Recurrence and distant free survival: study on breast cancer prognostic factor in Yogyakarta

ABSTRAK Recurrence and Distant free Survival : Study on Breast Cancer Prognostic Factor in Yogyakarta. Background : Relapse and distant metastasis in breast cancer depends on several factor such as clinical, morphological and biological prognostic factors. Objective: The aim of this study was to know prognostic factors of operable breast cancer patients in Yogyakarta, and its relation with recurrence and distant free survival. Methods : Prospective design was applied duct invasive operable breast cancer patients who had been diagnosed and treated since 1993 were followed prospectively for clinical, pathological stage, age, tumor size, lymph node status, histological grade, mitotic index, ER,PR, c-erbB2, p53 and MIB-1, until revealed outcome (recurrence and distant metastasis). Prognostic factor was analyzed univariately for recurrence and distant metastasis with Kaplan Meier method. Difference between two survival group was analyzed with log- rank test. Independent prognostic factor was analyzed multivariately using proportional hazard (Cox) regression. Results: Significant prognostic factor for recurrence was c-erbB2 expression (p=0.0341. Univariate analysis showed that significant prognostic factors for distant metastasis were pathological stage, lymph node status, age and c-erbB2 expression. With multivariate analysis, most significant prognostic factors for distant metastasis were lymph node status (p=0.0151 and age (p=0.042). Conclusion: Independent prognostic factors for recurrence were c-erbB2 expression, while for distant metastasis were lymph node status and age. Key Words : breast cancer, prognostic factor, recurrence free survival, distant free survival-c-erbB

Implementation of Medical Genetics in Medical Education Curriculum

Primary care physicians should be aware that genomics has arrived at the doorstep of their practice. Genetic knowledge, skills, and attitudes are important to primary care physicians providing support and management to patients and families with (higher risks of) genetic conditions. At least one in ten patients seen in primary care has a disorder with a genetic component, including hereditary cancer.Primary care physicians must be able to advise patients on genetic and genomic manifestations of the associated diseases and disorders, to outline a primary pedigree to deliver the necessary information: the disease which the patients are at risk of, and to decide whether to refer the patients to genetic services.There is more and more evidence to the importance of clinical emphasis in the genetics classes, probably proceeding to a third-year refresher program in the longitudinal curriculum. An enhanced educational experience to improve genetics and genomics knowledge should be better structured in the imminent future.Keywords: primary care physicians, hereditary cancer, genetic curriculum, genetic service

Sensitivity and specificity test of fine needle aspiration biopsy in determining thyroid nodule diagnosis

Based on guideline of the American Association of Clinical Endocrinologist, fine needle aspiration (FNA) is believedas effective method to differentiate between benign and malignant thyroid nodule. At Dr. Sardjito Hospital,during2004 – 2008 there were 12 cases of false negative from 14 cases of thyroid malignancy. The high false negativevalue raised question about the role of FNA in determining thyroid nodule diagnosis. The purpose of this study is tofind out sensitivity and specificity of FNA in determining thyroid nodule diagnosis at Dr. Sardjito Hospital Yogyakarta.Patients underwent FNA and surgery for thyroid nodule were collected between January 2004 until December2008. The result of FNAwas compared to histopathological result then sensitivity and specificity test were performedrespectively. The fine needle aspiration was conducted to 120 patients. It consist of 23 men and 97 women, mostly41 – 50 years old. The results of FNA were four of malignancy, 74 of benign, and 42 of follicular neoplasm.Histopathological result showed malignant in 23 patients and benign in 97 patients. The FNA at Dr. Sardjito Hospitalshowed 14.29%of sensitivity, 96.86%of specificity, 50%of PPV, 83.78% of NPV, 4.55 of LR +0.884 of LR-,18.92% of prevalence, and 86.49% of accuracy. The thyroid FNA at Dr. Sardjito Hospital showed low value ofsensitivity and high value of specificity. Futhermore, the thyroid FNA showed minimal role in determining thyroidnodule diagnosis.Keywords : thyroid nodule-diagnosis-fine needle aspiration-sensitivity-specificit

Penanganan Kanker Payudara Stadium Awal Dengan Breast Conserving Treatment: Evaluasi Kasus Di Yogyakarta

