Tesis

Peran Ekspresi CD44 dan CD24 terhadap disease free survival 2 tahun Penderita Karsinoma Ovarium Epitelial Stadium Lanjut = Role of CD44 and CD24 Expression in 2-year Disease Free Survival in Patients with Advanced Epithelial Ovarian Carcinoma.

Latar belakang: Kanker ovarium merupakan salah satu kanker yang banyak ditemui dengan angka kematian yang tinggi di seluruh dunia. Meskipun telah dilakukan terapi pembedahan optimal dan kemoterapi, kekambuhan tetap seringkali terjadi. Stem cell kanker yang mengekspresikan CD44 dan CD24 disinyalir menjadi faktor yang berkontribusi dalam kekambuhan Tujuan: Untuk mengetahui hubungan antara tingkat ekspresi CD44 dan CD24 terhadap disease-free survival pada pasien kanker ovarium stadium lanjut. Metode: Studi kasus-kontrol dengan analisis survival dilakukan pada pasien kanker ovarium stadium lanjut yang dilakukan pembedahan optimal dan kemoterapi 6 siklus pada RSUPN Cipto Mangunkusumo serta RSUP Fatmawati pada bulan Januari 2019 hingga Maret 2023. Dilakukan pemeriksaan imunohistokimia pada jaringan tumor dan dinilai ekspresi CD44 dan CD24 menggunakan metode H-Score lalu ditentukan titikpotong tingkat ekspresi menggunakan kurva ROC. Selanjutnya dinilai hubungan tingkat ekspresi tersebut dengan disease-free survival menggunakan kurva Kaplan-Meier. Hasil: Terdapat 48 subjek yang diikutsertakan dalam penelitian. Didapatkan tingkat ekspresi CD44 tinggi sebanyak 47.9% dan CD24 sebanyak 50% kasus. Ekspresi CD44 tinggi memiliki rerata dan median survival 13.2 ± 1.8 dan 11 bulan (HR 5.05, 95%IK 1.84-13.85). Ekspresi CD24 tinggi memiliki rerata dan median survival 13.5 ± 2.4 dan 7 bulan (HR 7.73, 95%IK 2,58 – 23,15). Kombinasi kedua ekspresi tinggi memiliki rerata dan median survival 10.44 ± 1.88 dan 7 bulan. Kesimpulan: Ekspresi tinggi CD44 dan CD24 akan memperpendek disease-free survival pasien kanker ovarium stadium lanjut.
Kata kunci: kanker ovarium, cancer stem cells, CD44, CD24, disease-free survival


Background: Ovarian cancer is one of the most common cancers with a high mortality rate worldwide. Despite optimal surgical therapy and chemotherapy, recurrence is still common. Cancer stem cells expressing CD44 and CD24 are thought to be contributing factors in recurrence Purpose: To determine the relationship between CD44 and CD24 expression levels on disease-free survival in advanced ovarian cancer patients. Methods: A case-control study with survival analysis was carried out in advanced ovarian cancer patients who underwent optimal surgery and 6 cycles of chemotherapy at Cipto Mangunkusumo General Hospital and Fatmawati General Hospital from January 2019 to March 2023. Immunohistochemical examination was performed on tumor tissue and CD44 and CD24 expression were assessed using The H-Score method then determined the expression level cut off-point using the ROC curve. Furthermore, the relationship between these expression levels and disease-free survival was assessed using the KaplanMeier curve. Results: There were 48 subjects who were included in the study. There were high expression levels of CD44 in 47.9% and CD24 in 50% of cases. High CD44 expression had mean and median survival of 13.2 ± 1.8 and 11 months (HR 5.05, 95% CI 1.84- 13.85). High CD24 expression had mean and median survival of 13.5 ± 2.4 and 7 months (HR 7.73, 95% CI 2.58 – 23.15). The combination of the two high expressions had mean and median survival of 10.44 ± 1.88 and 7 months. Conclusions: High expression of CD44 and CD24 will shorten the disease-free survival of patients with advanced ovarian cancer.
Keywords: ovarian cancer, cancer stem cells, CD44, CD24, disease-free survival