Tesis

Hubungan antara Prognostic Nutritional Index dengan Perubahan Indeks Massa Otot pada Pasien Kanker Kepala dan Leher yang Menjalani Radioterapi di RSUPN Cipto Mangunkusumo = Relationship between Prognostic Nutritional Index and Changes in Muscle Mass Index in Head and Neck Cancer Patients Undergoing Radiotherapy at RSUPN Cipto Mangunkusumo.

Latar belakang: Pasien kanker kepala dan leher yang menjalani radioterapi berisiko tinggi mengalami malnutrisi dan penurunan massa otot sejak fase awal terapi. Prognostic Nutritional Index (PNI), yang dihitung dari albumin serum dan jumlah limfosit perifer, merefleksikan status nutrisi sekaligus inflamasi-imunitas, namun hubungannya dengan perubahan indeks massa otot (Skeletal Muscle Index/SMI) selama radioterapi pada populasi ini belum banyak diteliti. Penelitian ini bertujuan menilai hubungan PNI pra radioterapi dengan perubahan SMI pada minggu ke-3 radioterapi di RSUPN Cipto Mangunkusumo. Metode: Penelitian potong lintang dilakukan pada pasien kanker kepala dan leher usia 18–65 tahun yang menjalani radioterapi hingga minggu ke-3. PNI dihitung dari albumin serum dan total limfosit pra radioterapi. SMI diukur menggunakan bioelectrical impedance analysis (BIA) pada pra radioterapi dan minggu ke-3 radioterapi. Asupan energi-protein dinilai melalui food recall 3×24 jam pada pra radioterapi dan minggu ke-3. Korelasi antara PNI dan perubahan SMI dianalisis menggunakan uji Spearman. Hasil: Sebanyak 78 subjek dianalisis; rerata usia 51 tahun dan 66,7% berjenis kelamin laki-laki. Sebanyak 56,4% subjek mengalami malnutrisi sedang menurut ASPEN. Lokasi kanker terbanyak adalah nasofaring (43,6%), dan sebagian besar subjek berada pada stadium IVA (78,2%). Pada pra radioterapi, rerata asupan energi sekitar 26 kkal/kgBB/hari dengan 56,4% subjek mencapai energi yang cukup, sedangkan rerata asupan protein 0,95 g/kgBB/hari dan 75,6% subjek memiliki asupan protein rendah. Pada minggu ke-3 radioterapi, rerata energi turun menjadi 24,5 kkal/kgBB/hari dengan 80,8% subjek energi kurang, sementara asupan protein rata-rata 0,96 g/kgBB/hari dan 73,1% subjek asupan protein masih rendah. Efek samping mukositis oral ditemukan pada 61,5% subjek dan aktivitas fisik ringan mendominasi (74,4%). Rerata PNI pra radioterapi adalah 40 (25–49). Rerata SMI pra radioterapi 7,1±2,3 kg/m² dan menurun menjadi 6,9±2,3 kg/m² pada minggu ke- 3. Terdapat korelasi positif sedang yang bermakna antara PNI pra radioterapi dan perubahan SMI pada minggu ke-3 (r=0,426; p < 0,001). Kesimpulan: Nilai PNI pra radioterapi berkorelasi positif sedang dengan perubahan SMI pada minggu ke-3 radioterapi.
Kata kunci: kanker kepala dan leher, radioterapi, prognostic nutritional index, indeks massa otot


Background: Patients with head and neck cancer undergoing radiotherapy are at high risk of malnutrition and loss of muscle mass from the early phase of treatment. The Prognostic Nutritional Index (PNI), calculated from serum albumin and peripheral lymphocyte count, reflects both nutritional status and inflammation– immune function; however, its relationship with changes in skeletal muscle index (SMI) during radiotherapy in this population has not been widely studied. This study aimed to assess the association between pre-radiotherapy PNI and changes in SMI at the third week of radiotherapy at Dr. Cipto Mangunkusumo National Central General Hospital. Methods: This cross-sectional study included patients with head and neck cancer aged 18–65 years who underwent radiotherapy up to week 3. PNI was calculated from pre-radiotherapy serum albumin and total lymphocyte count. SMI was measured using bioelectrical impedance analysis (BIA) before radiotherapy and at week 3. Energy and protein intake were assessed using 3×24-hour food recalls at baseline and week 3. The correlation between PNI and change in SMI was analyzed using Spearman’s test. Results: A total of 78 subjects were analyzed; the mean age was 51 years and 66.7% were male. A total of 56.4% of the subjects had moderate malnutrition according to ASPEN criteria. The most common cancer site was nasopharynx (43.6%), and most subjects were in stage IVA (78.2%). Before radiotherapy, mean energy intake was about 26 kcal/kgBW/day with 56.4% achieving adequate energy intake, while mean protein intake was 0.95 g/kgBW/day and 75.6% had low protein intake. At week 3 of radiotherapy, mean energy intake decreased to 24.5 kcal/kgBW/day with 80.8% having inadequate energy intake, whereas mean protein intake was 0.96 g/kgBW/day and 73.1% still had low protein intake. Oral mucositis occurred in 61.5% of subjects, and light physical activity predominated (74.4%). The median pre-radiotherapy PNI was 40 (25–49). Mean SMI before radiotherapy was 7.1±2.3 kg/m² and decreased to 6.9±2.3 kg/m² at week 3. There was a statistically significant moderate positive correlation between pre-radiotherapy PNI and change in SMI at week 3 (r=0.426; p < 0.001). Conclusion: Pre-radiotherapy PNI shows a significant moderate positive correlation with changes in SMI at the third week of radiotherapy.
Keywords : head and neck cancer, radiotherapy, prognostic nutritional index, skeletal muscle index