Hubungan antara Ekspresi Protein NM23-H1, Densitas Limfovaskuler Peritumoral dan Invasi Limfovaskuler dengan Stadium dan Diferensiasi Histopatologi Adenokarsinoma Kolorektal

Tejo Jayadi, dr. Harijadi, SpPA(K)

2012 | Tesis | S2 Ilmu Patologi Anatomi

Latar Belakang: Salah satu penyebab kekambuhan karsinoma kolorektal adalah metastasis locoregional atau metastasis jauh. NM23-H1 salah satu gena penghambat metastasis yang berperan dalam menurunkan potensi metastasis. Hasil penelitian-penelitian tentang peran NM23-H1 dan invasi limfovaskuler terhadap peningkatan derajat histopatologi dan stadium adenokarsinoma hasilnya masih kontroversial. Tujuan: Menetapkan hubungan ekspresi protein NM23-H1 dan invasi limfovaskuler dengan derajat histopatologi dan stadium karsinoma kolorektal. Metoda: Rancangan retrospektif observasional analitik secara potong lintang dengan menggunakan blok parafin dari 50 kasus pasien karsinoma kolorektal yang diagnosisnya ditegakkan secara histopatologis sebagai adenokarsinoma kolorektal stadium Duke B dan C di RSUP DR. Sardjito mulai tanggal 1 Januari 2007. Blok parafin dipotong 4 µm diwarnai dengan antibodi poliklonal anti NM23-H1 dan antibodi monoklonal anti D2-40. Antibodi monoklonal anti D2-40 adalah petanda endotel limfatik spesifik. Korelasi NM23-H1 dengan invasi limfovaskuler dianalisa dengan uji korelasi Spearman; asosiasi NM23-H1 dan invasi limfovaskuler dengan diferensiasi histopatologi dan stadium memakai uji Chi-square. Hasil: Didapatkan perbedaan bermakna antara ekspresi NM23-H1 dan invasi limfovaskuler dengan stadium adenokarsinoma kolorektal Duke B dan C (p: 0,006 dan 0,013; ); ekspresi NM23-H1 tidak menunjukkan perbedaan bermakna dengan diferensiasi histopatologi (p: 0,644); invasi limfovaskuler menunjukkan perbedaan bermakna terhadap diferensiasi histopatologi (p:0,018); densitas limfovaskuler peritumoral tidak menunjukkan perbedaan bermakna terhadap diferensiasi histopatologi dan stadium (p:0,556 dan p:0,768); dan tidak didapatkan korelasi bermakna antara NM23-H1 dengan densitas limfovaskuler peritumoral dan invasi limfovaskuler (p: 0,996 dan p: 0,176), dengan nilai rasio odds 1,071 dan 2,1. Kesimpulan: Ekspresi NM23-H1 dan invasi limfovaskuler berperan dalam perluasan dan metastasis adenokarsinoma kolorektal, sedangkan derajat diferensiasi sedang sampai buruk sel tumor berhubungan dengan invasi limfovaskuler.

One of the causes of Background: recurrence of colorectal carcinoma due to loco regional or distant metastasis. NM23-H1 is one of metastasis suppressor gene, and many studies showed that the correlation of NM23-H1 expression and lymphovascular invasion to the grading and staging of colorectal carcinoma still controversial. The aim Purpose: of this study is to determine the correlation of NM23-H1 expression and lymphovascular invasion in the grading and staging of colorectal carcinoma. A restrospective cross sectional study Methode: , using analytic and observational of 50 paraffin embedded tissue of patient with adenocarcinoma colorectal Duke B and C paraffin block, which diagnosed as adenocarcinoma colorectal Duke B and C by histopathological examination in Dr. Sardjito Central General Hospital since 1 January 2007. Those embeded tissues were cut 4µ and stained by polyclonal antibody against NM23-H1 and monoclonal antibodi against D2-40. Correlation NM23-H1 with lymphovascular invasion were analyzed using Spearman test. Chi Square test was performed to analyzed the association of NM23-H1 and lymphovascular invasion with grading and staging of the tumor. were Result: There significant differences in the aspect of NM23-H1 expression and lymphovascular invasion in the cases with adenocarcinoma colorectal stage B and C (p: 0,006 and 0,013); there was no significant difference between NM23-H1 expression with the grading of tumor (p: 0,644). There was significant difference between lymphovascular invasion and grading of the tumor (p: 0,018); there was no significant difference between peripheral lymphvessel density with grading dan staging of the tumor (p:0,556 and p:0,768); but there was no significant correlation NM23-H1 with peripheral lymphvessel density and lymphovascular invasion (p: 0,996 and p: 0,176), with odds ratio 1,071 and 2,1. the Conclusion: NM23-H1 expression and lymphovascular invasion may have a role in adenocarcinoma colorectal expansion and metastasis, while moderate and high grade have relationship with lymphovascular invasion.

Kata Kunci : NM23-H1, invasi limfovaskuler, stadium, diferensiasi histopatologi, adenokarsinoma kolorektal