Analisis Spasial dan Temporal Insidensi Kanker Prostat di Yogyakarta pada tahun 2009-2019

Rahayu Reni Utami, dr. Nungki Anggorowati, Ph.D., Sp.PA, Sub.Sp.HLE (K); dr. M. Lutfan Lazuardi, M.Kes., Ph.D

2025 | Tesis-Spesialis | S2 Ilmu Patologi Anatomi

Latar Belakang: Kanker prostat merupakan jenis kanker yang paling sering terjadi pada pria dan menjadi salah satu penyebab utama kematian akibat kanker di banyak negara, termasuk Indonesia. Meningkatnya jumlah populasi lanjut usia serta meluasnya distribusi pemeriksaan Prostate-Specific Antigen (PSA) turut berkontribusi terhadap peningkatan insidensi kanker prostat di Indonesia, khususnya di wilayah Daerah Istimewa Yogyakarta (DIY). Peningkatan ini dipengaruhi oleh berbagai faktor, antara lain ketersediaan fasilitas pelayanan kesehatan, perkembangan sosial-ekonomi, serta faktor demografis dan sosial lainnya.

 

Tujuan: Penelitian ini bertujuan untuk menganalisis distribusi spasial serta tren temporal insidensi kanker prostat di Provinsi Daerah Istimewa Yogyakarta selama periode 2009–2019. Hasil penelitian ini diharapkan dapat memberikan dasar ilmiah dalam perumusan kebijakan serta pengambilan keputusan yang lebih efektif dalam upaya pencegahan dan pengendalian kanker prostat.

 

Metode: Penelitian ini merupakan penelitian observasional deskriptif dan analitik dengan desain cross-sectional dan metode analisis temporal-spasial. Sumber data berasal dari Sistem Registrasi Kanker Berbasis Populasi di Provinsi Yogyakarta periode 1 Januari 2009 sampai dengan 31 Desember 2019. Penelitian ini dilakukan setelah mendapat ijin etik dari Komisi Etik Penelitian Kedokteran dan Kesehatan FKKMK UGM dan ijin penelitian dari bagian penelitian RSUP Dr Sardjito. Variabel univariat dianalisis secara deskriptif. Analisis bivariat menggunakan Microsoft Excel dan Statistical Package for Social Sciences (SPSS) Statistics 29.0.2.0 for Windows. Analisis spasial dengan metode Moran's Global Index dan LISA (local indicator of spatial association) menggunakan R statistical software versi 4.2.2. Pemetaan sebaran kasus menggunakan ArcGIS dan Microsoft Power BI, sedangkan analisis temporal menggunakan Jointpoint Regression Program versi 4.9.1.0.

Hasil: Selama periode 2009–2019, tercatat sebanyak 447 kasus kanker prostat di Provinsi Daerah Istimewa Yogyakarta (DIY). Kasus terbanyak ditemukan pada kelompok usia >70 tahun (49%) dan paling banyak berasal dari Kabupaten Sleman (34,5%). Berdasarkan morfologi, jenis yang paling sering dijumpai adalah adenokarsinoma, NOS (76,3%). Sebagian besar kasus terdiagnosis pada stadium lokal (64,9%), dan mayoritas pasien mendapatkan terapi awal berupa pembedahan (49,2%). Hasil analisis bivariat menunjukkan bahwa tidak terdapat hubungan yang signifikan secara statistik antara usia dengan stadium penyakit (p=0,137), jenis terapi awal (p=0,904), lokasi geografis (kabupaten/kota) (p=0,584), maupun derajat histopatologis (p=0,673). Analisis spasial global terhadap distribusi kumulatif kasus menunjukkan nilai Indeks Moran’s I sebesar 0,0047, yang mengindikasikan adanya autokorelasi spasial positif yang signifikan antar kabupaten/kota. Analisis LISA lebih lanjut menunjukkan adanya autokorelasi spasial lokal yang signifikan di Kabupaten Sleman dan Bantul. Selain itu, teridentifikasi tujuh kecamatan yang termasuk dalam klaster tinggi-tinggi (high-high) dan tiga kecamatan dalam klaster rendah-tinggi (low-high), yang mencerminkan pola pengelompokan spasial yang bermakna dalam distribusi kanker prostat di wilayah tersebut.

