Korelasi Serum Alfa-Fetoprotein (AFP) dengan Tingkat Keparahan Karsinoma Hepatoseluler Berdasarkan Sistem Staging Barcelona Clinic Liver Cancer (BCLC) di RSUP Dr. Sardjito Yogyakarta

AMELIA SOPHIA RAMADHINI, Dr.dr. Neneng Ratnasari, Sp.PD-KGEH, FINASIM; dr. Noor Asyiqah Sofia, M.Sc, Sp.PD-KPsi; dr. Fahmi Indrarti, Sp.PD, K-GEH

2022 | Skripsi | S1 KEDOKTERAN

Latar Belakang: Karsinoma Hepatoseluler (KHS) memiliki prognosis yang buruk dan mayoritas pasien didiagnosis saat telah mencapai stadium lanjut. Untuk menilai derajat keparahan KHS, EASL merekomendasikan Barcelona Clinic Liver Cancer (BCLC). BCLC dipandang lengkap karena mempertimbangkan derajat fungsi hati, status performa, prognosis, dan rekomendasi terapi. Alfa-fetoprotein (AFP) merupakan salah satu biomarker yang digunakan sebagai prediktor keparahan KHS, namun lebih umum digunakan sebagai alat diagnostik KHS. Penelitian yang menguji peran AFP sebagai prediktor prognosis KHS menunjukkan peningkatan nilai AFP diasosiasikan dengan prognosis yang lebih buruk. Namun demikian, kadar AFP pada staging BCLC belum dipertimbangkan. Tujuan: Mengetahui korelasi antara kadar AFP dengan derajat keparahan KHS yang dinilai dengan sistem staging BCLC. Metode Penelitian: Penelitian dilakukan secara observasional retrospektif. Karakteristik dasar pasien, nilai AFP, stage BCLC, dan karakteristik tumor berdasarkan multislice spiral computed tomography (MSCT) 3 fase diperoleh dari rekam medis pasien KHS RSUP Dr. Sardjito tahun 2016-2020. Hubungan kadar AFP dengan staging BCLC dianalisis menggunakan Spearman’s rank correlation. Hasil: Dari 120 pasien, sebagian besar telah berada pada stadium lanjut dengan 58 pasien (48.3%) berada pada stage BCLC C, diikuti BCLC B (45 pasien, 37.5%), BCLC D (14 pasien, 11.7%), dan BCLC A (3 pasien, 2.5%). Terdapat korelasi positif dan signifikan antara kadar AFP dengan BCLC (r=0.23, p=0.01). Kesimpulan: Kadar AFP berkorelasi positif lemah bermakna dengan keparahan KHS berdasarkan kriteria staging BCLC.

Background: Hepatocellular Carcinoma (HCC) has a poor prognosis with the majority of patients diagnosed at later stages. To evaluate the severity of HCC, EASL recommended Barcelona Clinic Liver Cancer (BCLC) staging. BCLC staging system is a comprehensive way in evaluating hepatic functions, performance status, prognosis, and recommendation for therapy. Alpha-fetoprotein (AFP) is a biomarker used as a predictor for HCC severity. However it is commonly used as a diagnostic tool for HCC. Studies that evaluates the role of AFP as a prognostic predictor of HCC showed that an elevated level of AFP is associated with poor prognosis. However, AFP level in BCLC staging has not been determined. Objective : To analyze the correlation between AFP level and the severity of HCC based on BCLC staging. Methods : This is an observational retrospective study. The baseline characteristics of patient such as AFP level, BCLC stages, and tumor characteristics according to three phase multislice spiral computed tomoghraphy (MSCT) were acquired from the medical records of HCC patients in RSUP Dr. Sardjito from 2016 to 2020. The correlation between AFP level and BCLC staging is analyzed using spearman’s rank correlation. Result : From 120 Patients, most of them are in the later stages of the disease with 58 Patients (48.3%) are at BCLC stage C, followed by BCLC stage B (45 patients, 37.5%), BCLC stage D (14 patients, 11.7%), and BCLC stage A (3 patients, 2.5%). There is a positive and significant correlation between AFP levels and BCLC (r=0.23, p=0.01). Conclusion : There is a weak positive but significant correlation between AFP levels and HCC severity according to the BCLC staging criteria.

Kata Kunci : Alfa-fetoprotein, karsinoma hepatoseluler, Barcelona Clinic Liver cancer, korelasi, staging/ Alpha-Fetoprotein, Hepatocellular Carcinoma, Barcelona Clinic Liver Cancer, Correlation, Staging