emphysema was based on thorax CT-scan. Results: Subjects were 52 lung cancer patients and most of them were males (76.9%) and smokers (71.2%). Most of them were diagnosed as non-small cell lung cancer (NSCLC) (98.1%), were in end-stage of the disease (88.0%) and were in performance status of 1 (50.0%). The prevalence of COPD and emphysema was 46.2% and 30.8%, respectively. Most of the COPD subjects (91.7%) experienced moderate airway obstruction (GOLD 2), along with mixed obstruction-restriction spirometric results (70.8%). Centrilobular emphysema was common (43.7%) radiological finding in this study. Degree of obstruction by spirometry (VEP1) and detection of central tumor lesion by thorax CT-scan in COPD and emphysema subjects was found to be correlated. Conclusion: COPD in lung cancer was found in males, smokers, and NSCLC patients. Centrilobular emphysema was commonly found in this study, particularly in smoker sub-group.
Keywords: COPD in lung cancer; emphysema in lung cancer; PNEUMOBILE among lung cancer; non-small cell lung cancer lung function