KORELASI SERUM ALFA FETOPROTEIN DENGAN KURAN DAN JUMLAH TUMOR PADA KARSINOMA HEPATOSELULER

Eristan N Napitupulu, Dr. dr. Bagaswoto P, Sp.Rad(K), Sp.KN, M.Kes, FICA

2018 | Tesis | MAGISTER ILMU KEDOKTERAN KLINIS

Latar Belakang. Karsinoma hepatoseluler (KHS) adalah tumor paling sering pada tumor hepar primer, terhitung sekitar 85-90% dari seluruh keganasan hepar primer. Insidensi KHS di seluruh dunia semakin bertambah, menjadi tumor paling sering kelima di dunia. Diagnosis KHS biasanya dengan modalitas pencitraan, biopsi atau tumor marker Alfa Fetoprotein (AFP). Secara klinis kenaikan level serum AFP berkaitan dengan KHS. Beberapa penelitian masih kontroversi terhadap korelasi level serum AFP terhadap progresifitas tumor KHS. Tujuan. Mengetahui adanya korelasi antara level serum AFP dengan ukuran dan jumlah tumor pasien KHS. Bahan dan Metode. Subyek penelitian terdiri dari 33 citra multislice computed tomography scanning (MSCT scan) abdomen 4 fase mulai Januari 2016-Mei 2018 di RSUP Dr. Sardjito Yogyakarta. Interpretasi dilakukan pada citra CT scan abdomen 4 fase yang didiagnosis dengan KHS, telah dibuktikan dengan pemeriksaan histopatologi disertai pemeriksaan level serum AFP. Uji korelasi dengan Spearman antara level serum AFP dengan ukuran tumor dan antara level serum AFP dengan jumlah tumor. Level serum AFP dibagi atas < 20 ng/mL, 20-399 ng/mL dan 400 ng/mL. Ukuran tumor dikelompokan atas < 2 cm, 2-5 cm dan > 5 cm. Jumlah tumor hepar dikelompokan atas 1 nodul, 2-3 nodul dan > 3 nodul. Hasil. Dari 33 subyek penelitian didapatkan 24 (72,7%) laki-laki dan 9 (27,3%) perempuan dengan rerata usia 55,69 tahun mulai dari usia 25 tahun-79 tahun. Etiologi paling sering adalah infeksi virus hepatitis B yaitu 15 (45,5%), HCV 9 (27,3%) dan lain-lain 9 (27,3%). Nilai level AFP terbanyak 18 (39,4%) < 20 ng/mL. Tidak ada subyek yang masuk dalam ukuran < 2 cm, 1 (3%) berukuran 2-5 cm, dan 32 (97%) berukuran > 5 cm. Terdapat 15 (45,5%) soliter, 12 (36,4%) memiliki 2-5 nodul, dan 6 (18,2%) > 5 nodul. Kesimpulan. Ada korelasi yang tidak signifikan antara level serum AFP dengan ukuran tumor (p = 0,239), serta ada korelasi yang tidak signifikan antara level serum AFP dengan jumlah tumor (p = 0,808).

Background: Hepatocellular carcinoma (HCC) is the most common primary tumor, approximately 85-90% of all primary liver malignancies. The incidence of HCC is increasing, becoming the fifth most frequent tumor in the world. Diagnosis of HCC is usually with imaging modalities, biopsy or tumor markers of Alfa Fetoprotein (AFP). Clinically elevated serum AFP levels associated with HCC. Some studies are still controversial about the correlation of serum AFP levels to HCC tumor progression. Objective: Determine the correlation between serum AFP levels and the size and number of tumors of HCC patients. Material and Methods: The study subjects consisted of 33 multislices computed tomography scanning (MSCT scan) 4-phase abdominal images in January 2016-May 2018 at Dr. Sardjito general hospital, Yogyakarta. Interpretation is performed on 4-phase abdominal CT scan images diagnosed with HCC, has been proven by histopathological examination and accompanied by serum AFP level examination. Correlation test with Spearman between serum AFP level with tumor size and number of tumors. Serum AFP levels are divided into < 20 ng / mL, 20-399 ng / mL and 400 ng / mL. Tumor size is grouped < 2 cm, 2-5 cm and > 5 cm. Number of tumors grouped into 1 nodule, 2-3 nodules and > 3 nodules. Results: 33 study subjects, there 24 (72.7%) were male and 9 (27.3%) female with a mean age of 55.69 years starting from the age of 25-79 years. The most etiologies were hepatitis B virus (HBV) infection of 15 (45.5%), 9 (27.3%) HCV and 9 (27.3%) others. At serum AFP, 13 (39.4%) < 20 ng/mL, 2 (6.1%)) 20-399 ng/mL, and 18 (54.5%) 400 ng/mL. No subjects entered in size < 2 cm, 1 (3%) measuring 2-5 cm, and 32 (97%) measuring > 5 cm. There were 15 (45.5%) solitary, 12 (36.4%) had 2-5 nodules, and 6 (18.2%) > 5 nodules. Conclusion: There was no significant correlation between serum AFP level and tumor size (p = 0.239), and there was no significant correlation between serum AFP level and tumor number (p = 0.808).

Kata Kunci : Alpha Fetoprotein, Hepatocellular Carcinoma, tumor size, number of tumors.