Tesis

Hubungan antara Vascular Endothelial Growth Factor (VEGF) dengan Ukuran Massa Tumor dan Jenis Histopatologi pada Kanker Serviks = Relationship between Vascular Endothelial Growth Factor (VEGF) with Tumor Mass Size and Histopathology Type in Cervical Cancer.

Latar Belakang: Kanker serviks menjadi penyebab kematian wanita terbanyak keempat di dunia. Prognosis kanker serviks dipengaruhi oleh stadium klinis, jenis histopatologi, derajat diferensiasi, serta modalitas pengobatan. Angiogenesis merupakan salah satu proses yang sangat penting untuk pertumbuhan, invasi, dan metastasis tumor padat, termasuk kanker serviks. Angiogenesis menjadi faktor prognostik pada kanker serviks dan dapat dideteksi dengan ekspresi Vascular Endothelial Growth Factor (VEGF). Penelitian ini bertujuan untuk mengetahui hubungan antara VEGF dengan ukuran massa tumor dan jenis histopatologi kanker serviks. Metode: Penelitian cross sectional terhadap pasien kanker serviks yang berobat di RSUPN Cipto Mangunkusumo pada bulan Juli - Desember 2024. Evaluasi dilakukan terhadap ekspresi VEGF kanker serviks berdasarkan H-score melalui pemeriksaan imunohistokimia. Analisis dilakukan terhadap ukuran massa tumor (> 4 cm dan < 4 cm) melalui pemeriksaan USG transvaginal dan histopatologi tumor serviks (karsinoma sel skuamosa dan non-karsinoma sel skuamosa). Analisis juga dilakukan terhadap keberadaan metastasis KGB dan stadium kanker serviks. Penentuan nilai cut off ekspresi VEGF terhadap ukuran massa tumor dilakukan menggunakan kurva ROC. Analisis dilakukan dengan tabulasi silang 2x2 berdasarkan nilai cut off yang telah ditentukan menggunakan uji fisher exact. Hasil signifikan p 195 dengan area under curve sebesar 0.605, sensitivitas 100%, spesifisitas 44.4%, dengan nilai Youden Indeks tertinggi yaitu 0.444 terhadap ukuran massa tumor. Analisis didapatkan adanya perbedaan signifikan sebaran ekspresi VEGF antar kelompok penelitian (p < 0.001), dimana proporsi ekspresi VEGF > 195 secara signifikan lebih banyak didapatkan pada subjek dengan ukuran massa tumor > 4 cm. Namun tidak terdapat hubungan signifikan antara ekspresi VEGF dengan jenis histopatologi kanker serviks (p=0.562). Pasien yang memiliki ekspresi VEGF > 195 secara signifikan memiliki prevalensi metastasis KGB yang lebih tinggi (100%; p=0.009) dan kanker serviks stadium lanjut (97.7%; p=0.014). Kesimpulan: Terdapat hubungan signifikan antara ekspresi Vascular Endothelial Growth Factor (VEGF) dengan ukuran massa tumor kanker serviks dimana proporsi ekspresi VEGF > 195 secara signifikan lebih banyak didapatkan pada subjek dengan ukuran massa tumor > 4 cm.
Kata Kunci: kanker serviks, ukuran massa tumor, jenis histopatologi, vascular endothelial growth factor


Background: Cervical cancer is the fourth leading cause of death in women worldwide. The prognosis of cervical cancer is influenced by clinical stage, histopathology type, degree of differentiation, and treatment modality. Angiogenesis is one of the most important processes for the growth, invasion, and metastasis of solid tumors, including cervical cancer. Angiogenesis is a prognostic factor in cervical cancer and can be detected by the expression of Vascular Endothelial Growth Factor (VEGF). This study aims to determine the relationship between VEGF and tumor mass size and histopathology type of cervical cancer. Methods: Cross-sectional study of cervical cancer patients treated at RSUPN Cipto Mangunkusumo in July - December 2024. Evaluation was carried out on the expression of VEGF in cervical cancer based on the H-score through immunohistochemical examination. Analysis was carried out on the size of the tumor mass (> 4 cm and < 4 cm) through transvaginal ultrasound examination and histopathology of cervical cancer (squamous cell carcinoma and non-squamous cell carcinoma). Analysis was also carried out on the presence of lymph node metastasis and stage of the cancer. Determination of the cut-off value of VEGF expression against the size of the tumor mass was carried out using the ROC curve. The analysis was carried out by 2x2 cross-tabulation based on the cut-off value that had been determined using the fisher exact test. Significant results p 195 with an area under the curve of 0.605, sensitivity of 100%, specificity of 44.4% with the highest Youden Index value of 0.444 against the size of the tumor mass. The analysis found a significant difference in the distribution of VEGF expression between study groups (p < 0.001), where the proportion of VEGF expression > 195 was significantly more in subjects with tumor mass size > 4 cm. However, there was no significant relationship between VEGF expression and the histopathology type of cervical cancer (p = 0.562). Patients who had VEGF expression > 195 had a significantly higher prevalence of lymph node metastasis (100%; p = 0.009) and advanced stage cervical cancer (97.7%; p = 0.014). Conclusion: There is a significant relationship between the expression of Vascular Endothelial Growth Factor (VEGF) and the size of cervical cancer tumor mass, where the proportion of VEGF expression > 195 is significantly more common in subjects with tumor mass size > 4 cm. Keywords: cervical cancer, tumor mass size, histopathology type, vascular endothelial growth factor