Hubungan Ki-67, Lymphovascular Invasion (LVI), dan Status Limfonodi terhadap Disease-Free Survival pada Pasien Kanker Payudara di RSUP Dr Sardjito

Ade Ringgo Afarel, dr. Herjuna Hardiyanto, Sp.B, Subsp. Onk (K), dr. Sumadi Lukman Anwar, M.Sc., Ph.D, Sp.B, Subsp. Onk(K)

2023 | Tesis-Spesialis | S2 Ilmu Bedah

Latar belakang: Kanker payudara masih menjadi salah satu kanker dengan tingkat kematian tinggi di Indonesia. Tingkat prognosis kanker payudara bergantung pada stadium dan penyebaran penyakit. Disease-free survival yaitu jangka waktu pasien bebas tanda dan gejala dari menjalankan terapi hingga penyakit mulai berprogresi memburuk. Penilaian prognosis pasien kanker payudara dipengaruhi oleh berbagai faktor dan memengaruhi keputusan regimen terapi pada pasien. Adanya invasi limfovaskular dan keterlibatan limfonodi teridentifikasi sebagai indikator prognosis untuk DFS dan OS kanker payudara invasif.

Tujuan: Mengetahui hubungan Ki-67, lymphovascular invasion, dan status nodal terhadap disease-free survival pasien kanker payudara di RSUP Dr. Sardjito.

Metode: Penelitian ini merupakan penelitian kohort retrospektif dengan subjek pasien kanker payudara yang berobat di Departemen Bedah Onkologi RSUP Dr. Sardjito dari Januari 2018- Desember 2022. Data diperoleh dari rekam medik. Pasien dengan data rekam medik tidak lengkap dan terdapat keganasan lain dieksklusi dari penelitian ini. Data kemudian dianalisis menggunakan SPSS versi 26.0

Hasil: Pada penelitian ini, dilakukan analisis pada 197 subjek penelitian dan 166 (84,3%) di antaranya terkonfirmasi kanker payudara berdasarkan hasil histopatologi. Terdapat hubungan signifikan antara ketaatan terapi (p=0,018), rekurensi (p=0,000), dan luaran (p=0,000) terhadap DFS. Ketaatan terapi (p=0,026) dan rekurensi (p=0,000) merupakan prediktor independen terhadap DFS. Analisis Kaplan-Meier menunjukkan bahwa LVI positif berhubungan signifikan dengan DFS yang lebih singkat (p=0,011)

Kesimpulan: Pasien kanker payudara dengan LVI positif menunjukkan waktu disease-free survival lebih pendek secara signifikan pada pasien kanker payudara. Rekurensi dan ketaatan terapi merupakan prediktor independen terhadap disease-free survival pada pasien kanker payudara.

Background: Breast cancer is one of the malignancies with high mortality rate in Indonesia. The prognosis for breast cancer depends on the stage and spread of the disease. Disease-free survival is the length of time after primary treatment for a cancer ends that the patient survives without any signs or symptoms of that cancer. Assessment of the prognosis of breast cancer patients is influenced by various factors and affect the decision for therapeutic regimen. The presence of lymphovascular invasion and lymph node involvement were identified as predictors for DFS and OS of invasive breast cancer.

Objective: To determine the relationship between Ki-67, lymphovascular invasion, and nodal status on disease-free survival of breast cancer patients at RSUP Dr. Sardjito.

Methods: This study was a retrospective cohort study in breast cancer patients who were treated at the Department of Surgical Oncology, Dr. Sardjito from January 2018- December 2022. Data was obtained from medical records. Patients with incomplete medical record and presence of other malignancies were excluded from this study. The data were then analyzed using SPSS version 26.0.

Results: In this study, there were 197 subjects and 166 (84.3%) of them were confirmed for breast cancer based on histopathological results. There is a significant relationship between adherence to therapy (p=0.018), recurrence (p=0.000), and outcome (p=0.000) to DFS. Treatment adherence (p=0.026) and recurrence (p=0.000) were independent predictors of DFS. Kaplan-Meier analysis showed that positive LVI is significantly associated with shorter DFS (p=0.011)

Conclusion: Breast cancer patients with positive LVI showed a significantly shorter disease-free survival time. Recurrence and adherence to therapy are independent predictors of disease-free survival in breast cancer patients

Kata Kunci : kanker payudara, disease-free survival, invasi limfovaskular, status nodal, ketaatan terapi, Ki-67