PERBEDAAN PROPORSI EKSPRESI ANGIOGENESIS VASCULAR ENDOTHELIAL GROWTH FACTOR-A (VEGF-A) DAN MICRO VESSEL DENSITY (MVD) PADA JARINGAN KANKER KOLOREKTAL METASTASIS SINKRONUS DAN METAKRONUS DI RSUP DR. SARDJITO YOGYAKARTA

Joyo Santoso, dr. Johan Kurnianda, Sp.PD-KHOM; dr. Susanna Hilda Hutajulu, Ph.D, Sp.PD-KHOM

2016 | Tesis-Spesialis | S2 Ilmu Penyakit Dalam

Latar Belakang. Kanker kolorektal adalah keganasan dengan tingkat insidensi yang tinggi. Pertumbuhan kanker dan terjadinya metastasis sangat tergantung pada proses angiogenesis. Ketergantungan terhadap angiogenesis terjadi sejak ukuran tumor sangat kecil. Angiogenesis juga merefleksikan potensi invasi dan metastasis. Micro vessel density (MVD) dengan pewarnaan CD31 dan VEGF-A merupakan penanda angiogenesis. Tujuan Penelitian. Menganalisis perbedaan proporsi ekspresi MVD dan VEGF-A pada jaringan kanker kolorektal metastasis sinkronus dan metakronus. Metode Penelitian. Penelitian disain potong lintang pada jaringan penderita kanker kolorektal metastasis yang berkunjung ke poli Tulip RSUP Dr. Sardjito, Yogyakarta mulai Januari 2007 sampai Desember 2014. Perbedaan proporsi antara kanker kolorektal metastasis sinkronus dan metakronus dianalisis menggunakan Chi-Square, dengan signifikansi p<0,05. Hasil. 63 jaringan terdiri dari 38 metastasis sinkronus dan 25 metakronus. Pasien laki-laki 32 (50,79%) dan wanita 31 (49,21%), rata-rata usia pasien 53,97 ± 10,9 tahun, lokasi kanker terbanyak berasal dari usus kiri 55 (87,3%) dibanding kanan 6 (9,52%), metastasis terbanyak di hepar 32 (50,79%), jenis adenokarsinoma mendominasi sebesar 57 (91,93%) dengan diferensiasi baik 31 (52,54%). Nilai median MVD 24 (4-69) dan VEGF-A 2,3 (0,4-12). Jaringan dengan MVD > 24 (hipervaskuler) sebanyak 29 (46%) dan kurang atau sama dengan 24 sebanyak 34 (54%) sedangkan VEGF-A tinggi (>2,3) dan rendah (kurang atau sama dengan 2,3) berjumlah sama sebanyak 25 (50%). Perbedaan Proporsi hipervaskuler pada jaringan metastasis sinkronus berbeda signifikan dibanding metakronus [22/38 (57,89%); 7/25 (28%); p=0.02] sedangkan VEGF-A tidak berbeda [15/31 (48,38%); 10/19 (52,63%); p=0,77]. Simpulan. Hasil menunjukkan bahwa proporsi MVD hipervaskular metastasis sinkronus lebih tinggi dibanding metakronus sedangkan VEGF-A tidak berbeda.

Background. Colorectal cancer is a malignancy with a high incidence rate. Cancer growth and metastasis occurrence is highly dependent on angiogenesis process. Dependence on angiogenesis occurred since the size of the tumor is very small. Angiogenesis also reflect the potential for invasion and metastasis. Micro vessel density (MVD) with CD31 staining and VEGF-A is a marker of angiogenesis. Objective . Analyze differences in the proportion of expression VEGF-A and MVD in tissues synchronous and metachronous metastatic colorectal cancer Methods. A cross-sectional study design in patients with metastatic colorectal cancer tissue visiting Tulip clinic Dr. Sardjito Hospital, Yogyakarta from January 2007 to December 2014. The difference between the proportion of synchronous and metachronous metastatic colorectal cancer analyzed using Chi-Square, with a significance of p <0.05. Results. 63 tissue consists of 38 synchronous and 25 metachronous metastasis. 32 male patients (50.79%) and 31 women (49.21%), the average age is 53.97 ± 10.9 years, the location of most cancers originate from the left intestine 55 (87.3%) compared to the right 6 (9.52%), with most metastases in the liver 32 (50.79%), adenocarcinoma dominates 57 (91,93%), with good differentiation 31 (52,54%). MVD median value of 24 (4-69) and VEGF-A 2.3 (0.4 to 12). Tissue with MVD> 24 (hypervascular) is 29 (46%) and less or equal 24 as many as 34 (54%) whereas high VEGF-A (> 2.3) and low (less or equal 2,3) equally 25 (50%). The proportion of hypervascular synchronous metastatic tissues significantly different than metachronous [22/38 (57.89%); 7/25 (28%); p = 0.02] whereas VEGF-A are no different [15/31 (48,38%); 10/19 (52,63%); p = 0.77]. Conclusions. Results showed that the proportion of hypervascular MVD in synchronous metastasis is higher than metachronous whereas VEGF-A are no different.

Kata Kunci : MVD (micro vessel density), VEGF-A (Vascular Endothelial Growth Factor), kanker kolorektal, metastasis sinkronus, metastasis metakronus