KORELASI RESPONS TERAPI TRANSARTERIAL CHEMOEMBOLIZATION DENGAN GRADING SKOR ALBUMIN-BILIRUBIN PADA PASIEN KARSINOMA HEPATOSELULER

ADE PERDANA SETIAWAN, Prof. dr. Arif Faisal, Sp.Rad (K), DHSM ; dr. Wigati Dhamiyati, Sp.Rad (K) Onk

2021 | Tesis-Spesialis | RADIOLOGI

Latar belakang : Karsinoma hepatoseluler (KHS) adalah keganasan hepar primer paling sering dengan prognosis yang buruk. Pilihan terapi dan prognosis pada pasien KHS sangat bergantung pada kondisi klinis dan stadium kanker pasien. Transarterial chemoembolization (TACE) adalah terapi pilihan khususnya pada KHS stadium intermediate kriteria Barcelona Clinic Liver Cancer (BCLC). Penelitian-penelitian sebelumnya mengkonfirmasi bahwa grading skor albumin-bilirubin (ALBI) dapat digunakan untuk memprediksi prognosis pasien KHS yang mendapatkan terapi TACE. Tujuan penelitian : Mengetahui hubungan antara respons TACE dengan grading skor ALBI pada pasien KHS Bahan dan Cara : Penelitian ini adalah penelitian observasional analitik uji korelasi cross-sectional dengan subjek dari data sekunder secara consecutive nonrandom sampling. Subjek penelitian adalah hasil CT scan abdomen 4 fase pasien KHS sebelum dan setelah menjalani TACE pertama kali dan nilai albumin-bilirubin sebelum tindakan TACE di RSUP Dr. Sardjito Yogyakarta periode Juni 2016 – Juni 2021. Respons TACE dikelompokan dalam empat kategori yakni complete response (CR), partial response (PR), progressive disease (PD), dan stable disease (SD). Untuk grading skor ALBI dikelompokan dalam tiga kategori yakni grade 1, grade 2, dan grade 3. Dilakukan uji korelasi Somers’d antara respons terapi TACE dengan grading skor ALBI. Hasil : Diperoleh 33 subjek, berjenis kelamin laki-laki 75,8% dan perempuan 24,2%. Rentang usia dari 42 hingga 78 tahun dengan rerata usia 57,272 ± 10,329 tahun. Etiologi KHS lebih banyak disebabkan oleh infeksi VHB 55,8%. Jumlah tumor soliter pada sebelum TACE 78,8% dan setelah TACE 72,7%. Besar ukuran tumor rerata 104,424 ± 33,704 mm sebelum TACE dan 79,151 ± 44,666 mm setelah TACE. Grading skor ALBI pada ALBI grade 2 60,6%, grade 1 33,3% dan grade 3 6,1%. Respons terapi TACE kategori PR dan SD masing-masing 39,4 %, PD 15,1% dan CR 6,1%. Kesimpulan: Tidak terdapat korelasi yang bermakna secara statistik antara grading ALBI dengan respons terapi TACE pada KHS (p = 0,447). Penelitian lebih lanjut diperlukan untuk mengkonfirmasi kemampuan prediksi grading ALBI dengan respons terapi TACE pada KHS

Background: Hepatocellular carcinoma (HCC) is the most common primary liver malignancy with a poor prognosis. The choice of therapy and prognosis in HCC patients is highly dependent on the clinical condition of the patient and the stage of cancer. Transarterial chemoembolization (TACE) is the treat of choice, especially in the intermediate stage HCC criteria for Barcelona Clinic Liver Cancer (BCLC). Previous studies confirmed that the albumin-bilirubin (ALBI) grade can be used to predict the prognosis of HCC patients receiving TACE therapy. Objective: To determine the relationship between TACE response and ALBI grade in HCC patients. Materials and Methods: This study is an analytic observational study with a cross-sectional correlation test with subjects from secondary data with non-random consecutive sampling. The research subjects were the results of abdominal CT scan 4 phases of HCC patients before and after undergoing TACE for the first time and albumin-bilirubin values before the TACE procedure at Dr. Sardjito Hospital Yogyakarta period June 2016 – June 2021. TACE responses are grouped into four categories, complete response (CR), partial response (PR), progressive disease (PD), and stable disease (SD). For grading the ALBI scores, they are grouped into three categories, grade 1, grade 2, and grade 3. A correlation test with Somers'd was conducted between the response to TACE therapy and the ALBI grade. Results: There were 33 subjects, 75.8% male and 24.2% female. The age range is from 42 to 78 years with a mean age of 57,272 ± 10,329 years. The etiology of KHS was mostly caused by HBV infection 55.8%. The number of solitary tumors before TACE was 78.8% and after TACE was 72.7%. The mean tumor size was 104,424 ± 33,704 mm before TACE and 79,151 ± 44,666 mm after TACE. The ALBI grade was at ALBI grade 2 60.6%, grade 1 33.3%, and grade 3 6.1%. Response to TACE therapy for PR and SD categories were 39.4%, PD 15.1%, and CR 6.1%, respectively. Conclusion: There was no statistically significant correlation between ALBI grade and response to TACE therapy in HCC (p = 0.447). Further studies are needed to confirm the predictive ability of ALBI grade with response to TACE therapy in HCC.

Kata Kunci : karsinoma hepatoseluler, transarterial chemoembolization, grading skor albumin-bilirubin