HUBUNGAN ANTARA STATUS KLINIKOPATOLOGIS PADA PENDERITA KANKER PAYUDARA LANJUT LOKAL YANG MENJALANI MASTEKTOMI RADIKAL MODIFIKASI PASCAKEMOTERAPI NEOAJUVAN DENGAN KETAHANAN HIDUP LIMA TAHUN
Jati Rimba Agung, dr. Kunta Setiaji, Sp.B(K)Onk
2014 | Tesis | S2 Ilmu BedahLatarBelakang: Kanker payudara merupakan kanker terbanyak pada wanita di dunia. Ketahanan hidup lima tahun penderita kanker payudara banyak dipengaruhi oleh status klinikopatologis penderita. Ketahanan hidup lima tahun pada penderita kanker payudara lanjut lokal lebih rendah dibandingkan kanker payudara operabel. TujuanPenelitian: Untuk mengetahui hubungan antara status klinikopatologis pada penderita kanker payudara lanjut lokal yang menjalani mastektomi radikal modifikasi pascakemoterapi neoajuvan dengan ketahanan hidup lima tahun. SubyekPenelitian: Penderita kanker payudara lanjut lokal yang menjalani mastektomi radikal modifikasi pascakemoterapi neoajuvan di RSUP Dr Sardjito pada bulan Januari sampai Desember 2008 serta memenuhi kriteria inklusi. MetodePenelitian: Penelitian ini adalah penelitian diskriptif analitik dengan rancangan cross sectional. Uji statistik yang digunakan adalah chi-square dengan nilai p<0,05 dianggap bermakna. Variabel yang bermakna kemudian dianalisis dengan uji regresi logistik dan analisis multivariat (uji regresi logistik multipel). Hasil Penelitian: Jumlah populasi penelitian ini ada 62 penderita, semua berjenis kelamin wanita (100%). Penderita yang bertahan hidup sebanyak 53,22% (33/62). Berdasarkan kelompok umur : <40 tahun yang bertahan hidup 62,5% (5/8) ; ≥40 tahun 51,85% (28/54). Berdasarkan stadium : stadium IIIA yang bertahan hidup 69,05% (29/42) , stadium IIIB 20% (4/20) , stadium IIIC pada penelitian ini tidak ada. Berdasarkan grading : grade I yang bertahan hidup 66,67% (2/3) , grade II 50% (21/42) , grade III 58,82% (10/17). Berdasarkan ukuran tumor : ukuran ≤2 cm yang bertahan hidup 77,78% (7/9) , ukuran >2 - 5 cm 53,33% (16/30) , ukuran >5 cm 43,48% (10/23). Berdasarkan keterlibatan limfonodi aksila : lymph node (+) 0 yang bertahan hidup 68,42% (13/19) , lymph node (+) 1 - 3 buah 62,96% (17/27) , lymph node (+) ≥ 4 buah 18,75% (3/16). Berdasarkan subtipe imunohistokimia : luminal A yang bertahan hidup 70% (21/30) , luminal B 100% (1/1) , triple negative 39,13% (9/23) , overekspresi HER-2/neu 25% (2/8). Semua penderita mendapat kemoterapi neoajuvan dengan preparat AC (100%). Hasil pemeriksaan histopatologi semuanya karsinoma duktal infiltrative (100%). Pada penelitian ini status klinikopatologis yang bermakna adalah stadium (p-value=0,000), status nodal (p-value=0,005) dan imunohistokimia (p-value=0,034). Dengan uji regresi logistik multipel didapatkan faktor klinikopatologis yang paling berpengaruh terhadap ketahanan hidup lima tahun adalah stadium dan status nodal. Kesimpulan: Ada hubungan yang bermakna antara status klinikopatologis yaitu stadium, status nodal dan subtipe imunohistokimia pada penderita kanker payudara lanjut lokal yang menjalani mastektomi radikal modifikasi pascakemoterapi neoajuvan dengan ketahanan hidup lima tahun. Status klinikopatologis yang paling berpengaruh terhadap ketahanan hidup lima tahun adalah stadium dan status nodal
Background: Breast cancer is the most cancer among women in the world. The five years survival rate of breast cancer was highly associated with the clinicopathologic status. The five years survival rate of the locally advanced breast cancer was less than operable breast cancer. Purpose of Study: To find out the correlation between clinicopathologic status in the locally advanced breast cancer patients who underwent modified radical mastectomy after getting neoadjuvant chemotherapy with five years survival rate. Subjects of Study: Our subjects were locally advanced breast cancer patients who underwent modified radical mastectomy after getting neoadjuvant chemotherapy in dr Sardjito General Hospital Yogyakarta during January-December 2008, and met with the inclusive criterias. Methods: This study was a descriptive analytical study with cross sectional design. We used chi-square test in statistical analysis, with p-value<0.05 considered as significant. The significant variable was analyzed using logistic regression and multivariate analysis (multiple logistic regression). Results: There were 62 peoples in population, all of them were women (100%). Among of them, 53.22% (33/62) were still alive. Based of age : group of < 40 y.o. 62.5% (5/8) still alive , group of ≥40 y.o. were 51.58% (28/54). Based of stadium : stadium IIIA were 69.05% (29/42) still alive , stadium IIIB were 20% (4/20) , there is no subject in stadium IIIC (0%). Based of grade : grade I were 66.67% (2/3) still alive , grade II were 50% (21/42) , grade III were 58.82% (10/17). Based of size of tumour : diameter ≤2 cm were 77.78% (7/9) still alive , diameter >2-5 cm were 53.33% (16/30) , diameter >5 cm were 43.48% (10/23). Based of axillary node involved : lymph node (+) 0 were 68.42% (13/19) still alive , lymph node (+) 1-3 were 62.96% (17/27) , lymph node (+) ≥4 were 18.75% (3/16). Based of imunohistochemical subtyping : luminal A were 70% (21/30) still alive, luminal B was only 1 people (100%) still alive , triple negative were 39.13% (9/23) , Her2-neu Overexpresion were 25% (2/8). All of subject were using AC regiment for neoadjuvant chemotherapy (100%). All of histopathologic results were Ductal Infiltrative Carcinoma (100%). Stadium (p-value=0.000), nodal status (pvalue= 0.005) and imunohistochemical subtyping (p-value=0.034) were significant clinicopathologic status. The most significant of the clinicopathologic factor that correlated with the five years survival rate were stadium and nodal status, using multiple logistic regression. Conclussion: Clinicopathologic status that correlated with five years survival rate in breast cancer patients who underwent modified radical mastectomy after getting neoadjuvant chemotherapy significantly were stadium, nodal status and imunohistochemical subtyping. The most significant among clinicopathologic status were stadium and nodal status.
Kata Kunci : status klinikopatologis, kanker payudara lanjut lokal, mastektomi radikal modifikasi, kemoterapi neoajuvan, ketahanan hidup lima tahun
