Pengaruh derajat diferensiasi histopatologik karsinoma epidermoid serviks uteri stadium lanjut terhadap respon kemoradiasi

BAHRI, Muh. Saiful, Dr. H.R. Suharyono, SpOG(K)

2004 | Tesis | PPDS I Obstetri dan Ginekologi

Tujuan: Menilai pengaruh derajat diferensiasi histopatologik karsinoma epidermoid serviks uteri stadium lanjut terhadap respon kemoradiasi dan kejadian residif pasca kemoradiasi. Rancangan penelitian: Penelitian ini adalah penelitian observasional dengan rancangan historical cohort. Bahan dan cara: Data penelitian diambil dari catatan medik, sebagai populasi penelitian adalah pasien karsinoma epidermoid serviks uteri stadium lanjut (IIB-IV) yang mendapatkan kemoradiasi bulanan dari Januari 1999 sampai Desember 2002. Sebanyak 92 pasien yang memenuhi kriteria inklusi dan eksklusi. Derajat diferensiasi baik dan sedang sebagai kelompok pertama, derajat diferensiasi buruk sebagai kelompok kedua, selanjutnya diamati hasil Pap’s smear satu bulan pasca kemoradiasi, prosentase pengecilan massa tumor, dan kejadian residif. Uji hipotesis tanpa pengendalian variabel luar dengan X2 dan uji t. Identifikasi variabel luar terhadap variabel tergantung dengan X2 dan uji t. Analisis multivariat menggunakan uji regresi logistik dan regresi linier. Untuk menentukan hubungan variabel bebas dan variabel luar dengan kejadian residif digunakan analisis Kaplan-Meier, dan tingkat kemaknaannya dengan uji log rank. Hasil: Hasil Pap’s smear positif sel ganas pada derajat diferensiasi baik 2,54 kali dibandingkan pada diferensiasi buruk (p=0,01). Terdapat perbedaan rerata prosentase pengecilan tumor sebesar 21,5% antara diferensiasi baik dengan diferenesiasi buruk (p=0.01). Tidak ada perbedaan bermakna dalam hal respon komplit pasca kemoradiasi pada diferensiasi baik dan buruk (p=0,06). Derajat diferensiasi histopatologik tidak berpengaruh terhadap kejadian residif pasca kemoradiasi (p log rank= 0,21). Kesimpulan: Tidak ada perbedaan respon komplit pasca kemoradiasi antara karsinoma epidermoid serviks uteri derajat diferensiasi baik dan derajat diferensiasi buruk, meskipun terdapat perbedaan bermakna pada hasil Pap’s smear dan prosentase pengecilan ukuran massa tumor pasca kemoradiasi. Tidak ada perbedaan bermakna kejadian residif pasca kemoradiasi antara karsinoma epidermoid serviks uteri derajat diferensiasi baik dan derajat diferensiasi buruk.

Objectives: Determining the effect of histopathologic grading on epidermoid cervical cancer later stage to chemoradiation response and residive incidence after chemoradiation. Study design: Historical cohort Material and methods: Data was taken fom medical record of Dr.Sardjito General Hospital from Januari 1999 until December 2002. The population of this study were epidermoid cervical cancer patients at later stage (IIB-IV) whose given monthly chemoradiation. There were 92 patients those fulfilled inclusion and exclusion criteria. First group with good and moderate grading differentiation and second group with poor differentiation. Follow up of these patient were using Pap’s smear test one month after chemoradiation, percentage of smaller tumor mass and residive inidence of cervical cancer. Hypothesis without using confounding factors was test by using Chi square and T test. These tests were also used for identification of confounding factors and dependent variables. Logistic regression and linier regression tests used for multivariat analysis. In the other hand, Kaplan - Meier analysis was used for determining the relationship between independent and confounding variables and log rank test were used for these significancies. Results: Positive malignant cells Pap’s smear test on good differentiation is 2,54 times higher than poor differentiation type (p=0,01). There were differences on mean percentage of smaller size tumor that is 21,5% between good and poor differentiation (p=0,01). There are no significant differences on complete respond after chemoradiation between good and poor differentiation (p=0,06). Histopathologic grading was not influenced by residive incidence after chemoradiation (log rank p= 0,21). Conclusions: There are no differences in complete respond after chemoradiation between good and poor differentiation of epidermoid cervical cancer. Thus, there are significant differences on Pap’s smear test and pecentage of smaller size of tumor mass after chemoradiation. However, residive incidence after chemoradiation between epidermoid cervical cancer with good and poor differentiation are still statistically unsignificant.

Kata Kunci : Karsinoma Serviks Uteri,Terapi,Kemoradiasi, Histopathologic grading- epidermoid cervical cancer- chemoradiationresponse- residive