Analisis ketahanan hidup Karsinoma Koloraktal di RSUP Dr. Sardjito Yogyakarta tahun 2002-2004
RADJAGUKGUK, Arnold Marantu Sanggam, dr. Hendro Wartatmo, SpB-KBD
2007 | Tesis | PPDS I Ilmu BedahLatar Belakang. Karsinoma kolorektal merupakan keganasan ketiga terbanyak di dunia dan penyebab kematian kedua terbanyak di Amerika Serikat. Di Indonesia, dari berbagai laporan terdapat kenaikan jumlah kasus hingga ke dalam 10 jenis kanker tersering, namun belum ada angka insidensi yang pasti. Kunci utama keberhasilan penanganan karsinoma yaitu penemuan dalam stadium dini, sehingga terapi bedah kuratif dapat terlaksana. Namun sayang sebagian besar penderita datang dalam stadium lanjut, sehingga angka ketahanan hidup rendah. Tujuan. Untuk menentukan angka ketahanan hidup pasien kanker kolorektal di RSUP Dr. Sardjito Yogyakarta, baik keseluruhan maupun menurut berbagai faktor prognostik klinis dan patologik. Metode. Dilakukan penelitian kohort retrospektif/historik yang bersumber pada rekam medik pasien karsinoma kolorektal di RSUP Dr Sardjito Yogyakarta dalam periode tahun 2002-2004. Data dikoleksi dari tiap pasien, mencakup identitas, tanggal diagnosis, laboratorium kadar albumin dan CEA darah pra-operatif, stadium penyakit, lokasi tumor primer, derajat histopatologik, serta terapinya. Lama ketahanan hidup dihitung sejak terdiagnosis hingga meninggal dunia atau follow-up terakhir (tersensor), diperoleh dari rekam medik dan kuesioner. Analisis statistik dijalankan secara univariat dengan metode estimasi Kaplan-Meier guna menentukan faktor prognostik mana saja yang signifikan dan regresi multivariat model Cox guna menentukan faktor yang paling independen. Hasil. Didapati 197 pasien karsinoma kolorektal sebagai sampel dengan usia median 52 tahun. Faktor-faktor prognostik dianalisis pada semua pasien baik yang menjalani operasi maupun tidak, juga baik yang mendapat terapi adjuvan maupun tidak. Angka ketahanan hidup (AKH) 1-tahun yaitu 35,52%, AKH 2-tahun 18,48%, AKH 3-tahun 13,16%, AKH 4-tahun 8,62%, AKH 5-tahun 6,73%. Ketahanan hidup keseluruhan rerata yaitu 15,6 bulan dan median 7,21 bulan. Pada analisis univariat, yang signifikan adalah para variabel stadium Dukes, kadar albumin darah, kadar CEA darah, resektabilitas tumor, kedaruratan operasi, dan perolehan terapi adjuvan (p < 0,05), sedangkan usia, jenis kelamin, lokasi tumor, dan derajat diferensiasi tidak. Dalam analisis multivariat, stadium Dukes merupakan faktor prognostik paling berpengaruh. Simpulan. Perbedaan ketahanan hidup pasien karsinoma kolorektal di RSUP Dr. Sardjito dipengaruhi oleh stadium Dukes, kadar albumin darah pra-operatif, kadar CEA darah pra-operatif, serta terapi bedah maupun adjuvan. Perlu dipikirkan perbaikan diagnosis dan terapi untuk memperbaiki angka ketahanan hidup.
Background. Colorectal carcinoma is the fourth commonest form of cancer occurring worldwide and the second-ranked cause of death in the United States. In Indonesia, new cases have been reported, suggesting the cancer to become 1 of 10 commonest cancer, with an undetermined incidence rate. The key to a successful treatment is identifying the disease at an early and curable stage. Unfortunately, most of the patients came at later stages, which led to a lower survival rate. Aims. To determine the overall and prognostic factor-specific survival rates of colorectal cancer patients at Dr. Sardjito General Hospital, Yogyakarta.. Methods. A retrospective cohort study was performed in 197 colorectal carcinoma patients admitted to Dr. Sardjito General Hospital, Yogyakarta, between January 2002 and December 2004. Identity, diagnosis, pre-operative serum albumin and CEA concentrations, stage of the disease, primary tumor site, histologic grade, and treatment details were registered. Survival time was counted from the time of diagnosis to the time of death or lost of follow-up. Kaplan-Meier’s estimation method of observed survival was used. Cox proportional hazards regression analysis was used to examine the most significant prognostic factor. Results. One hundred and ninety-seven patients were identified with a median age of 52 years and a mean age of 52 years. Prognostic factors were analyzed in all patients regardless of the treatment. In univariate analysis, Dukes’ stage, preoperative serum albumin concentration, serum CEA concentration, tumor resectability, type of operation, and adjuvant therapy were found to be statistically significant (p < 0.05), while age, sex, tumor site, and histologic grade were not. The 1-year observed overall survival rate was 35.52%, 2-year 18.48%, 3-year 13.16%, 4- year 8.62%, and 5-year survival rate was 6.73%. Mean overall survival time was 15.6 months with a median of 7.21 months. Multivariate analysis showed that Dukes’ stage was the most significant prognostic factor. Conclusions. The difference in colorectal carcinoma survival rates at Dr. Sardjito General Hospital was found to be influenced by Dukes’ stage, pre-operative serum albumin and CEA concentrations, and either surgical or adjuvant treatment. It is necessary to improve the diagnostic and therapeutic strategies, which in turn may improve the survival rate.
Kata Kunci : Kanker Kolorektal,Ketahanan Hidup,Prognostik,colorectal carcinoma, survival analysis, prognostic factor
