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Disusun Oleh :
Annisa Rahmadhania : 1102013038
Diana yunus : 1102013083
SKENARIO
Seorang wanita berumur 52 tahun, ibu rumah tangga, mempunyai 2 orang anak usia
20 tahun dan 18 tahun datang ke rumah sakit karena merasakan adanya benjolan pada
payudara sebelah kanan yang semakin lama semakin membesar sejak 3 bulan terakhir dan
tidak terasa nyeri. Ibu pasien 3 tahun lalu meninggal karena kanker payudara.
Pada pemeriksaan fisik didapatkan keadaan umum baik, vital sign dalam keadaan
normal, BMI 35,5 kg/m² (N:25-29,9 kg/m²). Hasil pemeriksaan inspeksi payudara kanan
dan kiri tampak simetris, tidak ditemukan ulkus dan retraksi pada papilla mammae, tidak
tampak adanya skin rash ataupun peau d’orange pada kedua payudara. pada pemeriksaan
palpasi ditemukan adanya benjolan di region mammae dextra kuadran lateral atas ukuran
2x2x1 cm3, permukaan licin, konsistensi kenyal, terfiksisir dan tidak ada nipple discharge.
Pada saluran getah bening di ketiak ditemukan adanya 1 benjoliopsisan ukuran 1x1x1
cm3. Dokter mencurigai pasien terkena kanker payudara dan menyarankan melakukan
pemeriksaan mammografi dan USG untuk mendeteksi kanker payudara pada tahap awal
dan menunjukkan lesi yang tidak bisa di deteksi dengan pemeriksaan klinis. Biopsi insisi
memastikan pasien menderita kanker payudara stadium II kemudian menjalani operasi
mastektomi radikal dilanjutkan dengan kemoterapi dan radioterapi. Pasien menanyakan
kemungkinan penyakitnya, apakah BMI yang tinggi dapat mempengaruhi lama
penyembuhan penyakitnya?
Pertanyaan (Foreground Question)?
Apakah Body Mass Index (BMI) mempengaruhi prognosis pada pasien kanker
payudara stadium II?
PICO
Population : wanita dengan karsinoma payudara stadium II
Intervention : BMI > 30 kg/m²
Comparison : BMI < 30 kg/m²
Outcome : BMI > 30 kg/m² menurunkan angka survival rate kanker payudara
stadium II
PENCARIAN BUKTI ILMIAH
Kami meninjau dengan metode retrospektif. 456 pasien yang di diagnosis kanker
payudara di Departemen Radiasi Onkologi dari Kayseri teaching hospital antara tahun
2005 dan 2013. Kami menginvestigasi hubungan dari indeks massa tubuh dengan
prognosis dan faktor prognosis lainnya.
Penelitian ini melibatkan 456 pasien (447 wanita dan 9 pria). Usia rata-rata pada
presentase adalah 55,6 tahun. Dari kasus, 96,9% dimodifikasi dengan mastektomi
radikal, dan 95% mendapatkan kemoterapi, sedangkan 82,4% mendapatkan
radioterapi dan 60% diberi terapi hormon. Indeks massa tubuh >25mg/kg2 dalam 343
kasus. 5 dan 10 tahun secara keseluruhan angka harapan hidup adalah masing-masing
65% dan 49%.
Penelitian
We retrospectively reviewed operated breast cancer patients who were followed in Radiation
Oncology department of Kayseri Teaching Hospital between 2005 and 2013. Patients with
missing data and those lost in follow- up were excluded from analysis. The study was planned
in accordance to local ethics regulations and Helsinki Declaration. We reviewed age, gender,
menopausal status, family history of breast cancer, height, weight, BMI, tumor localization,
tumor stage, surgery type, histopathological findings, data regarding chemotherapy and
radiotherapy, and survival times. In the histopathological diagnosis, tumor type, tumor
localization, tumor diameter, lymphatic metastasis, number of lymph nodes excised, number
of lymph nodes with metastatic infiltration, level of estrogen and progesterone receptors,
cerb-B2 status, grade, and lymphovascular and perineural invasion status were recorded.
2. Apakah follow up lengkap dan cukup lama/ sufficiently long and complete?
Subjek penelitian ini di follow up cukup lama yaitu dijadwalkan tiap 3 bulan dalam satu tahun;
dua kali tiap tahun sampe tahun ke lima; dan setiap tahun
We retrospectively reviewed operated breast cancer patients who were followed in Radiation
Oncology department of Kayseri Teaching Hospital between 2005 and 2013. Patients with missing
data and those lost in follow- up were excluded from analysis.
Follow-up visits were scheduled by 3-months interval within first year; biannually until end of year
5; and annually thereafter. Complete blood count, biochemical parameters, and Ca 15-3 and CEA
levels were measured biannually, while chest radiographs, mammography, abdominal sonography
and bone scintigrapy were obtained annually.
In terms of breast cancer, it was shown that low body weight increases risk during
premenopausal period, while increased body weight increases risk during postmenopausal
period. As a result, investigators began to evaluate prognostic value of obesity in breast
cancer,
In our study, significant correlations were detected between BMI and menopausal status,
histological type, chemotherapy and hormone therapy. It has been thought that many
metabolic and hormonal pathways are involved in the relationship between obesity and
prognosis.
that hormone therapy was less effective in women with higher BMI. There are several
randomized studies comparing AIs and tamoxifen in adjuvant treatment of breast cancer
effects of BMI on relative effectiveness of AI and tamoxifen were reported in four of these
studies (ATAC, BIG 1-98 and TEAM in the postmenopausal setting and ABCSG-12 in the
premenopausal setting).
In the study by Ladoire et al., it was reported that obesity remained to be associated with
poorer baseline tumor characteristics but had no effect on the prognosis when modern
adjuvant chemotherapy was delivered at appropriate doses (Ladoire et al., 2014).
3. Apakah penelitian berguna untuk konseling pada penderita dan keluarganya?
Ya, menurut jurnal ini ada hubungan antara indeks massa tubuh dengan prognosis kanker
payudara.
In conclusion, in our study, it was found that overall survival was shorter in patients with
BMI<18.5 kg/m2 or >25.0 kg/m2 when compared to other patient groups. In addition, it was
also found that progression-free survival was shorter but the difference didn’t reach statistical
significance. We think that this finding could be due to small sample size. These findings should
be further tested in comprehensive studies.
In our study, 343 of 456 patients were in obesity group with a BMI >25 kg/m2. It was found
that OS was significantly higher in the group with normal BMI when compared to those in
the underweight and obese patient groups. It was found that the factors significantly
associated with OS were stage, tumor diameter, lymph node metastasis and BMI.
Kesimpulan
Dalam penelitian ini, dapat dilihat bahwa waktu overall survival lebih pendek pada
pasien dengan berat badan rendah dan obesitas dibandingkan dengan berat badan
normal