Tesis

Hubungan Malnutrisi Menurut Kriteria Global Leadership Initiative On Malnutrition Dengan Rasio Neutrofil Limfosit Pada Pasien Kanker Dengan Metastasis Sistem Saraf Pusat = Association between Malnutrition according to Global Leadership Initiative on Malnutrition Criteria and Neutrophil-Lymphocyte Ratio in Central Nervous System Metastases Cancer Patients.

Latar Belakang: Metastasis sistem saraf pusat (SSP) pada otak maupun spinal terjadi pada 10-40% pasien kanker. Metastasis SSP memiliki kesempatan yang sama untuk menyebabkan malnutrisi akibat gejala neurologis yang terjadi mamupun efek sistemik karena kanker. Malnutrisi berkaitan dengan sistem imun. Rasio neutrofil limfosit (RNL) dapat digunakan untuk menentukan prognosis. Kriteria malnutrisi berdasarkan Global Leadership Initiative on Malnutrition (GLIM) dapat lebih sensitif untuk menegakkan malnutrisi. Penelitian ini dilakukan untuk mengetahui hubungan antara malnutrisi menurut kriteria GLIM dengan RNL pada pasien metastasis SSP. Metode: Penelitian ini adalah studi potong lintang pada pasien kanker dengan metastasis SSP di RSCM, jakarta. Karakteristik subjek berupa usia, jenis kelamin, lokasi tumor primer, lokasi metastasis, antropometri, komposisi tubuh dengan bio impedance analysis (BIA), nilai RNL, dan gejala neurologis. Dilakukan analisis hubungan malnutrisi menurut GLIM dengan RNL. Hasil: Terdapat 62 pasien mengalami metastasis SSP. Subjek mayoritas metastasis otak (60,3%) , dan perempuan (61,3%) dengan rerata usia 46 tahun. Tumor primer tersering berasal dari payudara (24,1%), kepala leher (17,7%), serta paru dan saluran cerna (masing-masing 11,2%). Prevalens malnutrisi serupa pada metastasis otak (76,3%) dan spinal (70,8%). Gejala klinis yang paling sering ditemukan pada subjek metastasis otak yang mengalami malnutrisi adalah disfagia (100%), nyeri kepala (82%), dan penurunan kesadaran (81,2%). Pada subjek metastasis spinal 80% subjek dengan nyeri kanker, dan masing-masing 75% subjek dengan kelemahan anggota gerak dan otonom mengalami malnutrisi. Subjek memiliki rerata IMT yang normal, namun mayoritas subjek mengalami malnutrisi (74,2%). Median RNL 7,09 (0,97–35,59). Berdasarkan komponen kriteria fenotip dan etiologik GLIM, rerata RNL lebih tinggi secara signifikan pada subjek dengan penurunan asupan, penurunan BB, dan IMT < 18,5. Rerata RNL secara signifikan lebih tinggi pada kelompok yang mengalami malnutrisi (p=0,002). Perbedaan rerata pada dua kelompok adalah 4,70 dengan KI95% (1,2-8,2). Kesimpulan: Malnutrisi berhubungan dengan RNL, subjek yang mengalami malnutrisi memiliki NLR yang lebih tinggi dibandingkan dengan yang tidak malnutrisi. Metastasis otak dan spinal memiliki kesempatan yang sama untuk terjadi malnutrisi akibat gejala klinis dan efek sistemik.
Kata kunci: metastasis sistem saraf pusat, malnutrisi, global leadership on Malnutrition, rasio neutrofil limfosit.


Background: Central nervous system (CNS) metastases to the brain or spine occur in 10-40% of cancer patients. CNS metastases have an equal chance of causing malnutrition due to neurological symptoms and systemic effects due to cancer. Malnutrition is related to the immune system. The neutrophil lymphocyte ratio (NLR) can be used to determine prognosis. Malnutrition criteria based on the Global Leadership Initiative on Malnutrition (GLIM) can be more sensitive in diagnosing malnutrition. This study was conducted to determine the relationship between malnutrition according to GLIM criteria and NLR in patients with CNS metastases. Methods: This research is a cross-sectional study of cancer patients with CNS metastases at RSCM, Jakarta. Subject characteristics included age, gender, primary tumor location, metastasis location, anthropometry, body composition measurements with bio impedance analysis (BIA), NLR value, and neurological symptoms. An analysis of the relationship between malnutrition according to GLIM and NLR was carried out. Results: There were 62 patients experiencing CNS metastases. The majority of subjects had brain metastases (60.3%), and were female (61.3%) with an average age of 46 years. The most common primary tumors originate from the breast (24.1%), head and neck (17.7%), and the lungs and gastrointestinal tract (11.2% each). The prevalence of malnutrition was similar in brain (76.3%) and spinal (70.8%) metastases. The clinical symptoms most frequently found in malnourished brain metastases subjects were dysphagia (100%), headache (82%), and decreased consciousness (81.2%). In spinal metastases subjects, 80% of subjects with cancer pain, and 75% of subjects with limb weakness and autonomic dysfunction experienced malnutrition. Subjects had a normal BMI, but the majority of subjects experienced malnutrition (74.2%). Median RNL 7.09 (0.97–35.59). Based on the GLIM phenotypic and etiologica criteria components, the mean RNL was significantly higher in subjects with decreased intake, decreased weight, and BMI < 18.5. The mean RNL was significantly higher in the malnourished group (p=0.002). The mean difference in the two groups was 4.70 with KI95% (1.2-8.2). Conclusion: There is a relationship between malnutrition and NLR. Malnourished subjects have a higher NLR compared to those who are not malnourished. Brain and spinal metastases have the same chance of developing malnutrition due to clinical symptoms and systemic effects.
Keyword: central nervous system metastasis, malnutrition, global leadership on Malnutrition, neutrophil lymphocyte ratio.