Transfusi Pada Pasien Kanker: Manfaat Dan Resiko

Transfusi darah pada pasien kanker biasanya diperlukan pada terapi radiasi, terapi operasi, kemoterapi, terapi suportif/ paliatif. Walaupun saat ini transfusi darah diyakini lebih aman dibandingkan dengan masa-masa sebelumnya, namun transfusi juga masih memiliki banyak risiko, antara lain peristiwa yang menyimpang (adverse events), baik berupa peristiwa imunologik maupun non imunologik yang berpotensi fatal. Peristiwa imunologik antara lain berupa reaksi transfusi, alloimunisasi, transfussion-related acute lung injury (TRALI), dan transfussion-associated immunomodulation (TRIM), sedangkan peristiwa non-imunologik antara lain meliputi kelebihan beban volume, hemodilusi, dan infeksi. Selain itu, human error sering dikaitkan juga sebagai salah satu faktor risiko yang berakibat fatal. Dengan mengingat berbagai keterbatasan dan risiko yang dapat terjadi, maka perlu dipertimbangkan pemberian transfusi sesuai manfaat dan indikasinya

Non-Alcoholic Fatty Liver as A Risk Factor for Breast Cancer Among Indonesian Pre-Menopausal Women: A Case-Control Study

Non-alcoholic fatty liver was commonly found in breast cancer patients. However, the role of fatty liver as risk factor for breast cancer development has not been established in Indonesian population. We designed a case-control study to evaluate the effect of obesity and/or fatty liver on breast cancer occurrence in Indonesian women. Subjects were breast cancer patients between July and December 2018 in Dharmais National Cancer Centre Hospital. Control group was female hospital staff. Characteristics of subjects included age, body mass index, and presence of fatty liver by abdominal ultrasound. Independent risk factor was identified using logistic regression analysis and expressed as adjusted OR with its 95% confidence interval (CI). A total of 218 patients and 218 controls were enrolled. Both of subject and control group had equal mean of age. Among breast cancer patients, tumor was predominated by estrogen-receptor positive (69.7%) and luminal A subtype (57.8%). Mean of body mass index was significantly higher in subject group compared to control (26.8 kg/m2 vs 25.7 kg/m2 ; p=0.007). Fatty liver (49.5% vs 35.8%; p=0.004) was significantly more common in subject groups than controls. In multivariate analysis, fatty liver was confirmed as risk factor for breast cancer in subjects (ORadj: 1.56; 95%CI: 1.04–2.33; p=0.032). Obesity and fatty liver are common in breast cancer patients. Fatty liver is an independent risk factor for sporadic breast cancer. These findings warrant further studies to evaluate the mechanism of breast cancer in younger women that associated with non-alcoholic fatty liver pathogenesis. Perlemakan Hati Non-Alkoholik sebagai Faktor Risiko Kanker Payudara pada Perempuan Pre-Menopause Indonesia: Studi Kasus-KontrolPerlemakan hati non-alkoholik sering ditemukan pada pasien kanker payudara namun studi terkait peran perlemakan hati sebagai faktor risiko kanker payudara, hingga saat ini belum ada di Indonesia. Studi kasuskontrol ini dilakukan untuk mengevaluasi efek obesitas dan atau perlemakan hati terhadap kejadian kanker payudara pada perempuan Indonesian. Subjek adalah pasien kanker payudara antara bulan Juli hingga Desember 2018 di RS Pusat Kanker Nasional Dharmais. Kelompok kontrol adalah staf perempuan rumah sakit. Karakteristik subjek yang diteliti adalah usia, indeks massa tubuh, perlemakan hati yang didiagnosis dari pemeriksaan ultrasonografi abdomen. Faktor risiko independen dinilai menggunakan analisis regresi logistik dan ditampilkan sebagai adjusted OR dengan interval kepercayaan 95%. Sebanyak 218 pasien dan 218 kontrol diikutsertakan dalam studi. Kedua kelompok memiliki nilai mean usia yang sama. Pada kelompok pasien kanker payudara, jenis kanker didominasi oleh tipe estrogen-receptor positive (69,7%) dan subtype luminal A (57,8%). Mean dari indeks massa tubuh lebih tinggi bermakna dibandingkan kelompok kontrol (26,8 kg/m2 vs 25,7 kg/m2 ; p=0,007). Perlemakan hati (49,5% vs 35,8%; p=0,004) secara bermakna lebih sering ditemukan pada kelompok subjek dibandingkan kelompok kontrol. Pada analisis multivariat, perlemakan hati terbukti bermakna sebagai faktor risiko kanker payudara (ORadj: 1,56; 95%CI: 1,04–2,33; p=0,032). Disimpulkan obesitas dan perlemakan hati sering ditemukan pada pasien kanker payudara. Perlemakan hati merupakan faktor risiko independen kasus kanker payudara yang sporadik. Temuan ini dapat menjadi landasan penelitian berikutnya untuk meneliti patogenesis perlemakan hati menyebabkan kanker payudara pada perempuan usia muda. &nbsp