Kesimpulan: Distribusi spasial insidensi kanker prostat di Provinsi DIY menunjukkan pola yang tidak merata (heterogen) di tingkat kabupaten/kota, dengan kasus tertinggi terjadi di Kabupaten Sleman dan Bantul. Ditemukan pola pengelompokan spasial (spatial clustering) di tingkat kecamatan tertentu, khususnya di wilayah dengan Indeks Pembangunan Manusia (IPM) tinggi. Selain itu, analisis temporal menunjukkan bahwa insidensi kanker prostat mengalami peningkatan yang signifikan selama periode 2009–2019. Temuan ini menegaskan pentingnya penguatan sistem surveilans kanker dan pengembangan kebijakan berbasis spasial dan temporal untuk pengendalian kanker prostat di wilayah Yogyakarta.

 

Background: Prostate cancer is the most common cancer among men and one of the leading causes of cancer-related deaths in many countries, including Indonesia. The increasing population of elderly individuals and the wider distribution of Prostate-Specific Antigen (PSA) screening contribute to the rising incidence of prostate cancer in Indonesia, particularly in the Yogyakarta region. This condition is influenced by various factors such as access to healthcare services, economic development, and social determinants.

Objective: This study aims to analyze the spatial distribution and temporal trends of prostate cancer incidence in the Special Region of Yogyakarta (DIY) from 2009 to 2019. The findings are expected to support evidence-based policy and decision-making in prostate cancer control strategies.

Methods: This was an observational, descriptive-analytic study with a cross-sectional design and spatial-temporal analytical approach. Data on prostate cancer incidence were obtained from the Population-Based Cancer Registry of Yogyakarta Province covering the period from January 1, 2009, to December 31, 2019. The study was conducted after obtaining ethical approval from the Medical and Health Research Ethics Committee of FKKMK UGM and research permission from the Research Division of Dr. Sardjito General Hospital. Univariate variables were analyzed descriptively. Bivariate analysis was conducted using Microsoft Excel and the Statistical Package for the Social Sciences (SPSS) Statistics version 29.0.2.0 for Windows. Spatial analysis was performed using Global Moran’s I Index and Local Indicators of Spatial Association (LISA) with R statistical software version 4.2.2. Mapping of case distribution was conducted using ArcGIS and Microsoft Power BI, while temporal trend analysis was performed using the Joinpoint Regression Program version 4.9.1.0.

Result: Between 2009 and 2019, a total of 447 prostate cancer cases were recorded in the Special Region of Yogyakarta (DIY). The highest incidence was observed in the >70 years age group (49%), with Sleman Regency reporting the largest proportion of cases (34.5%). The most prevalent morphological type was adenocarcinoma, NOS (76.3%). Most cases were diagnosed at the localized stage (64.9%), and surgical intervention was the most common initial treatment modality (49.2%). Bivariate analysis revealed no statistically significant associations between age and disease stage (p=0.137), initial treatment (p=0.904), district/municipality (p=0.584), or histopathological grade (p=0.673). Global spatial analysis showed a statistically significant positive spatial autocorrelation with a Moran’s I index of 0.0047, indicating clustering across districts/municipalities. Local Indicators of Spatial Association (LISA) identified significant local spatial autocorrelation in Sleman and Bantul Regencies. Additionally, seven subdistricts were categorized as high-high clusters and three as low-high clusters, indicating meaningful spatial clustering patterns in the regional distribution of prostate cancer.

Conclusion: The spatial distribution of prostate cancer incidence in the Special Region of Yogyakarta is heterogeneous across districts, with the highest case numbers found in Sleman and Bantul districts. There is clear evidence of spatial clustering in certain subdistricts, particularly in areas with higher Human Development Index (HDI) scores. Temporal analysis further indicates a significant increase in prostate cancer incidence over the study period (2009–2019). These findings highlight the need to strengthen cancer surveillance systems and formulate spatially and temporally informed policies to improve prostate cancer control efforts in the region.

Kata Kunci : Prostate cancer, spatial-temporal analysis, cancer registry