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Pengembangan Model Probabilitas Respons Akhir Terapi Radiasi Kanker Serviks Stadium Lanjut Menggunakan Parameter Apparent Diffusion Coefficient dan T2 Tumor pada Magnetic Resonance Imaging: Kaitannya Dengan Ekspresi Survivin = Development of Probability Model for Final Response to Advanced Stage Cervical Cancer Therapy using Apparent Diffusion Coefficient and T2 Tumour Parameter on Magnetic Resonance Imaging: Associated with Survivin Expression.

Kanker serviks merupakan kanker pada perempuan nomor dua di Indonesia. Sebagian besar kanker serviks di Indonesia terdiagnosis pada stadium lanjut. Respons terapi radiasi pada kanker serviks stadium lanjut dapat berbeda-beda meskipun berada pada stadium yang sama. Prediktor respons akhir terapi kanker serviks sangat penting karena dapat menentukan tata laksana sejak dini untuk meningkatkan keberhasilan terapi dan angka harapan hidup penderita kanker serviks. Magnetic resonance imaging (MRI) non-kontras merupakan salah satu pemeriksaan radiologis non invasif yang memiliki nilai akurasi tinggi dalam penentuan stadium kanker serviks, dan lebih jauh lagi dapat dimanfaatkan sebagai modalitas prediktor respons akhir terapi kanker serviks melalui parameter Apparent Diffusion Coefficient (ADC) dan T2 tumor yang dihasilkan oleh sequence MRI. Penelitian ini bertujuan mengembangkan suatu model probabilitas respons akhir terapi kanker serviks stadium lanjut menggunakan parameter klinis dan MRI yang dikaitkan dengan ekspresi biomarker survivin tumor. Pengumpulan data dilakukan di Rumah Sakit Cipto Mangunkusumo, Jakarta pada periode Januari 2023 hingga Mei 2024 dengan total 35 subjek penelitian. Seluruh subjek penelitian dilakukan evaluasi penilaian klinis, histopatologis kanker serviks, kadar survivin jaringan tumor, pemeriksaan MRI pra terapi, MRI di pertengahan siklus terapi, dan evaluasi respons akhir terapi menggunakan MRI atau penilaian klinis. Hasil penelitian menghasilkan suatu model probabilitas respons akhir terapi melalui sistem skoring dari satu variabel klinis yaitu usia penderita kanker serviks dan tiga variabel MRI yaitu ukuran tumor, gambaran metastasis nodal, dan rasio nilai T2 tumor dibandingkan muskulus gluteus maksimus (Rasio T2 t/m) pada pemeriksaan MRI di pertengahan siklus terapi. Model probabilitas ini memiliki nilai akurasi yang tinggi dengan sensitivitas 92,86% dan spesifisitas 85,71%, dan dapat menjadi alternatif baru penentuan prediktor respons akhir terapi kanker serviks dengan menggunakan pemeriksaan radiologis yang tidak invasif yaitu MRI non kontras pra terapi dan di pertengahan siklus terapi.
Kata kunci: Kanker serviks, magnetic resonance imaging, model probabilitas, prediktor respons akhir, survivin


Cervical cancer is the second most common women's cancer in Indonesia. Most cervical cancers in Indonesia are diagnosed at an advanced stage. The response to radiation therapy in advanced cervical cancer can vary even though they are at the same stage. Predictors of the final response of cervical cancer therapy are very important to determine the early patient’s management to increase the success of therapy and the survival rate of the patients. Non-contrast magnetic resonance imaging (MRI) is a non-invasive radiological examination that has a high accuracy in determining the stage of cervical cancer, and further can be used as a predictor modality for the final response of cervical cancer therapy through the Apparent Diffusion Coefficient (ADC) and T2 tumour parameters from MR sequence. This study aims to develop a probability model for the final response of advanced cervical cancer therapy using clinical and MR parameters, which are associated with the expression of survivin biomarkers in tumour. Data collection was conducted at Cipto Mangunkusumo Hospital, Jakarta from January 2023 to May 2024 with a total of 35 subjects. All subjects underwent clinical assessment, histopathology examination of cervical cancer, examination of survivin levels of tumour tissue biopsies, pre therapy MR examination, mid-cycle therapy MR examination, and final response therapy evaluation using final MR examination or clinical judgement. The results of this study is a probability model of the final response of therapy through a scoring system of one clinical variable, the age of cervical cancer patients and three MR variables, tumour size, nodal metastasis findings, and the ratio of T2 tumour to the gluteus maximus muscle on MR in the mid-cycle of the therapy. This probability model has a high accuracy value with a sensitivity of 92.86% and a specificity of 85.71%, and can be used as a new alternative predictor of the final response of cervical cancer therapy using a noninvasive radiological examinations, non-contrast MRI on pre therapy and in the mid-cycle of the therapy.
Keyword: Cervical cancer, magnetic resonance imaging, probability model, final response predictor, survivin