Metabolic Profile and Negatively Association Between Insulin Resistance and Metastatic Incidence in Indonesian Primary Invasive Breast Cancer: A Cross-Sectional Study

Andhika Rachman,1,2 Zaenal Hakiki Fiantoro,3 Noorwati Sutandyo,4 Dimas Priantono,1 Pradana Zaky Romadhon,5 Reganedgary Jonlean6 1Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia; 2Siloam MRCCC Semanggi Hospital, Jakarta, Indonesia; 3Departement of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia; 4Dharmais National Cancer Referral Hospital, Jakarta, Indonesia; 5Division of Hematology and Medical Oncology, Department of Internal Medicine, Airlangga University, Surabaya, Indonesia; 6Tzu Chi Hospital, Jakarta, IndonesiaCorrespondence: Andhika Rachman, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Pangeran Diponegoro No. 71, Jakarta, 10430, Indonesia, Tel +62 813 9862 0570, Email [email protected]; [email protected]: Metastatic breast cancer was associated with high morbidity and mortality. Insulin resistance was hypothesized to be related to the incidence of advanced breast cancer. Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and Triglyceride/Glucose Index (TyG Index) are two metrics used to measure the degree of insulin resistance. This study aims to assess the relationship between the incidence of metastatic breast cancer and insulin resistance as reflected by both metrics.Material and Methods: This study is a cross-sectional study involving 150 primary invasive breast cancer patients recruited from two hospitals of different sectors from August 2019 to April 2020. Patients with double cancer and autoimmune disorder were excluded from this study. Data obtained from the patients include age, body mass index (BMI), type 2 diabetes mellitus (T2DM) status and treatment, and low-density lipoprotein (LDL) cholesterol. The electronic medical records (EMR) was consulted to find histopathology examination result, cancer staging, and any missing data. The association between HOMA-IR and TyG with metastatic incidence was analyzed using either the Mann–Whitney test (for non-normally distributed data) or the independent-sample t-test (for normally distributed data).Results: The mean of the TyG index is 8.60, and the median of HOMA-IR is 1.22. We found no significant correlation between both variables and the incidence of metastases.Conclusion: Insulin resistance was not associated with metastatic breast cancer.Keywords: HOMA-IR, TyG index, breast cancer, metastase

Fatty Liver and Its Associated Factors Among Breast Cancer Patients in Dharmais Cancer Hospital, Jakarta

Background: Fatty liver is frequently found during ultrasound (US) examination of breast cancer patients. It is not known how the association between breast cancer and fatty liver. This study was aimed to obtaine the prevalence of fatty liver in breast cancer patients and its association with clinical characteristics of the patients.Method: This was a cross-sectional study in Dharmais Cancer Hospital, Jakarta. Study subjects were breast cancer patients who came between January 2011 and December 2013. Fatty liver was assessed by using abdominal US and were grouped into mild, moderate, and severe. Clinical characteristics of the patients included age, body mass index (BMI), menopausal status, breast tissue density using Breast Imaging Reporting and Data System (BI-RADS), and immunohistochemical estrogen receptor (ER) status.Results: A total of 72 patients were enrolled during the study period with the mean age of 47.5 years. Fatty liver was found in 68 (94.4%) patients. Sixty (83.3%) patients had moderate-to-severe fatty liver. Patients with moderate-to-severe fatty liver had significantly higher BMI (26.9 ± 5.39 vs. 23.6 ± 4.05 kg/m2; p = 0.005). Fatty liver was not associated with the patient's age, menopausal status, and breast tissue density.Conclusion: This study showed that the prevalence of fatty liver in breast cancer patients is very high. Fatty liver shows significant association with obesity but is not associated with breast tissue density or estrogen receptor status

Brain metastases in Asian HER2-positive breast cancer patients: Anti-HER2 treatments and their impact on survival

10.1038/bjc.2012.346British Journal of Cancer10771075-1082BJCA