Tesis

Hubungan ekspresi protein penanda sel punca kanker prostat CD44 dan CD133 dengan kejadian castrate resistant prostate cancer (CRPC). = Association of CD44 and CD133 as prostate cancer stem cells marker with castrate resistant prostate cancer (CRPC).

Latar Belakang: Sebagian besar kasus adenokarsinoma prostat terdiagnosis sebagai stadium lanjut pada saat pasien pertama kali datang berobat. Umumnya pasien akan diberikan androgen deprivation therapy (ADT). Pemberian regimen ADT bersama dengan anti androgen dalam jangka waktu rata-rata 2 tahun dapat menyebabkan sebagian sel tumor menjadi independen terhadap androgen dan berkembang menjadi castrate resistant prostate cancer (CRPC). CRPC menunjukkan prognosis yang lebih buruk, angka harapan hidup yang lebih rendah dan penatalaksanaan yang lebih sulit. Salah satu penyebab terjadi CRPC adalah keberadaan sel punca kanker (SPK) prostat yang mempunyai kemampuan memperbarui diri dan berdiferensiasi. Beberapa protein yang dapat menjadi penanda SPK prostat antara lain adalah CD44 dan CD133. Tujuan: Tujuan penelitian ini adalah untuk mengetahui protein penanda imunohistokimia yang dapat digunakan untuk membantu memprediksi prognosis pasien adenokarsinoma prostat serta kejadian CRPC selama terapi ADT dan anti androgen. Metode: Penelitian ini merupakan penelitian analitik observasional terhadap kasus-kasus adenokarsinoma prostat CRPC dan tanpa CRPC periode Januari 2011 sampai Desember 2019 yang dilakukan secara retrospektif di RSCM. Pasien telah diterapi dengan ADT dan anti androgen selama minimal 2 tahun. Dilakukan pulasan imunohistokimia CD44 dan CD133 terhadap 22 kasus adenokarsinoma prostat CRPC dan 43 kasus adenokarsinoma prostat tanpa CRPC. Analisis statistik menggunakasn SPSS 20.0 dengan uji Chi square. Hasil: Terdapat perbedaan ekspresi protein CD44 yang bermakna pada adenokarsinoma prostat CRPC (63,6%) dan tanpa CRPC (37,2%), p 0,043. Tidak terdapat perbedaan ekspresi protein CD133 yang bermakna pada adenokarsinoma prostat CRPC (59,1%) dan tanpa CRPC (39,5%), p 0,135. Terdapat perbedaan ekspresi protein CD44/CD133 yang bermakna pada adenokarsinoma prostat CRPC (45,5%) dan tanpa CRPC (16,3%), p 0,011. Kesimpulan: Terdapat perbedaan ekspresi protein CD44 dan CD44/CD133 yang bermakna antara adenokarsinoma prostat CRPC dan tanpa CRPC. Tidak terdapat perbedaan ekspresi protein CD133 yang bermakna antara adenokarsinoma prostat CRPC dan tanpa CRPC.
Kata kunci: adenokarsinoma prostat, ADT, SPK, CD44, CD133, CRPC.



Backgroud: Most cases of prostate adenocarcinoma were diagnosed in advanced stage when patients first came for treatment. Generally, patients will be given androgen deprivation therapy (ADT). Management of ADT regimen along with anti-androgens for two years will cause androgen-independent tumor cells and developing into castrate resistant prostate cancer (CRPC). CRPC is associated with worse prognosis, lower life expectancy and more challenging management. CRPC can be caused by the presence of prostate cancer stem cells (CSC) with has self-renewal and differentiation capabilities. Several proteins such as CD44 and CD133 can be a marker for prostate CSC. Aim: This study aims to determine the immunohistochemical markers that can be used to help predict the prognosis of prostate adenocarcinoma and the incidence of CRPC during management of ADT and anti-androgen. Method: An observational analytic study with cross-sectional design on prostate adenocarcinoma with CRPC and without CRPC at RSCM from January 2011 to Desember 2019. Patients has been treated with ADT and anti-androgen for at least 2 years. Immunohistochemical staining was performed on 22 cases of prostate adenocarcinoma with CRPC and 43 cases of prostate adenocarcinoma without CRPC. Statistical analysis using SPSS 20.0 with Chi square test. Result: There was a significant difference in the expression of CD44 protein in prostate adenocarcinoma with CRPC (63,6%) and without CRPC (37,2%), p 0,043. There was no significant difference in the expression of CD133 protein in prostate adenocarcinoma with CRPC (59,1%) and without CRPC (39,5%), p 0,135. There was a significant difference in the expression of CD44/CD133 protein in prostate adenocarcinoma with CRPC (45,5%) and without CRPC (16,3%), p 0,011. Conclusion: There was a significant difference in the expression of CD44 and CD44/CD133 proteins between prostate adenocarcinoma CRPC and without CRPC. There was no significant difference in the expression of CD133 proteins between prostate adenocarcinoma CRPC and without CRPC.
Key Word: prostate adenocarcinoma, ADT, CSC, CD44, CD133, CRPC.