Tesis

Pengaruh Rasio Neutrofil-Limfosit Sebagai Faktor PrognostikTerhadap Tingkat Kesintasan Pasien Anak dengan DiffuseIntrinsic Pontine Glioma = Neutrophil-to-Lymphocyte Ratio as a Prognostic Factor forOverall Survival in Pediatric Diffuse Intrinsic Pontine Glioma.

Pendahuluan: Diffuse Intrinsic Pontine Glioma (DIPG) adalah tumor otak anak yangagresif dengan prognosis buruk, di mana radioterapi tetap menjadi standar utamapengobatan. Rasio Neutrofil-Limfosit (NLR) diketahui mencerminkan keseimbanganinflamasi dan imunitas, serta berpotensi menjadi biomarker prognostik non-invasifsebagaimana terlihat pada glioma dewasa. Penelitian ini bertujuan mengevaluasi pengaruhNLR praterapi terhadap respons tumor dan overall survival (OS) pasien anak dengan DIPG.Metode: Studi kohort retrospektif melibatkan pasien anak dengan DIPG yang menjalaniradioterapi di RSUPN Dr. Cipto Mangunkusumo (Januari 2018–Juni 2025). Variabel bebasadalah NLR praterapi, sedangkan luaran meliputi overall survival dan respons tumor(kriteria RAPNO). Analisis kesintasan dilakukan menggunakan metode Kaplan–Meier,sedangkan regresi Cox digunakan untuk mengidentifikasi faktor prognostik independenterhadap overall survival.Hasil: Sebanyak 39 pasien DIPG, terdapat 33 pasien dengan data NLR praterapi. MedianNLR adalah 3,3 (IQR 1 ,6–7,1), dengan 39% pasien memiliki NLR > 4,0. Analisis univariatmenunjukkan NLR > 4,0 berhubungan dengan peningkatan risiko kematian 2,96 kali lipat(95% CI 1 ,25–7,00, p=0,013). Temuan tetap signifikan setelah penyesuaian multivariatdengan hazard ratio 3.23 (95% CI 1 ,19–8,78, p=0,021). Median OS untuk NLR ≤ 4,0adalah 11 bulan (95% CI 8–15) versus 3 bulan (95% CI 1 –5) untuk NLR > 4.0 (log-rankp=0,012). Radioterapi berhubungan dengan penurunan risiko kematian 74% (adjusted HR0,26, p=0,01). NLR tidak berkorelasi dengan respons radiologis (p=0,80).Kesimpulan: NLR praterapi adalah faktor prognostik independen signifikan pada pasienpediatrik dengan DIPG, merefleksikan imunosupresi sistemik yang berkontribusi padaprognosis buruk. NLR dapat diintegrasikan ke dalam penilaian prognostik awal untukstratifikasi risiko dan konseling keluarga, namun radioterapi tetap menjadi standar terapiuntuk semua pasien DIPG tanpa memandang status NLR.
Kata kunci: Diffuse intrinsic pontine glioma, rasio neutrofil-limfosit, prognostik, responstumor, tingkat kesintasan.


Introduction: Diffuse intrinsic pontine glioma (DIPG) is a highly aggressive pediatricbrain tumor with poor prognosis, for which radiotherapy remains the standard treatment.The neutrophil-to-lymphocyte ratio (NLR), a marker of systemic immune–inflammatorybalance, has demonstrated prognostic value in adult gliomas, but its role in pediatric DIPGremains unclear.Methods: A retrospective cohort study was conducted among pediatric patients with DIPGtreated with radiotherapy at Dr. Cipto Mangunkusumo National General Hospital betweenJanuary 2018 and June 2025. Pre-treatment NLR was analyzed in relation to OS andradiologic tumor response using RAPNO criteria. Survival was assessed using the Kaplan–Meier method and Cox proportional hazards regression.Results: Among 39 patients with DIPG, 33 had available pre-treatment NLR data. Themedian NLR was 3.3 (interquartile range 1.6–7.1), with 39% of patients exhibiting NLR> 4.0. NLR > 4.0 was associated with significantly worse OS on univariate (hazard ratio[HR] 2.96, p=0.013) and multivariate analysis (HR 3.23, p=0.021). Median OS was 11months in patients with NLR ≤ 4.0 compared with 3 months in those with NLR > 4.0 (logrank p=0.012). Radiotherapy independently reduced mortality risk by 74% (adjusted HR0.26, p=0.01). NLR was not associated with radiologic tumor response (p=0.80).Conclusion: Pre-treatment NLR is an independent prognostic factor for overall survivalin pediatric DIPG, likely reflecting tumor-induced systemic immunosuppression. NLR mayaid early risk stratification, while radiotherapy remains essential regardless of NLR status.
Keywords: Diffuse intrinsic pontine glioma; Neutrophil-to-lymphocyte ratio; Pediatricbrain tumor; Prognostic biomarker; Survival