Hubungan faktor-faktor Prognosis dan ketahanan hidup penderita Tumor Wilms di RS Dr. Sardjito tahun 2002-2006

HARTONO, Salwan, Dr. Rochadi, SpB.-SpBA(K)

2007 | Tesis | PPDS I Ilmu Bedah

Latar belakang: Tumor Wilms merupakan tumor ginjal yang sering dijumpai pada anak di bawah 10 tahun dan merupakan 10% keganasan pada anak. Ada banyak faktor-faktor prognosis yang mempengaruhi angka ketahanan hidup penderita tumor Wilms yang antara lain meliputi: umur saat terdiagnosis, jenis kelamin, status gizi, letak lesi kanan/kiri/bilateral, albumin, kemoterapi praoperasi, jenis operasi, lama operasi, kemoterapi post operasi, radioterapi, jenis histopatologis, limfonodi regional dan stadium penyakit Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan faktor-faktor prognosis dan ketahanan hidup penderita tumor wilms yang berobat di RS Dr Sardjito Yogyakarta. Bahan dan cara: Data dikumpulkan dari tahun 2002-2006 yang memenuhi kriteria inklusi dan ekslusi. Penderita tumor Wilms yang didapatkan dicatat variabel-variabel yang menjadi faktor-faktor prognosis meliputi: umur saat terdiagnosis, jenis kelamin, status gizi, letak lesi kanan/kiri/bilateral,albumin, kemoterapi praoperasi, jenis operasi, lama operasi, kemoterapi post operasi, radioterapi, jenis histopatologis, limfonodi regional dan stadium penyakit. Dilakukan analisis kesintasan/ survival rate dengan metode Kaplan-Meier pada faktor-faktor prognosis. Kemudian dari variabel yang signifikan dilakukan uji analisis multivariat Cox Regression untuk melihat variabel yang paling berpengaruh. Hasil: Didapatkan 33 kasus, usia termuda 8 bulan tertua 8.2 tahun dengan usia rata-rata 35 bulan/ usia 2,9 tahun, laki-laki 54,5% perempuan 45,5%. Stadium terbanyak adalah stadium III (70%), Jenis Histopatologis terbanyak jenis Favorable Histology (FH) 79%. Pada follow up kematian terjadi 27%. Berdasar uji statistik ada 5 faktor prognosis yang signifikan pada ketahanan hidup penderita tumor Wilms yaitu: Status gizi p = 0,018 log rank = 5,56, Jenis histopatologis p = 0,021 log rank = 5,32, limfonodi regional p = 0,016 log rank = 5,80, kemoterapi praoperasi p = 0,006 log rank = 7,53, jenis operasi p = 0,016 log rank = 5,80.Dari kelima variabel tersebut yang paling berpengaruh adalah jenis histopatologis p = 0,004 Kesimpulan: Faktor-faktor prognosis yang signifikan (p<0,05) terhadap angka ketahanan hidup meliputi: status gizi, jenis histopatologis, limfonodi regional, kemoterapi praoperasi dan jenis operasi. Faktor prognosis yang paling berpengaruh adalah jenis histopatologis.

Background: Wilms tumor is a renal tumor frequently found in children under ten years old and is ten percent of malignancies in children. The prognostic factors affecting the survival rate of wilms tumor patient include: age at diagnosis, sex, nutritional state, site of lesion (right/left/bilateral), albumin, preoperative chemotherapy, type of surgery, duration of surgery, post operative chemotherapy, radiotherapy, histopatological type, regional lymphnode and state of disease. Target of research: To know the correlation between the prognostic factors of and survival rate of wilms tumor patients at Sardjito General Hospital. Materials and methods: The data were collected during 2002-2006 and met the inclusion and exclusion criteria. The variables affecting the prognostic factors included : age at diagnosis, sex, nutritional state, site of lesion (right/left/bilateral), albumin, preoperative chemotherapy, type of surgery, duration of surgery, post operative chemotherapy, radiotherapy, histopatological type, regional lymphnode and state of disease. Survival rate analysis using Kaplan-Meier methods was performed on the prognostic factors. Multivariate Cox regression analysis was conducted on the significant variables in order to identify the most influencial variable. Results: There were 33 cases with the youngest age of 8 months and the oldest was 8,2 years old, the average age was 35 months/ 2,9 years old, male 54,5% and female 45,5%. Stage III was the highest (70%), Favorable histology (FH) was the highests histopatologycal type (79%), positive regional lymphnode was 20%. There was 27% of death during follow up. The statistic test revealed 5 prognostic factors significantly affecting the survival rate of wilms tumor patients including nutritional state ( p = 0,018 log rank = 5,58 ) histopatological type ( p = 0,021 log rank = 5,32 ) regional limphnode ( p = 0,016 log rank = 5,80 ) preoperative chemotherapy ( p = 0,006 log rank = 7,53 ) and type of surgery ( p = 0,0016 log rank = 5,80 ). The histopatological type was the most influencial variable with p = 0,004. Conclusion: The significant prognostic factors (p<0,05) affecting the survival rate included nutritional state, histopatological type, regional limphnode, preoperative chemotherapy, and type of surgery. The histopatological type was the most influencial prognostic factors.

Kata Kunci : Tumor Wilms,Prognosis,Ketahanan Hidup, wilms tumor, prognostic factors, survival rate