ANALISIS PENGARUH BODY MASS INDEX (BMI) PRE-KEMOTERAPI TERHADAP KESINTASAN PASIEN TRIPLE NEGATIVE BREAST CANCER (TNBC) DI RSUP DR. SARDJITO

HANA DWI SETYARINI, Dr. dr. Ibnu Purwanto, Sp.PD-KHOM; Dr. dr. Usi Sukorini, Sp. PK(K), M.Kes

2021 | Skripsi | S1 KEDOKTERAN

Latar belakang: Kanker payudara merupakan jenis kanker yang menempati urutan kedua paling banyak terjadi di dunia dan memiliki 4 subtipe molekular, salah satunya jenis triple negative. Triple negative breast cancer (TNBC) memiliki hasil ekspresi gen ER, PR, dan HER-2 negatif serta memiliki prognosis yang terbilang buruk. Pasien TNBC dengan BMI prekemoterapi tinggi memiliki tingkat kesintasan yang lebih rendah akibat terganggunya sumbu insulin-leptin-adiponektin. Tujuan: Mengetahui pengaruh BMI pre-kemoterapi terhadap kesintasan menyeluruh pasien triple negative breast cancer (TNBC). Metode: Penelitian ini menggunakan desain studi kohort retrospektif dengan data registri klinis pasien TNBC di RSUP Dr. Sardjito yang terdiagnosis sejak tahun 2014 hingga 2018 sebanyak 97 sampel. Analisis statistik dilakukan pada variabel BMI prekemoterapi dan lainnya menggunakan uji chi square dan survival analysis yaitu grafik Kaplan Meier dengan log rank test dan uji cox regression proportional hazard models untuk melihat hazard ratio menggunakan perangkat lunak SPSS. Hasil: Berdasarkan uji chi square dan uji cox regression diketahui bahwa tidak ada hubungan statistik antara BMI prekemoterapi dengan kesintasan pasien (nilai p = 0,632) dan bukan faktor prognostik TNBC (nilai p = 0,949). Risiko kematian antara kelompok overweight obesitas (BMI >=23 kg/m2) dan kelompok underweight normal (< 23 kg/m2) hampir sama (HR = 1,022). Dari hasil subanalisis overweight obesitas diketahui bahwa kedua sub kategori memiliki risiko kematian yang hampir sama pula (HR = 1,062). Grafik Kaplan-Meier menunjukkan 3-years overall survival kedua kelompok pasien TNBC sama yaitu 51,4%. Kesimpulan: BMI prekemoterapi tidak berpengaruh secara statistik terhadap kesintasan pasien TNBC dan bukan faktor prognostik yang signifikan. Kelompok overweight obesitas dan underweight -normal memiliki 3-years overall survival yang sama.

Background: Breast cancer is a cancer that take place second position the most frequent cancer in the world and it has 4 molecular subtype, which one of them is triple negative. Triple negative breast cancer (TNBC) has negative results of ER, PR, and HER-2 gene expression and it has poor prognosis. High prechemotherapy body mass index in triple negative breast cancer patients gives lower survival rate caused by disturbance of insulin-leptin-adiponectin axis. Objective: To determine the effect of prechemotherapy BMI towards overall survival of triple negative breast cancer patients. Method: This research use retrospective cohort study design with clinical registry of TNBS patients in RSUP Dr. Sardjito that has been diagnosed since 2014 until 2018 as much as 97 samples. Statistical analysis was carried out between prechemotherapy BMI and other variables using chi-square test and survival analysis which are Kaplan-Meier with log rank test and cox regression proportional hazard models test to determine the hazard ratio by SPSS software. Result: Based on chi-square test and cox regression test, there is no statistically significant relationship between prechemotherapy BMI and patients survival (p value = 0,632) and it is not a prognostic factor of TNBC (p value = 0,949). Hazard ratio between overweight obesity group (BMI >= 23 kg/m2) and underweight normal group (< 23 kg/m2) is nearly similar (HR = 1,022). From subanalysis of overweight obesity group, it was known that both subcategory also have closely similar hazard ratio (HR = 1,062). Kaplan-Meier graphic shows that 3-years overall survival rate of TNBC patients in both group is equal in 51,4%. Conclusion: Prechemotherapy BMI has not statistically effect towards TNBC patients survival and it is not significant prognostic factor. Both overweight obesity and underweight normal group have equal 3-years overall survival.

Kata Kunci : kanker payudara, triple negative breast cancer, BMI pre-kemoterapi, prognostik, kesintasan, overall survival