T. Aryandono - Management of early breast cancer with breast conserving treatment : Evaluation of cases in Yogyakarta Background: Breast conserving treatment (BCT) can be done for early breast cancer, with the same survival as mastectomy. The patients should not lost the breast resulted from the treatment. Objective: To evaluate the patients with breast conserving treatment in two hospitals in Yogyakarta, in connection with locoregional recurrence, distant metastasis, cosmetic result and general condition. The results can be used for improving the technique of breast conserving treatment in this region. Methods: Five patients with BCT from 1996 until 2001 were treated with wide excision (lumpectomy), axillary dissection level I and II, and radiotherapy 5000 cGy. Histopathological examination, estrogen and progesterone receptor and c-erbB-2 examination were conducted for these patients. All patients received hormonal adjuvant treatment with tamoxifen, no one received adjuvant chemotherapy. Results: The age range was 28-51 years old, stage one, maximum diameter of tumor was 1.5 cm. Most of them were invasive duct carcinoma, with positive ER, PR and c-erbB-2. Follow up from 8 to 66 months, with median follow up 37 months. No locoregional recurrences, one with distant metastasis (lung). The cosmetic result as well as the general condition were good. Conclusions: Breast conserving treatment had been done on patients and resulted in good cosmetic result, no locoregional recurrences and good general condition. With early detection and good patient selection, the patient should have not lost the breast with the same survival as in mastectomy. Key words: breast conserving treatment- lumpectomy - radiotherapy - estrogen receptor - progesterone receptor

Clinical aspects of gastrointestinal lymphoma

Teguh Aryandono, Taufiq Nugroho, Ahmad Ghozali -- Aspek Minis limfoma gastrointestinal. Diagnosis sebagian besar limtoma gastrointestinal hanya dapat ditegakkan dengan laparotomi. Duapuluh empat penderita limtoma gastrointestinal primer diteliti. Penderita dikelompokkan menurut umur, jenis kelamin, keluhan, adanya simtom B (demam, penurunan berat badan, dan keringat malam), lokasi tumor, tindakan bedah, diagnosis histopatologis menurut International Working Formulation, dan terapi. Dari 16 orang penderita laki-laki, umur antara 6,5 - 76 tahun dengan rerata 44,7 tahun, lama keluhan pada 10 penderita tidak Iebih dari 6 bulan, hanya terdapat 8 penderita dengan simtom B. Lima betas penderita dengan keluhan massa pada abdomen, 5 dengan gangguan pola pencernaan, 4 dengan obstruksi, dan sakit perut pada 10 penderita. Biopsi laparotomi dikerjakan pada 16 penderita dan reseksi hanya dapat dikerjakan pada 6 penderita. Dua penderita dilakukan apendektomi karena gejala yang mirip dengan apendisitis. Menurut International Working Formulation, 17 penderita dengan derajat keganasan sedang, 5 dengan derajal keganasan tinggi dan 2 dengan derajat keganasan rendah. Hanya 9 penderita mendapat kemoterapi dengan sikiotostamid, vinkristin dan prednisolon dan hanya 3 penderita mendapatkan 3 siklus atau Iebih kemoterapi. Key Words : gastrointestinal lymphoma -- laparotomy -- chemotherapy -- working formulation

The effect of combination of hemofilter, pre- and intraoperative methylprednisolone administration on systemic inflammatory response syndrome (SIRS) post open heart surgery

Systemic inflammatory response syndrome (SIRS) occurs in almost all patients whom undergo open heart surgery causes the increase its morbidity and mortality. The effect of pre- and intraoperative methylprednisolone administration combined with hemofilter application in cardiopulmonary bypass machine in the reduction of SIRS incidence remains controversial. This study aimed to evaluate the effect pre- and intraoperative methylprednisolone administration combined with hemofilter on SIRS incidence after open heart surgery. This was an experimental study using prospective randomized open-blinded evaluation (PROBE) design. Ninety-five patients from Dr. Sardjito General Hospital, Yogyakarta, and Dr. Cipto Mangunkusumo General Hospital, Jakarta, who had open heart surgery within the period of December 2011 to May 2012 were enrolled in this study. The patients were randomly allocated into two groups i.e. Group A (48 patients) received pre-; intra-; and postoperative methylprednisolone (15; 5 and 5 mg/kg BW, respectively) and hemofilter and Group B (47 patients) just received intra- and postoperative methylprednisolone (15 and 5 mg/kg BW). The SIRS incidence was evaluated in 3; 24; 48 and 72 hours post surgery. This study showed that the SIRS incidence in Group B at 3 (OR= 0.12; 95%CI=0.03-0.39; p< 0.001) and 24 (OR= 0.38; 95%CI=0.14-0.996; p< 0.031) hours postoperative were significantly higher than that in Group A. In conclusion, pre- and intraoperative methylprednisolone administration combined hemofilter significantly decrease the SIRS incidence post open heart surgery

