Tesis

Hubungan Faktor Klinikopatologis terhadap Respons Terapi pada Pasien Karsinoma Tiroid Risiko Sedang-Tinggi yang menjalani Tiroidektomi Total dan Radioablasi = Relationship Between Clinicopathological Factors and Treatment Response in Medium- to High-Risk Thyroid Carcinoma Patients Undergoing Total Thyroidectomy and Radioablation.

Latar Belakang: Karsinoma tiroid berdiferensiasi merupakan keganasan endokrin tersering, dengan variasi respons terapi pada pasien risiko sedang–tinggi yang menjalani tiroidektomi total dan radioablasi. Faktor klinikopatologis diduga berperan dalam menentukan respons terapi, namun data lokal Indonesia masih terbatas. Metode: Studi kohort retrospektif menggunakan data rekam medis pasien karsinoma tiroid di RSUPN Dr. Cipto Mangunkusumo periode 2020–2024. Faktor klinikopatologis dievaluasi meliputi usia, jenis kelamin, ukuran tumor, ekstensi ekstratiroid, invasi vaskular, multifokalitas, metastasis kelenjar getah bening, metastasis jauh, dan subtipe histopatologi. Analisis dilakukan menggunakan uji chi-square/Spearman dan regresi logistik ordinal untuk mengidentifikasi prediktor independen respons terapi sesuai kriteria American Thyroid Association (ATA) 2015. Hasil: Sebanyak 85 pasien dianalisis; mayoritas perempuan (74,1%) dan subtipe papiler (89,4%). Respons terapi terdiri atas excellent (41,2%), biochemical incomplete (14,1%), structural incomplete (43,5%), dan indeterminate (1,2%). Analisis bivariat menunjukkan ukuran tumor, ekstensi ekstratiroid, invasi vaskular, metastasis kelenjar getah bening, dan metastasis jauh berhubungan signifikan dengan respons terapi (p < 0,05). Analisis multivariat menunjukkan ukuran tumor sebagai satu-satunya prediktor independen terhadap respons terapi yang lebih buruk (p=0,005). Kesimpulan: Ukuran tumor dan beberapa faktor agresivitas klinikopatologis berhubungan dengan respons terapi pada karsinoma tiroid risiko sedang–tinggi, namun ukuran tumor merupakan prediktor independen utama. Temuan ini menegaskan pentingnya evaluasi klinikopatologis dalam stratifikasi risiko dan penentuan tata laksana.
Kata Kunci: kanker tiroid, respons terapi, ekstensi ekstratiroid, invasi vaskular, tiroidektomi total, radioablasi


Differentiated thyroid carcinoma is the most common endocrine malignancy, with variable treatment response in intermediate–high risk patients undergoing total thyroidectomy and radioactive iodine ablation. Clinicopathological factors are believed to influence therapy response, yet local Indonesian data remain limited. A retrospective cohort study was conducted using medical records of intermediate–high risk thyroid carcinoma patients treated at RSUPN Dr. Cipto Mangunkusumo from 2020 to 2024. Clinicopathological factors assessed included age, sex, tumor size, extrathyroidal extension, vascular invasion, multifocality, lymph node metastasis, distant metastasis, and histopathological subtype. Chi-square/Spearman tests and ordinal logistic regression were used to determine independent predictors of therapy response based on ATA 2015 criteria. Eighty-five patients were included; most were female (74.1%) with papillary subtype (89.4%). Therapy responses comprised excellent (41.2%), biochemical incomplete (14.1%), structural incomplete (43.5%), and indeterminate (1.2%). Bivariate analysis demonstrated significant associations for tumor size, extrathyroidal extension, vascular invasion, lymph node metastasis, and distant metastasis (p < 0.05). Multivariate analysis identified tumor size as the only independent predictor of poorer therapy response (p=0.005). Tumor size and several aggressive clinicopathological features are associated with therapy response in intermediate–high risk thyroid carcinoma, but T3 tumor size emerges as the main independent predictor. These findings highlight the importance of clinicopathological evaluation in risk stratification and treatment planning.
Keywords: thyroid cancer, treatment response, extrathyroidal extension, vascular invasion, total thyroidectomy, radioactive iodine ablation.