Tesis

Kesesuaian Skor Indeks Karsinomatosis Peritoneal dari Computed Tomography Scan dengan Temuan Intraoperatif pada Kanker Ovarium Stadium Lanjut = Agreement of the Peritoneal Carcinomatosis Index Score on Computed Tomography with Intraoperative Findings in Advanced-Stage Ovarian Cancer.

Latar Belakang: Kanker ovarium merupakan kanker ginekologi ketiga terbanyak di Indonesia dengan angka kematian yang tinggi. Penyebaran kanker ke peritoneum menyebabkan karsinomatosis peritoneal yang dapat dinilai menggunakan skor Peritoneal Carcinomatosis Index (PCI). Penilaian skor PCI praoperatif melalui CT scan penting untuk menentukan strategi operasi sitoreduktif. Namun, kesesuaian skor PCI dan lokasi lesi antara CT scan dan temuan intraoperatif belum banyak dikaji secara spesifik di Indonesia. Metode: Penelitian ini menggunakan desain retrospektif longitudinal operasional dengan data sekunder pasien kanker ovarium stadium lanjut (FIGO III–IV) di Rumah Sakit Ciptomangunkusumo (RSCM) Jakarta periode Juli 2020 – Mei 2025. Sebanyak 78 subjek yang memenuhi kriteria inklusi dianalisis. Skor PCI dari CT scan praoperatif dan skor PCI intraoperatif dilakukan analisis kesesuaian dengan menggunakan Intraclass Correlation Coefficient (ICC), serta uji Bland-Altman untuk nilai bias antar kedua metode. Kesesuaian lokasi lesi dilakukan dengan uji Cohen’s Kappa. Hasil: Nilai ICC sebesar 0,857 (CI 95%: 0,282–0,947; p < 0,01) menunjukkan kesesuaian yang baik antara skor PCI CT scan dan PCI intraoperatif. Analisis Bland-Altman menunjukkan nilai rata-rata bias 3,91 (CI 95%: 3,05–4,77; p < 0,01) dengan Limits of Agreement (LoA) -3,59 hingga 11,41. Terdapat 6,41% subjek dengan nilai bias Bland-Altman yang berada di luar LoA. Kesesuaian lokasi lesi bervariasi antar regio, dengan nilai Cohen’s Kappa tertinggi pada regio flank kiri (0,634; p < 0,01) dan terendah di regio pelvis (0,188; p < 0,01). Kesimpulan: Skor PCI dari CT scan menunjukkan kesesuaian yang baik dengan PCI intraoperatif pada kanker ovarium stadium lanjut, meskipun terdapat variasi skor individual. Kesesuaian lokasi lesi peritoneal berbeda antar regio PCI, hal ini dipengaruhi oleh karakteristik anatomi dari tiap regio. Hasil ini menunjukkan peran penting CT scan praoperatif dalam penilaian PCI dan perencanaan pembedahan pada kanker ovarium stadium lanjut.
Kata kunci: Kanker ovarium, CT scan, Peritoneal Carcinomatosis Index


Background: Ovarian cancer is the third most common gynecological cancer in Indonesia with a high mortality rate. The spread of cancer to the peritoneum causes peritoneal carcinomatosis, which can be assessed using the Peritoneal Carcinomatosis Index (PCI) score. Preoperative PCI scoring with CT scan is important to determine the strategy for cytoreductive surgery. However, the agreement between PCI scores and lesion locations on CT scan versus intraoperative findings has not been specifically studied in Indonesia. Methods: This study used a retrospective longitudinal operational design with secondary data from advanced stage ovarian cancer patients (FIGO III–IV) at Ciptomangunkusumo Hospital (RSCM) Jakarta during July 2020 – May 2025. A total of 78 subjects meeting the inclusion criteria were analyzed. PCI scores from preoperative CT scans and intraoperative PCI scores were analyzed for agreement using the Intraclass Correlation Coefficient (ICC) and Bland-Altman test for bias between the two methods. Agreement of lesion location was assessed using Cohen’s Kappa test. Results: The ICC value of 0.857 (95% CI: 0.282–0.947; p < 0,01) indicated good agreement between CT-derived PCI and intraoperative PCI scores. Bland-Altman analysis showed a mean bias value of 3.91 (95% CI: 3.05–4.77; p < 0,01) with Limits of Agreement (LoA) from -3.59 to 11.41. There were 6.41% of subjects with bias values outside the LoA. Agreement of lesion location varied between regions, with the highest Cohen’s Kappa value in the left flank region (0.634; p < 0.01) and the lowest in the pelvic region (0.188; p < 0.01). Conclusion: PCI scores from CT scans show good agreement with intraoperative PCI scores in advanced stage ovarian cancer, although individual score variations exist. Agreement of peritoneal lesion locations differs among PCI regions, influenced by anatomical characteristics of each region. These results highlight the important role of preoperative CT scans in PCI assessment and surgical planning for advanced stage ovarian cancer.
Keywords: Ovarian cancer, CT scan, Peritoneal Carcinomatosis Index