Fungsi Hati dan Jenis Terapi Merupakan Prediktor Kesintasan Pasien Karsinoma Sel Hati

Irsan Hasan, Imelda Maria Loho, Cosmas Rinaldi Adhitya Lesmana, Rino Alvani Gani

Abstract

Pendahuluan. Karsinoma sel hati (KSH) merupakan masalah kesehatan yang besar di Indonesia karena sebagian besar pasien baru terdiagnosis pada stadium lanjut ketika terapi kuratif tidak mungkin dilakukan. Tujuan penelitian ini adalah untuk mengetahui angka kesintasan satu tahun, faktor-faktor prognostik, dan modalitas terapi yang diberikan pada pasien KSH.

Metode. Studi retrospektif dilakukan dengan mengevaluasi rekam medis pasien KHS yang berobat di Rumah Sakit Cipto Mangunkusumo (RSCM) pada bulan Januari 2013 sampai Maret 2014. Parameter klinis serta terapi yang diberikan dicatat dan luaran pasien ditentukan berdasarkan rekam medis atau dengan menghubungi pasien atau keluarganya melalui telpon. Kurva kesintasan dibuat dengan metode Kaplan-Meier. Analisis univariat dan multivariat dilakukan dengan menggunakan Cox proportional hazards model.

Hasil. Sebanyak 114 pasien KSH diikutkan dalam penelitian ini. Insidensi pasien yang meninggal adalah 57% dan angka kesintasan satu tahun adalah 29,4% dengan median kesintasan sebesar 135 hari (4,5 bulan). Pasien yang terdiagnosis pada stadium awal menurut BCLC (Barcelona Clinic Liver Cancer), menengah, lanjut, dan terminal secara berurutan adalah 0 (0%), 2 (1,8%), 48 (42,1%), 32 (28,1%), dan 32 (28,1%). Sebanyak 26,3% pasien memiliki fungsi hati yang buruk (Child-Pugh C) pada saat terdiagnosis. Hanya dua pasien yang didiagnosis melalui proses surveilans. Sebanyak 34,2% pasien mendapat terapi kuratif atau paliatif, sedangkan 65,8% mendapat terapi suportif saja. Pada analisis multivariat didapatkan bahwa klasifikasi Child-Pugh (p<0,001) dan jenis terapi (p<0,001) adalah faktor prognostik yang signifikan.

Simpulan. Derajat fungsi hati dan jenis terapi merupakan faktor yang dapat memprediksi kesintasan penderita KSH.

Kata Kunci: Karsinoma sel hati, kesintasan, prognosis

Liver Function and Treatment Modalities are Predictors of Survival in Patients with Hepatocellular Carcinoma

Introduction. Hepatocellular carcinoma (HCC) is a major health problem in Indonesia because most patients are diagnosed in late stages when curative treatment is no longer possible. The aim of this study is to evaluate one-year survival rate, prognostic factors, and treatment modalities of patients with hepatocellular carcinoma.

Methods. A retrospective analysis was done in patients with HCC who were admitted to Cipto Mangunkusumo General Hospital (CMGH) between January 2013 and March 2014. Clinical parameters and treatment modalities were evaluated. Patients outcome at one-year of follow-up were recorded from medical records or patients were contacted by phone call. Survival curve was produced using Kaplan-Meier method and a multivariate analysis was conducted using Cox proportional hazards model.

Results. A total of 114 patients were included in this study. Incidence of mortality was 57% and one-year survival rate was 29,4% with median survival as long as 135 days (approximately 4.5 months). According to the BCLC staging system, patients who were diagnosed as early, intermediate, late, and terminal stages were 2 (1.8%), 48 (42.1%), 32 (28.1%), and 32 (28.1%), respectively. Poor liver function (Child-Pugh C class) was diagnosed in 26.3% of patients. Only two patients were diagnosed during surveillance process. Proportion of patients treated with curative/palliative modalities and best supportive care were 34.2% and 65.8%, respectively. In multivariate analysis, Child-Pugh classification and treatment modalities were significant prognostic factors with p-value of <0,001 for both factors.

Conclusion. Liver function and treatment modalities are predictors of survival in patients with HCC.

Keywords

Hepatocellular carcinoma, prognosis, survival

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