KARAKTERISTIK DEMOGRAFI DAN KLINIKOPATOLOGI PASIEN KANKER KOLOREKTAL USIA DI BAWAH ATAU SAMA DENGAN 40 TAHUN

SANINDITA KUSUMASTUTI, dr. Susanna Hilda Hutajulu, Sp.PD,Ph.D

2014 | Skripsi | PENDIDIKAN DOKTER

Latar belakang: Kanker kolorektal memiliki angka insidensi yang cukup tinggi di Indonesia. Kejadian pada usia muda mulai meningkat di dua dekade terakhir. Diagnosis pada usia muda seringkali terlambat atau memiliki stadium klinis yang buruk sehingga memberikan prognosis yang buruk pula. Tujuan: Mengetahui gambaran demografi, klinikopatologi, dan terapi pada pasien kanker kolorektal usia muda(≤40 tahun). Metode: Penelitian ini merupakan penelitian deskriptif analitik retrospektif yang menggunakan data sekunder. Data penelitian berasal dari rekam medis pasien kanker kolorektal Poliklinik Tulip RSUD Dr. Sardjito pada tahun 2007-2011. Kajian data meliputi aspek demografi, aspek klinikopatologi, dan aspek terapi yang diterima pasien. Data tersebut dipindahkan ke dalam case report form(CRF). Dari CRF dilihat data yang memenuhi kriteria penelitian dan yang tidak. Data yang memenuhi kriteria penelitian dianalisis dengan menampilkan frekuensi dan distribusi beserta menilai kemaknaan berdasarkan standar p<0,05 pada beberapa variabel. Data hilang tidak ikut dianalisis. Hasil: Dari 330 sampel yang memenuhi kriteria, 17,6% (58/330) berusia <40 tahun. Sekitar 65,5% pasien adalah pria dengan rasio pria:wanita adalah 1,9:1. Sekitar 70% pasien merupakan rujukan dokter spesialis. 50% pasien terdeteksiawal dengan sigmoidoskopi/kolonoskopi. Gejala klinis yang paling sering ditemukan adalah pendarahan rektal. Sekitar 76,1% gambaran histopatologis adalah adenokarsinoma dan 53,5% kanker ditemukan di rektum. Sebanyak 74,2% pasien terdiagnosis pada stadium lanjut. Derajat diferensiasi baik ditemukan pada 56,25% pasien. Diabetes mellitus (17,7%) dan hipertensi (17,7%) merupakan komorbiditas terbanyak pasien. Status performa pasien adalah ECOG 1 (41,7%) atau 2 (58,33%). Sekitar 20,6% pasien memiliki metastasis (synchronous) saat terdiagnosis pertama kali. Rata-rata kadar CEA awal pasien adalah 91,42 ng/ml. Sebanyak 34,7% pasien menerima kombinasi operasi dan kemoterapi, dengan setting kemoterapi pertama berupa adjuvant (41,03%), locally advanced (41,03%), dan metastatic (17,96%). Dari 22,41% pasien yang dianalisis paska terapi, 69,23% mengalami progressive disease. Kesimpulan: Pasien kanker usia <40 tahun sebagian besar adalah pria dengan gejala klinis pendarahan rektal. Sebagian besar kanker adalah adenokarsinoma, berlokasi di rektum, dengan derajat diferensiasi baik, menerima kombinasi operasi dan kemoterapi, dan lebih dari setengahnya mengalami progressive disease.

Backgorund: Colorectal cancer has shown remarkable incidence in Indonesia, while incidence in young patients have been observed and increased in the last two decades. Diagnosis in young patients usually comes late or has a more advanced stadium thus giving a poor prognosis as well. Aim: To obtain demographical and clinicopathological characteristic as well as therapy given to colorectal cancer patients aged 40 years old and younger. Methods: A descriptive analytical retrospective research was conducted. Medical records of colorectal patients aged 40 years old and younger, that were registered in Tulip Cancer Center of Sardjito District Hospital Yogyakarta from 2007-2011, were collected and transformed to a case report form (CRF) before sampling was taken place. Data collected included demographical and clinicopathological characteristic, and therapy received by patients. All data that fulfilled research criteria were analyzed by using SPSS statistical program to shown frequency, distribution, and significance level of each. Missing data were not analyzed. Result: From 330 colorectal patients in Tulip Sardjito, 17,6% (58/330) were aged 40 years old and younger. 65,5% patients were male with ratio between male and female 1,9:1. About 70% patients were referred from a specialist and 50% were early diagnosed with colonoscopy. The most frequent symptoms were rectal bleeding. About 53,5% were located in rectum and 76,1% cancer were adenocarcinoma, 8,7% were mucinous adenocarcinoma, and 15,2% were signet-ring cell carcinoma. Late staging (III and IV) was found in 74,2% patients and 56,25% were well-differentiated tumor. Diabetes mellitus (17,65%) and hypertension (17,65%) were the most comorbids found in young patients. Performance status in young patients was ECOG’s 1 (41,67%) or 2 (58,33%). About 20,6% patients had synchronous tumor when firstly diagnosed. Mean initial CEA level in young patients was 91,42 ng/ml. 34,7% patients received both combination of surgery and chemotherapy, with adjuvant (41,03%), locally advanced (41,03%), and metastatic (17,94%) as the first line chemotherapy setting. From 22,41% patients that were analyzed, 69,23% were having progressive disease. Conclusion: Colorectal cancer patients aged 40 years old and younger were mostly male with rectal bleeding. Most of the cancer was well-differentiated adenocarcinoma in rectum with late staging. Patients were mostly treated with combination of surgery and chemotherapy and most of the patients which could be analyzed were having progressive disease.

Kata Kunci : Kanker kolorektal - gambaran demografi - klinikopatologi - terapi - usia muda