HUBUNGAN PROGNOSTIC NUTRITIONAL INDEX (PNI) PRETREATMENT TERHADAP OVERALL SURVIVAL PASIEN KANKER OVARIUM TIPE EPITELIAL DI RSUP DR. SARDJITO

Aditya Iqbal Maulana, Dr. dr. Ardhanu Kusumanto, Sp.O.G, Subps. Onk.; dr. Brian Prima Artha, Sp.O.G, Subsp. Onk.

2025 | Tesis-Spesialis | S2 Ilmu Kebidanan dan Penyakit Kandungan

Pendahuluan: Kanker ovarium merupakan salah satu penyebab kematian utama pada wanita di seluruh dunia. Angka kejadian kanker ovarium secara global adalah 6,6 per 100.000 dengan angka kematian yang sangat tinggi yaitu 3,9; sedangkan pada wanita Asia angka kejadiannya lebih tinggi yaitu 9,2 per 100.000. Prognostic nutritional index (PNI) merupakan prediktor status gizi yang digunakan untuk mengevaluasi prognosis penyakit kanker, termasuk kanker ovarium. Penelitian PNI pre-treatment terkait prognosis kanker ovarium sudah mulai diteliti secara luas untuk menentukan strategi penatalaksanaan yang tepat.

Tujuan: Membuktikan PNI pretreatment tinggi dapat meningkatkan overall survival dan terdapat hubungan signifikan secara statistik PNI pretreatment terhadap faktor-faktor prognosis (usia, tipe histologis, diferensiasi jaringan, stadium, adekuasi intervensi surgical staging, paritas, dan Karnofsky Peformance Status (KPS)) pada kanker ovarium tipe epitel di RSUP Dr. Sardjito.

Metode: Penelitian ini bersifat observasional analitik dengan desain studi kohort bidirectional dengan data Rekam Medis dengan periode 13 Februari 2024 sampai 1 Juni 2024. Pengukuran PNI pre-treatment dilakukan pada saat pasien akan menjalani tindakan surgical staging dan diikutsertakan sebagai populasi penelitian jika mereka didiagnosis menderita kanker ovarium epitel di RSUP Dr. Sardjito dan memenuhi kriteria inklusi, kemudian pasien akan dilakukan follow up sejak operasi dilakukan hingga endpoints atau selama pemantauan 1 tahun untuk menilai overall survival.

Hasil: Dari 126 pasien kanker ovarium epitel di RSUP dr. Sardjito, subjek penelitian berusia 18–75 tahun. Rata-rata indeks PNI pada subjek adalah 46,18±8,93; dengan cut-off 44,07. Terdapat hubungan yang signifikan antara PNI dengan overall survival dengan nilai p=0,001. Terdapat hubungan yang signifikan antara PNI dengan KPS dengan nilai p=0,001. Terdapat hubungan yang tidak signifikan antara PNI dengan faktor prognosis yaitu: tipe histologis, diferensiasi jaringan, adekuasi intervensi surgical staging, dan paritas; didapatkan nilai p sebesar 0,561; 0,594; 0,094; dan 0,971; masing-masing.

Kesimpulan: PNI pretreatment tinggi dapat meningkatkan overall survival pasien kanker ovarium tipe epitelial di RSUP Dr. Sardjito. Terdapat hubungan signifikan secara statistik PNI pretreatment terhadap faktor prognosis KPS; tetapi tidak terdapat hubungan signifikan secara statistik PNI pretreatment terhadap faktor prognosis: tipe histologis, diferensiasi jaringan, adekuasi intervensi surgical staging, dan paritas; pasien kanker ovarium tipe epitelial di RSUP Dr. Sardjito. 

Introduction: Ovarian cancer is one of the leading causes of death in women worldwide. The global incidence of ovarian cancer is 6.6 per 100,000 with a very high mortality of 3.9; while in Asian women the incidence is higher, namely 9.2 per 100,000. Prognostic nutritional index (PNI) is a predictor of nutritional status used to evaluate cancer prognosis, including ovarian cancer. Pre-treatment PNI researches associated with ovarian cancer prognosis has begun to be widely conducted to determine the right management strategy.

Objective: To proof high pretreatment PNI can increase overall survival and there is significance relationship statistically between PNI and prognostic factors (histological type, tissue differentiation, stage, adequacy of surgical staging intervention, parity, age, and Karnofsky Performance Status (KPS)) in epithelial ovarian cancer at Dr. Sardjito Hospital.

Methods: This research is an observational analytic using a bidirectional cohort study design with data from Medical Records with a period from February, 13th 2024 to July, 1st 2024. Pretreatment PNI measurements were carried out when patients were going to undergo surgical staging treatment and were included as a study population if they were diagnosed with epithelial ovarian cancer at Dr. Sardjito General Hospital and met the inclusion criteria, then patients would be followed from the time the surgery was performed until met the endpoints or the completion of 1-year monitoring to assess overall survival.

Results: Of 126 epithelial ovarian cancer patients at RSUP dr. Sardjito, the subjects were consisted of 18 - 75 years old. The average PNI index in the subjects was 46,18±8,93; with cut-off 44,07. There was significant relationship between PNI and overall survival with a p value of 0.001. There was significant relationship between PNI and KPS with a p value of 0.001. There was insignificant relationship between PNI and prognostic factors such as histological type, tissue differentiation, adequacy of surgical staging intervention, and parity, with p values of 0,561; 0,594; 0,094; and 0,971, respectively.

Conclusion: High pretreatment PNI can increase overall survival in epithelial ovarian cancer at Dr. Sardjito Hospital. There was significant relationship between PNI and KPS, but there was insignificant relationship between PNI and prognostic factors such as histological type, tissue differentiation, adequacy of surgical staging intervention, and parity; in epithelial ovarian cancer at Dr. Sardjito Hospital. 

Kata Kunci : kanker ovarium tipe epitel, PNI, overall survival, prognosis