ANEMIA SEBAGAI FAKTOR PROGNOSIS PENURUNAN SURVIVAL PENDERITA KANKER KOLOREKTAL METASTATIK YANG MENDAPATKAN KEMOTERAPI BERBASIS BEVACIZUMAB DI RSUP DR SARDJITO YOGYAKARTA

INDAH SAPTA WARDANI, dr. Johan Kurnianda, Sp.PD, KHOM.; dr. Susanna Hilda Hutajulu, SpPD, KHOM.

2016 | Tesis-Spesialis | SP Ilmu Penyakit Dalam

Pendahuluan. Anemia merupakan problem yang sering terjadi pada pasien kanker kolorektal. Anemia merupakan prediktor yang kuat yang berhubungan dengan kualitas hidup dan overall survival (OS) pada pasien kanker. Penelitian ini bertujuan untuk mengetahui anemia sebagai faktor prognosis survival pada pasien kanker kolorektal metastasis yang menjalani kemoterapi berbasis Bevacizumab di RSUP Dr. Sardjito Yogyakarta. Metode Penelitian.Penelitian ini merupakan penelitian prognostik dengan menggunakan metode cohort retrospektif pada penderita kanker kolorektal metastasis yang menjalani kemoterapi berbasis Bevacizumab. Analisis survival pada grup dengan anemia diestimasi dengan metode Kaplan-Meier. Hazard ratio dan 95% CI untuk analisis univariate dan multivariate diestimasi menggunakan Coxs Proportional hazard regression dengan prosedur eliminasi stepwise. Kemaknaan p <0,05 dianggap signifikan. Hasil Penelitian. Didapatkan 101 pasien yang masuk dijadikan subyek penelitian dengan subyek terbanyak wanita 52,48% dan median usia adalah 56 tahun. Pasien dengan status performa 1 terbanyak pada penelitian ini 49,5 %. Rerata kadar hemoglobin sebelum kemoterapi sebesar 11,3+1,84 mg/dl dengan 27,72% pasien dikategorikan tidak anemia, 49,5% mengalami anemia ringan, 19,8% mengalami anemia sedang, dan 2,97% mengalami anemia berat. Median OS adalah sebesar 21,5 bulan. Overall survival pasien dengan Hb<=10 gr/dl sebesar 25,89 bulan, sedangkan pada Hb < 10 gr/dl adalah 12,54 bulan. Analisis Bivariat menunjukkan Hazard Ratio sebesar 3,009 (IK 95%, 1,601-5,998; p=0,001). Berdasarkan analisis multivariat, anemia merupakan faktor yang mempengaruhi penurunan overall survival bersama dengan status performa yang rendah bila faktor yang lain tidak ada (tipe metastasis, jumlah metastasis, riwayat transfusi). Simpulan. Anemia merupakan faktor prognostik penurunan survival pada pasien kanker kolorektal metastatik yang menjalani kemoterapi berbasis bevacizumab.

Introduction. Anemia is a common problem in patients with colorectal cancer. Anemia is a strong predictor associated with quality of life and overall survival in patients with cancer. In cancer related anemia, the tumor hypoxia-induced reduction in oxygen-carrying capacity of the blood that is considered a major cause of decline in survival. This study is aims to determine anemia as prognostic factors of survival in patients with metastatic colorectal cancer who undergoing chemotherapy bevacizumab based in the Hospital Dr. Sardjito. Methods. This study was a prognostic study using a retrospective cohort of patients with metastatic colorectal cancer who undergone chemotherapy with bevacizumab based. Analysis of survival in the group with anemia was estimated by the Kaplan-Meier method. Hazard ratios and 95% CIs for univariate and multivariate analysis was estimated using Coxs proportional hazard regression with stepwise elimination procedure. Significance of p <0.05 was considered significant. Result. This study obtained 101 patients who entered used as research subjects most women 52.48% and the median age was 56 years. Patients with a performance status of 1 majority in this study 49.5%. Mean hemoglobin levels prior to chemotherapy was 11.3+1.84 mg / dl with 27.72% of patients categorized as not anemia, 49.5% had mild anemia, 19.8% had moderate anemia, and 2.97% have severe anemia. In this study of cancer in patients with cancer of the rectum is at 74.26%, the type of synchronous metastasis by 66.34%. Most chemotherapy regimens XELOX bevacizumab is 65.34%. Median overall survival was 21.5 months. Overall survival of patients with Hb<=10 g/dl is of 25.89 months, whereas Hb <10 g / dl was 12.54 months. Bivariate analysis showed HR of 3.009 (CI 95%, from 1.601 to 5.998; p = 0.001).Based on multivariate analysis, anemia is factor that influence survival of metastatic colorectal cancer with low performance status if other factors are not included (metastatic type, number of metastases and transfusions history) Conclusions. Anemia is prognostic factor of poor survival of patients with metastatic colorectal cancer who undergo chemotherapy with bevacizumab based

Kata Kunci : Anemia, metastatic colorectal cancer, overall survival