Disertasi

Mengeksplorasi Efek Suplementasi Vitamin D3 terhadap CD8, Jumlah Sel Tumor di Sirkulasi, dan Kesintasan pada Kanker Ovarium Tipe Epitel: Laporan Pendahuluan dari Uji Klinis Acak Tersamar Ganda = Exploring the Impact ofVitamin D3 Supplementation on CD8 Levels, Circulating Tumor Cells, and Survival Rates on Epithelial Ovarian Cancer: A Preliminary Report from Randomized Double-Blind Clinical Trial.

Latar Belakang: Kanker ovarium menduduki peringkat ke-10 dari seluruh keganasan di Indonesia di tahun 2020. Vitamin D telah banyak dikenal memiliki peranan penting dalam meningkatkan imunitas tubuh dan menghambat proliferasi sel kanker, namun uji klinis yang menganalisis efek suplementasi vitamin D pada kanker ovarium masih terbatas. Metode: Penelitian ini menggunakan desain uji klinis acak tersamar ganda yang dikerjakan pada 24 subyek kanker ovarium tipe epitel stadium II-III yang direkrut sejak Januari 2022 hingga Agustus 2023 dari tiga rumah sakit rujukan di Jakarta. Subyek diberikan vitamin D3 dosis 2000 IU/hari selama kemoterapi lini pertama. Pemeriksaan CD8+, sel tumor di sirkulasi (circulating tumor cells/CTC), dan 25- OH D dilakukan sebelum kemoterapi (T0), kemoterapi siklus ketiga (T3), dan kemoterapi siklus keenam (T6). Hasil: Kadar CD8 absolut cenderung menurun selama T3 dan meningkat pada bulan keenam khususnya pada kelompok vitamin D. sedangkan kadar CD8+ cenderung menurun pada T3 dan meningkat pada bulan keenam pada kelompok vitamin D. Namun, tidak terdeteksi CTC pada kedua kelompok selama kemoterapi. Hasil analisis kesintasan menunjukkan perbedaan bermakna dalam hal mortalitas pada subyek yang diberikan vitamin, dengan analisis lanjutan yang memperlihatkan faktor yang memengaruhi adalah pemberian vitamin D. Simpulan: Pemberian suplementasi vitamin D3 2000 IU/hari selama enam bulan kemoterapi meningkatkan kadar CD8+ dan memperbaiki kesintasan, namun tidak memengaruhi jumlah CTC. Diperlukan penelitian lebih lanjut untuk mengetahui efek vitamin D dalam menurunkan jumlah sel tumor melalui perbaikan sistem imun.
Kata kunci: vitamin D, CD8, sel tumor bersirkulasi, angka kesintasan, kanker ovarium


Background: Indonesia reporting that ovarian cancer as the 10th most prevalent malignancy in 2020. Vitamin D has been widely known for its significant role in enhancing immunity and inhibiting cancer cells proliferation. However, clinical trials assessing the impact ofvitamin D supplementation in ovarian cancer are still limited. Method: this is a randomized-controlled trial that conducted from Januari 2022 to August 2023. Twenty-four epithelial ovarian cancer stage II-III who undergoing chemotherapy were consecutively recruited from three referral hospital in Jakarta. They were administered vitamin D3 at 2000 IU/day during chemotherapy. Data of CD8+ levels, circulating tumor cells (CTC), and 25-OH D were carried out before chemotherapy (T0), at the 3rd chemotherapy (T3), and at the 6th cycle of chemotherapy (T6). Result: Absolute CD8 levels tended to decrease during T3, with an increase at T6 in vitamin D group. Meanwhile, CD8+ levels tended to decrease at T3 and increased significantly in vitamin D group at T6. However, the CTC levels in both group did not decrease during chemotherapy. The survival analysis revealed a significant differences in mortality in subjects who received vitamin D, with further analysis identifying vitamin D supplementation as the influencing factor. Conclusion: Administering vitamin D3 2000 IU/day during a 6-month of chemotherapy may enhance CD8+ levels and improve survival. However, vitamin D3 did not affect on CTC levels. Further research is needed to explore the role of vitamin D in decreasing tumor cells through immune system improvement.
Keywords: vitamin D, CD8, circulating tumor cells, survival rates, ovarian cancer