The effect of hemofilter, preoperative and intraoperative methylprednisolone on complications after open heart surgery

Complications after open heart surgery may threaten patient’s survival rate. Theintraoperative methylprednisolone administration alone shows controversial resultson open heart surgery complications. Similarly, the intraoperative and preoperativemethylprednisolone administration as well as the use of hemofilter in open heart surgeryis still controversial. This study aimed to evaluate the effect of hemofilter, preoperativeand intraoperative methylprednisolone administration on complications following openheart surgery. This was a Prospective Randomized Open-Blinded Evaluation (PROBE)experimental study. Ninety-five patients who had open heart surgery in Dr. SardjitoGeneral Hospital, Yogyakarta, and Integrated Cardiac Care of Dr. Cipto MangunkusumoGeneral Hospital, Jakarta within the period of December 2011 to May 2012 wereinvolved in this study. The patients were divided into two groups i.e. group A, 48 patientsreceived methylprednisolone 15mg/kg intraoperatively, methylprednisolone 5mg/kgpreoperatively, and hemofilter, while group B, 47 patients received methylprednisolone15mg/kg intraoperatively alone. From the total 95 patients, we found 26 (27.4%)patients experienced complications i.e. 19 in group B (40.4%) and 7 in group A(14.6%). The differences of the complications were statistically significant (p<0.05;OR=3.97; 95%CI=1.476-10.71). Complications risk decreased by 63.9% in the groupA compared to the group B with the hazard ratio of 3.2. In conclusion, the application ofhemofilter, preoperative and intraoperative methylprednisolone might decrease the risk ofcomplications after open heart surgery

MiR-21 and mRNA PTEN Expression Levels and Biomarker Potential in Breast Cancer

MiR-21 has been linked to tumorigenesis, development, and metastasis in tumor pathogenesis. All human cancers, including breast cancer, have increased expression of MiR-21, which is the only miRNA that has increased expression. PTEN expression was found to be reduced in the majority of solid tumors, including breast cancer. Since lymph node metastatic factors, estrogen receptor status, tumor grade, and tumor node metastasis (TNM) all decreased PTEN expression, the PTEN expression profile may be a very useful prognostic marker in breast cancer. PTEN inhibits PIP3 (phosphatidylinositol 3,4,5-triphosphate) activity by having protein phosphatase and lipid phosphatase activity that is the polar opposite of PI3K (Phosphatidyl Inositol 3-Kinase). The aim of this research was to see how often miR-21 and mRNA PTEN were expressed at different stages of breast cancer and whether they could be used as prognostic markers. This type of research is an observational study with a cross-sectional design. The sample size of 43 people came from breast cancer patients. Analysis of miR-21 expression and mRNA PTEN using Real-Time qPCR. The results showed that miR-21 expression increased 1.32 times at an advanced stage compared to an early stage, while mRNA PTEN expression decreased 1.33 fold at an advanced stage compared to an early stage. According to the findings, miR-21 expression in the blood plasma of breast cancer patients was upregulated at an advanced stage compared to an early stage and downregulated mRNA PTEN expression. MiR-21 which is increased at an advanced stage has the potential to be a poor prognostic marker at the stage of breast cancer. The change in miR-21 expression can be a good candidate as a molecular prognostic marker and for future research the role of miR-21 in breast cancer progression will further enrich the scientific repertoire, especially in the health and clinical fields

Treatment options for Indonesian triple negative breast cancer patients: a literature review of current state and potentials for future improvement

 Triple negative breast cancer (TNBC) is still associated with grave prognosis, especially compared to other breast cancer subtypes. Advances in medical science have improved our understanding on the biological nature and heterogeneity of TNBC, explaining the efficacy variability of existing chemotherapeutic drugs on TNBC patients. Complexity of TNBC has led to wide variation of TNBC treatment across the globe, resulting in unsatisfactory treatment outcome. This issue is further complicated by the absence of TNBC treatment guideline in many countries, including in Indonesia. This review discusses systemic treatment options for TNBC while taking account its molecular heterogeneity. Specific consideration is made for Indonesia, not only for current clinical practice, but also for future improvements. Immunotherapy, especially programmed cell death 1 (PD-1/PD-L1) inhibitor, has recently shown promising result in TNBC patients. It can be concluded that TNBC is heterogenous and treatment option should be tailored based on its molecular profile