Tesis

Peran Vimentin Terhadap Kesintasan Kanker Payudara Tripel Negatif, Kohort Retrospektif =

Pendahuluan : Triple negative breast cancer (TNBC) merupakan subtipe kanker payudara dengan prognosis terburuk dan karakteristik biologis yang agresif. Di Indonesia, sekitar 15–25% kasus kanker payudara termasuk dalam kelompok TNBC. Salah satu penanda biologis yang berperan dalam proses epithelial–mesenchymal transition (EMT) dan progresivitas TNBC adalah vimentin. Ekspresi vimentin positif dilaporkan berhubungan dengan penurunan kesintasan, namun data di populasi Indonesia masih terbatas. Metode : Penelitian retrospektif ini melibatkan 29 pasien TNBC yang mendapatkan tata laksana di RSUPN Dr. Cipto Mangunkusumo periode 2017–2022 dan diikuti selama tiga tahun. Data karakteristik klinikopatologis dan ekspresi vimentin dianalisis menggunakan uji bivariat dan analisis kesintasan Kaplan–Meier. Hasil : Sebagian besar pasien berusia ≥40 tahun (82,8%), memiliki indeks massa tubuh normal (82,8%), datang pada stadium lokal lanjut (72,4%), dengan grade histopatologi tinggi (62,1%) dan ekspresi Ki-67 tinggi (72,4%). Terdapat hubungan bermakna antara ekspresi vimentin dan overall survival (p=0,019), di mana peningkatan ekspresi vimentin berasosiasi dengan penurunan angka kesintasan (rata-rata 30,42 bulan pada ekspresi negatif menjadi 20,86 bulan pada ekspresi positif). Ekspresi vimentin juga berhubungan signifikan dengan ekspresi Ki-67 (p=0,045), menunjukkan keterkaitan antara proliferasi sel dan aktivasi EMT. Analisis lanjutan pada pasien TNBC menunjukkan bahwa ekspresi vimentin positif secara signifikan meningkatkan risiko kematian (p=0,015; HR 5,64; IK95% 1,39–22,7), sementara tata laksana yang tidak adekuat juga berasosiasi dengan penurunan overall survival (p=0,011; HR 4,05; IK95% 1,37–11,9). Kesimpulan : Ekspresi vimentin berhubungan signifikan dengan penurunan overall survival pada pasien TNBC dan berkaitan dengan ekspresi Ki-67 tinggi yang mencerminkan agresivitas tumor dan aktivasi EMT. Tata laksana yang tidak adekuat turut berkontribusi terhadap penurunan kesintasan. Temuan ini menegaskan potensi vimentin sebagai penanda molekuler prognostik pada TNBC di populasi Indonesia


Introduction : Triple negative breast cancer (TNBC) is a subtype of breast cancer with the poorest prognosis and aggressive biological behavior. In Indonesia, approximately 15–25% of breast cancer cases fall into the TNBC category. One of the biological markers involved in the epithelial–mesenchymal transition (EMT) process and tumor progression of TNBC is vimentin. Positive vimentin expression has been reported to correlate with reduced survival; however, data in the Indonesian population remain limited. Methods : This retrospective study included 29 TNBC patients who received treatment at Dr. Cipto Mangunkusumo National General Hospital between 2017 and 2022, with a three-year follow-up period. Clinicopathological data and vimentin expression were analyzed using bivariate analysis and Kaplan–Meier survival analysis. Results : Most patients were aged ≥40 years (82.8%), had a normal body mass index (82.8%), presented with locally advanced disease (72.4%), high histopathological grade (62.1%), and high Ki-67 expression (72.4%). A significant association was observed between vimentin expression and overall survival (p=0.019), where increased vimentin expression was associated with reduced survival (mean survival 30.42 months in the negative group vs. 20.86 months in the positive group). Vimentin expression was also significantly associated with Ki-67 expression (p=0.045), indicating a link between cellular proliferation and activation of EMT. Further analysis in patients with TNBC demonstrated that positive vimentin expression significantly increased the risk of mortality (p=0.015; HR 5.64; 95% CI 1.39–22.7), while inadequate treatment was also associated with poorer overall survival (p=0.011 ; HR 4.05; 95% CI 1.37–11.9). Conclusion : Vimentin expression is significantly associated with reduced overall survival in patients with TNBC and correlates with high Ki-67 expression, reflecting tumor aggressiveness and activation of EMT. Inadequate treatment also contributes to poorer survival outcomes. These findings highlight the potential role of vimentin as a prognostic molecular marker in TNBC within the Indonesian population.