HUBUNGAN ANTARA STATUS KLINIKOPATOLOGI PADA PENDERITA KANKER PAYUDARA OPERABEL YANG MENJALANI OPERASI MASTEKTOMI RADIKAL MODIFIKASI DENGAN REKURENSI LOKOREGIONAL DI RSUP Dr. SARDJITO 2010

Nanang Widodo, dr. Kunta Setiaji, Sp.B (K) Onk

2014 | Tesis | S2 Ilmu Bedah

Latar Belakang : Kanker payudara menduduki peringkat pertama kanker di Indonesia. Mortalitas 19.750 dari sekitar 48.998 kasus. Kejadian rekurensi lokoregional terjadi pada tahun ke-2 atau ke-3. Tingginya kejadian rekurensi hingga 20,2%. Faktor yang memprediksi kejadian rekurensi umur penderita, ukuran tumor, Stadium tumor, Status limfonodi, Grading histopatologi, reseptor estrogen, reseptor progesteron, HER-2/neu dan subtipe imunohistokimia. Tujuan : Mendapatkan data terbaru kejadian rekurensi lokoregional pada penderita kanker payudara operabel dan mengetahui hubungan faktor klinikopatologi dengan kejadian rekurensi. Metode : Penelitian deskriptif analitik non eksperimental dengan rancangan retrospektif cohort pada 109 penderita kanker payudara operabel terhitung 1 Januari sampai 31 Desember 2010. Hasil penelitian dianalisis dengan Chi-Square dinilai yang signifikan dan dilakukan analisis multivariat dengan regresi logistik ganda untuk mengetahui faktor klinikopatologi yang paling dominan mempengaruhi kejadian rekurensi. Hasil : Kejadian rekurensi 18 dari 109 (16,51%). Faktor klinikopatologi yang signifikan mempengaruhi kejadian rekurensi adalah stadium tumor (p=0,006) OR 2,619 stadium IIIb dibandingkan stadium IIIa, grading histopatologi (p=0,039) OR 3,611 grade 3 dibanding grade 1 dan 4,062 grade 3 dibanding grade 2. HER-2/neu (p=0,037) OR 0,22 HER-2/neu positif dibanding yang negatif. Subtipe imunohistokimia (p=0,009) dengan OR 4,235 triple negative dibanding luminal A, OR 10,889 triple negative dibanding luminal B. Faktor paling dominan mempengaruhi kejadian rekurensi subtipe imunohistokimia (p=0,041) khususnya triple negative (p=0,047). Kesimpulan : Kejadian rekurensi 16,51%. Faktor yang mempengaruhi rekurensi stadium tumor, grading histopatologi, HER-2/neu dan subtipe imunohistokimia. Faktor yang paling dominan mempengaruhi kejadian rekurensi adalah subtipe imunohistokimia (triple negative).

Background : Breast cancer emerges as the highest incident cancer in Indonesia. Mortality of breast cancer reaches up to 19,750 of 48,998 cases (40.31%) in 2012. Locoregional recurrence usually develops 2-3 year after operation. Recurrence incidence rate in Indonesia is very high affecting 20.2% of total breast cancer cases. Several factors are identified to play a role in the breast cancer recurrence, including age, tumor size, tumor stadium, lymph nodes status, histopathology grade, estrogen receptor, progesterone receptor, and HER-2/neu immunohistochemical subtypes. Objective: To identify the most recent variables involved in the locoregional recurrence of operable breast cancer after modified radical mastectomy and adjuvant chemotherapy. Subject: Patients with operable breast cancer who underwent a modified radical mastectomy in Dr Sardjito hospital on January until December 2010 and met the inclusion criteria. Methods: We used descriptive non-experimental study with a retrospective cohort design involving 109 patients with operable breast cancer treated in Dr Sardjito hospital Januari-December 2010. Chi-square test and multivariate analysis with logistic regression were used to determine clinicopathologic factors involved in the high recurrence rate of breast cancer in Indonesia. Results: In our cohort, we identified locoregional recurrence in 18 of 109 breast cancer patients (16.51%). Clinicopathologic factors that significantly affect the incidence of recurrence were tumor stadium (Breast cancer stadium IIIB vs IIIA, p=0,006, OR 2,62). Tumor grade (grade 1 vs grade 3, p=0,039, OR 3,6), and Her2/neu (Positive vs negative, p=0,037, OR 0,22). In addition, subtype of breast cancer using immunohistochemitry showed that triple negative increased recurrence rate in comparison to luminal B (p=0,009, OR 4,2). Multivariate analysis using logistic regression showed that immunohistochemical subtype was the most dominant factor influencing recurrence rate (p=0,041), particulary in triple negative breast cancer (p=0,047). Conclusion: In our study, clinicopathological variables affecting locoregional recurrence of breast cancer were tumor stadium, histopathological grading, and HER-2/neu immunohistochemical subtypes. The most dominant factor affecting the incidence of recurrence was subtype of immunohistochemistry (triple negative

Kata Kunci : Penderita kanker payudara operabel, Mastektomi radikal modifikasi, Rekurensi, Subtipe imunohistokimia, Klinikopatologi