VALIDASI PALLIATIVE PROGNOSTIC SCORE (PaP SCORE) PADA PENDERITA KANKER STADIUM METASTASIS DI RSUP DR SARDJITO YOGYAKARTA
PRAFITA CAHYA DEWANTI, dr. Johan Kurnianda, Sp.PD, KHOM.; dr. Kartika Widayanti, Sp.PD, KHOM.
2016 | Tesis-Spesialis | SP Ilmu Penyakit DalamLatar belakang. Peningkatan insidensi dan kematian akibat kanker di negara berkembang karena banyaknya penderita kanker yang datang ke pelayanan kesehatan sudah dengan stadium lanjut. Identifikasi kelompok stadium terminal penting dilakukan karena penderita kanker stadium terminal tidak lagi diberikan terapi agresif. Palliative prognostic score (PaP score) merupakan suatu sistem penilaian untuk membantu klinisi dalam memprediksi probabilitas kesintasan dalam 30 hari pada penderita kanker stadium lanjut. PaP score terbagi dalam 3 kategori, yaitu : Grup A, skor : 0-5,5 (probabilitas kesintasan dalam 30 hari >70%); grup B, skor : 6-11 (probabilitas kesintasan dalam 30 hari 30-70%) dan grup C, skor :11,5-17,5 (probabilitas kesintasan dalam 30 hari <30%). Tujuan Penelitian. Penelitian ini bertujuan untuk melakukan uji validasi dan evaluasi akurasi prognostik PaP score dalam memprediksi kesintasan dalam 30 hari pada penderita kanker stadium metastasis di RSUP Dr Sardjito Yogyakarta. Metode. Desain penelitian prognostik ini menggunakan desain kohort, mengikutkan pasien-pasien penderita kanker stadium metastasis di polikllinik Tulip, instalasi rawat inap dan rawat jalan di RSUP Dr Sardjito selama bulan Mei 2015-Mei 2016. Sebanyak 159 pasien yang ikut dalam penelitian ini dilakukan penilaian PaP score, kemudian subyek penelitian diikuti selama 30 hari setelah penilaian. Evaluasi nilai duga positif dan analisis kesintasan dilakukan untuk membandingkan kesintasan diantara ketiga grup PaP. Hasil Penelitian. Seratus tujuh puluh sembilan subyek dianalisis dengan median kesintasan 90 hari, 76 pasien dikategorikan ke dalam grup A, 22 pasien masuk ke dalam grup B dan 61 pasien ke dalam grup C. Probabilitas kesintasan dalam 30 hari untuk grup A 98,7 %, grup B 63,6 % dan grup C 3,3 %. Median kesintasan grup B 35 hari dan grup C 6 hari, sedangkan pada grup A median kesintasan belum dapat dinilai. Perbedaan kesintasan pada ketiga grup menunjukkan hasil yang bermakna (X 2 =203,97; P<0,0001). Nilai duga positif PaP score dalam memprediksi kematian dalam 30 hari sebesar 96,7 % dengan akurasi 93,1 %. Kesimpulan. PaP score merupakan alat uji yang valid dalam menentukan prognosis pada pasien kanker stadium metastasis dengan akurasi dan presisi yang tinggi dalam memprediksi kesintasan dalam 30 hari.
Background. The mortality burden of cancer continues to increase in developing countries, most likely because of a late stage at diagnosis. Identify the terminal stage is important in patients with advanced cancer because in patients with terminal cancer, the therapy is no longer aggressive. Palliative prognostic score (PaP score) is a scoring system to predict the probability of survival within 30 days in patients with advanced cancer. PaP score divided the heterogeneous patient sample into three iso-prognostic groups related to the chance of surviving 30-days : Group A, score: 0 to 5.5 (the probability of survival within 30 days > 70%); Group B, score: 6-11 (the probability of survival in 30 days 30-70%) and group C, the score: 11.5 to 17.5 (the probability of survival in 30 days <30%). Objectives. The aim of this study was to validate and to evaluate the predictive accuracy of the palliative prognostic (PaP score) to predict 30-day survival in patients with metastatic cancers in RSUP Dr Sardjito Yogyakarta. Methods. The design of this prognostic study was cohort, include patients with metastatic cancers were visited in clinic Tulip, inpatient and outpatient care in the Dr Sardjito hospital during May 2015 to May 2016. The PaP score was calculated in 159 consecutive patients with metastatic cancers. The positive predictive value of the PaP score was evaluated and survival analysis was performed to compare the survival of the three prognostic group. Results. PaP score was tested on 159 subjects with overall median survival was 90 days, 76 patients categorized into group A, 22 patients into group B and 61 patients into group C. The 30-day survival probability was 98,7% for group A (median survival could not be assessed), 63,6 % probability of 30-day survival for group B with median survival was 35 days and for group C with 3,3% probability of 30-day and median survival was 6 days. These survival differences were highly significant (log-rank test of trends, X 2 =203,97; P<0,0001). Positive predictive value of PaP score in predicting 30-day mortality was 96.7% with an accuracy of PaP score was 93.1%. Conclusion. PaP score is a valid test tool in determining prognosis in patients with metastatic cancers with high accuracy and precision in predicting survival within 30 days.
Kata Kunci : PaP score, validation, survival, prognosis, metastatic cancers
