PERBEDAAN RASIO ALPHA FETOPROTEIN-L3/ALPHA FETOPROTEIN (AFP-L3%) PADA KARSINOMA HEPATOSELULER BERDASARKAN SISTEM STAGING BARCELONA CLINIC LIVER CANCER (BCLC)

RISKADWI SEPTIANTI, Dr. dr. Neneng Ratnasari, Sp.PD-KGEH.; Prof. Dr. dr. Siti Nurdjanah, Sp.PD-KGEH

2018 | Tesis-Spesialis | SP Ilmu Penyakit Dalam

Latar belakang. Stadium awal KHS seringkali bersifat asimptomatik sehingga dibutuhkan tes diagnostik yang handal untuk mendiagnosis KHS sedini mungkin. Barcelona Clinic Liver Cancer (BCLC) merupakan sistim stagimg yang direkomendasikan karena dinilai cukup lengkap dan sangat direkomendasikan oleh AASLD dan EASL. Lens culinaris agglutinin-reactive AFP (AFP-L3) merupakan subfraksi AFP yang sangat spesifik yang dapat digunakan sebagai penanda diagnosis dini KHS. Tujuan Penelitian. Tujuan utama penelitian ini adalah (1) untuk mengetahui perbedaan rasio Alpha Fetoprotein-L3/Alpha Fetoprotein (AFP-L3%) pada karsinoma hepatoseluler berdasarkan sistim staging BCLC, (2) memprediksi keparahan KHS berdasarkan sistim staging BCLC dengan menggunakan rasio AFP-L3% Metode. Rancangan penelitian ini adalah cross sectional. Sebanyak 62 sampel pasien yang telah tegak diagnosis KHS dilakukan penilaian stadium BCLC, kemudian dilakukan pengambilan serum darah untuk pemeriksaan AFP total dan AFP-L3 untuk selanjutnya menghitung nilai AFP-L3%. AFP-L3 diperiksa menggunakan alat ELISA reader. Hasil Penelitian. Berdasarkan uji Kruskal Wallis, didapatkan nilai median AFP-L3% pada kelompok stadium A dan B adalah 0,08 (0,012-2,01), kelompok stadium C 0,83 (0,006359,2), dan kelompok stadium D 1,6 (0,004-358,7) dengan nilai p=0,812. Pada uji chi square dengan nilai cut-off AFP-L3% sebesar 0,6%, walaupun tidak didapatkan hasil yang bermakna, akan tetapi didapatkan PR=1,636 yang menunjukkan bahwa stadium D kemungkinan berisiko 1,6 kali lebih tinggi untuk memiliki nilai AFP-L3% >= 0,6% dibandingkan kelompok A dan B, dan PR=1,533 menunjukkan bahwa stadium C memiliki kemungkinan risiko 1,5 kali lebih tinggi untuk memiliki kadar AFP-L3% >= 0,6% pada stadium C dibandingkan stadium A dan B. Kesimpulan. Tidak didapatkan perbedaan yang bermakna secara statistik rasio Alpha fetoprotein-L3/Alpha fetoprotein (AFP-L3%) pada karsinoma hepatoseluler berdasarkan sistim staging Barcelona Clinic Liver Cancer (BCLC). Rasio AFP-L3% dengan cut-off 0,6% kemungkinan mampu memprediksi keparahan karsinoma hepatoseluler berdasarkan sistim staging BCLC walaupun tidak bermakna secara statistik.

Background. The initial stages of hepatocellular carcinoma (HCC) are often asymptomatic, requiring reliable diagnostic tests to diagnose HCC as early as possible. Barcelona Clinic Liver Cancer (BCLC) is a recommended stagimg system because it is considered quite complete and highly recommended by AASLD and EASL. Percentage of AFP-L3 to total AFP (AFP-L3%) can be used as a marker of early diagnosis of HCC. Objective. The main objectives of this study were (1) to determine the difference of Alpha-Fetoprotein-L3/Alpha Fetoprotein (AFP-L3%) ratio in hepatocellular carcinoma based on BCLC staging system, (2) to predict the severity of HCC based on BCLC staging system using AFP-L3% Method. The design of this study is cross sectional. A total of 62 samples of patients who had diagnosis of HCC were assessed for BCLC stage, then blood serum was taken for total AFP and AFP-L3 examination to further calculate AFP-L3% values. AFP-L3 is checked using the ELISA reader tool. Results. Based on Kruskal Wallis test, the median values of AFP-L3% in groups of stage A and B were 0.08 (0.012-2.01), stage C were 0.83 (0.006-359.2), and stage D 1,6 0,004358,7) with p-value = 0,812. In the chi square test with the cut-off value of AFP-L3% of 0.6%, although no significant results were obtained, PR=1.636 indicated that stage D may be at risk 1.6 times to have AFP-L3% >= 0.6% compared with groups A and B, and PR=1.533 indicated that stage C had a 1.5% higher risk of having AFP-L3% >= 0.6% in stage C compared with stage A and B. Conclusion. There was no statistically significant difference in the ratio of Alpha fetoprotein-L3 / Alpha fetoprotein (AFP-L3%) in hepatocellular carcinoma based on Barcelona Clinic Liver Cancer (BCLC) staging system. The AFP-L3% ratio with cut-off 0,6% might be able to predict the severity of hepatocellular carcinoma based on the BCLC staging system although not statistically significant.

Kata Kunci : Alpha fetoprotein, AFP-L3%, karsinoma hepatoseluler, sistim staging Barcelona Clinic Liver cancer, prevalence ratio, Alpha fetoprotein, AFP-L3%, hepatocellular carcinoma, Barcelona Clinic Liver Cancer staging system, prevalence ratio