Tesis

Korelasi antara Kadar Seng Serum Puasa dengan Rasio Neutrofil Limfosit pada Pasien Kanker Ginekologi dengan Malnutrisi selama Kemoterapi = Correlation between Fasting Serum Zinc Levels and Neutrophil-to-Lymphocyte Ratio in Gynecologic Cancer Patients with Malnutrition Undergoing Chemotherapy.

Latar belakang: Kanker ginekologi merupakan keganasan pada organ reproduksi wanita dengan prevalensi malnutrisi yang tinggi. Malnutrisi pada pasien kanker ginekologi dapat terjadi akibat proses penyakit dan terapi kanker, seperti kemoterapi. Inflamasi sistemik yang dimediasi oleh sel kanker berperan dalam progresivitas penyakit dan memengaruhi prognosis. Rasio neutrofil-limfosit (RNL) merupakan salah satu penanda inflamasi sistemik yang telah digunakan sebagai prediktor prognosis pada berbagai jenis kanker. Seng merupakan mikronutrien esensial yang berperan dalam imunitas dan regulasi inflamasi, namun kadar seng serum sering menurun pada pasien kanker dengan malnutrisi, sehingga berpotensi memengaruhi respons inflamasi sistemik melalui nilai RNL. Metode: Penelitian potong lintang pada pasien kanker ginekologi dengan malnutrisi yang menjalani kemoterapi ke-3 sampai 6 di RSCM. Status malnutrisi diklasifikasikan menurut ASPEN. Darah diambil 2 minggu setelah kemoterapi, kemudian diperiksa kadar seng serum puasa dan darah lengkap untuk mendapatkan RNL. Analisis korelasi menggunakan uji Spearman antara kadar seng serum dan RNL. Hasil: Terdapat 53 subjek; jenis kanker terbanyak ovarium 54,7%, diikuti serviks 22,6%, endometrium 15,1%, dan lainnya 7,6%. Berdasarkan ASPEN, 75,5% malnutrisi sedang dan 24,5% malnutrisi berat. Rata-rata seng serum 10,6 ± 2,52 µmol/L dengan defisiensi sebanyak 45,3%. Median RNL 1,83 (rentang 0,38– 19,02). Terdapat korelasi negatif antara seng serum puasa dan RNL (r = −0,312; p = 0,023). Kesimpulan: Terdapat korelasi negatif yang bermakna secara statistik antara kadar seng serum puasa dan RNL pada pasien kanker ginekologi dengan malnutrisi yang sedang menjalani kemoterapi, meskipun dengan kekuatan korelasi lemah.
Kata kunci: kanker ginekologi, malnutrisi, rasio neutrofil-limfosit, seng serum


Background: Gynecological cancer is a malignancy affecting the female reproductive organs with a high prevalence of malnutrition. Malnutrition in patients with gynecological cancer may result from the disease process itself and cancer therapies, such as chemotherapy. Cancer-mediated systemic inflammation plays an important role in disease progression and influences prognosis. The neutrophil-tolymphocyte ratio (NLR) is a marker of systemic inflammation that has been widely used as a prognostic predictor in various types of cancer. Zinc is an essential micronutrient involved in immune function and the regulation of inflammation; however, serum zinc levels are frequently reduced in malnourished cancer patients, potentially affecting systemic inflammatory responses as reflected by NLR. Methods: A cross-sectional study was conducted on gynecologic cancer patients with malnutrition undergoing chemotherapy cycles 3 through 6 at Cipto Mangunkusumo Hospital. Malnutrition status was classified according to ASPEN criteria. Blood samples were collected two weeks following each chemotherapy administration and analyzed for fasting serum zinc levels and complete blood count to determine NLR. Correlation analysis between serum zinc levels and NLR was performed using the Spearman correlation test. Results: The study included 53 subjects; the most common cancer type was ovarian (54.7%), followed by cervical (22.6%), endometrial (15.1%), and other types (7.6%). According to ASPEN classification, 75.5% of subjects had moderate malnutrition and 24.5% had severe malnutrition. Mean serum zinc was 10.6 ± 2.52 µmol/L with zinc deficiency present in 45.3% of subjects. The median NLR was 1.83 (range 0.38–19.02). A negative correlation was found between fasting serum zinc and NLR (r = −0.312; p = 0.023). Conclusion: There is a statistically significant negative correlation between fasting serum zinc levels and NLR in gynecologic cancer patients with malnutrition undergoing chemotherapy, although the strength of the correlation is weak.
Keywords : gynecologic cancer, malnutrition, neutrophil-to-lymphocyte ratio, serum zinc