Dharmais National Cancer Research Articles

Characteristics and Survival of Patients with WHO Grade 4 Diffuse Glioma in Dharmais National Referral Cancer Hospital

Background: The WHO grade 4 diffuse glioma are extremely aggressive and account for over 60% of adult Central Nervous System (CNS) tumors. The diagnosis and management pose significant challenges due to the need for comprehensive evaluation and holistic treatment approaches. This study aims to determine the clinical characteristics of WHO grade 4 diffuse glioma in Indonesia and the overall survival as a secondary goal. Methods: This is a retrospective cohort study of all WHO grade 4 glioma patients from 2017 to 2022 at Dharmais National Cancer Hospital, Jakarta, Indonesia. Demographic characteristics were presented descriptively. Kaplan-Meier plot was used to evaluate the median survival. Results: Twenty-eight patients were eligible for this study. The median age group is 45 years old, with equal male and female prevalence. Headache was the most prevalent primary symptom. The therapy following surgery was radiotherapy (RT) with chemosensitizer (82.1%) and RT alone (14.3%) with both followed by adjuvant chemotherapy. There was one patient (3.6%) underwent palliative therapy. The median survival of all patients was 10 months, whereas 10 months in RT with the chemo-sensitizer group and 1 month in RT only group. There was no statistically significant difference between RT with and without chemotherapy sensitizer in terms of survival rates. Conclusions: Our study reports a younger median age of WHO Grade 4 diffuse glioma. Male subjects were equivalent to females. Median OS was 10 months and were longer in RT with the chemosensitizer group. Further multicentered and at the genetic level investigation was needed, to achieve optimal outcomes.

Analysis of Presentation Delay in Patients with Advanced Breast Cancer Visiting Dharmais National Cancer Hospital

Background: Breast cancer is still one of the significant causes of the increasing mortality rate due to cancer. Treatment of breast cancer patients was delayed by 66.34%. The majority of patients arrive at stages IIIB and IV and are therefore treated at an advanced stage. This study aimed to analyze the factors causing the arrival delay of breast cancer patients to Dharmais Cancer Hospital with advanced stages. Methods: A descriptive study with a qualitative approach was used as the research design. Indepth interviews and document reviews were used to collect data. In-depth interviews were conducted with 12 advanced-stage breast cancer patients. Thematic data analysis was performed by tracing and identifying the main topics of the entire interview process. The triangulation method was used to validate the data by conducting interviews with 4 patient families and 2 oncology surgeons, as well as document review. Results: The presentation delay of advanced breast cancer patients was analyzed based on the interpretation and recognition of symptoms. There was an attitude of ignoring when there were symptoms and not seeking treatment. On psychological factors, there was a feeling of fear after being diagnosed and a sense of worry in the treatment process. On socioeconomic factors, there was no early detection, lack of information on early detection, waiting time constraints, and the selection of alternative treatments. Conclusions: Late-stage breast cancer patients were drawn to Dharmais Cancer Hospital due to issues with the interpretation and experience of symptoms, psychological issues patients reported, and socioeconomic difficulties during treatment. As a result, patients must be given additional care to deal with late arrivals, especially in cases of advanced breast cancer.

Circulating miR-10b, soluble urokinase-type plasminogen activator receptor, and plasminogen activator inhibitor-1 as predictors of non-small cell lung cancer progression and treatment response.

Despite advances in lung cancer treatment, most lung cancers are diagnosed at an advanced stage. Expression of microRNA10b (miR-10b) and fibrinolytic activity, as reflected by soluble urokinase-type plasminogen activator receptor (suPAR) and plasminogen activator inhibitor 1 (PAI-1), are promising biomarker candidates. To assess the expression of miR-10b, and serum levels of suPAR and PAI-1 in advanced stage non-small cell lung cancer (NSCLC) patients, and their correlation with progression, treatment response and prognosis. The present prospective cohort and survival study was conducted at Dharmais National Cancer Hospital and included advanced stage NSCLC patients diagnosed between March 2015 and September 2016. Expression of miR-10b was quantified using qRT-PCR. Levels of suPAR and PAI-1 were assayed using ELISA. Treatment response was evaluated using the RECIST 1.1 criteria. Patients were followed up until death or at least 1 year after treatment. Among the 40 patients enrolled, 25 completed at least four cycles of chemotherapy and 15 patients died during treatment. Absolute miR-10b expression ⩾ 592,145 copies/μL or miR-10b fold change ⩾ 0.066 were protective for progressive disease and poor treatment response, whereas suPAR levels ⩾ 4,237 pg/mL was a risk factor for progressive disease and poor response. PAI-1 levels > 4.6ng/mL was a protective factor for poor response. Multivariate analysis revealed suPAR as an independent risk factor for progression (ORa⁢d⁢j, 13.265; 95% confidence intervals (CI), 2.26577.701; P= 0.006) and poor response (ORa⁢d⁢j, 15.609; 95% CI, 2.221-109.704; P= 0.006), whereas PAI-1 was an independent protective factor of poor response (ORa⁢d⁢j, 0.127; 95% CI, 0.019-0.843; P= 0.033). Since miR-10b cannot be used as an independent risk factor for NSCLC progression and treatment response, we developed a model to predict progression using suPAR levels and treatment response using suPAR and PAI-1 levels. Further studies are needed to validate this model.

The Role of Liquid Biopsy for Detecting Epidermal Growth Factor Receptor (EGFR) Mutations in Patients with Advanced Non-Small Cell Lung Cancer (NSCLC) – A Preliminary Study in Indonesian Population

Background: The development of new biomarker-targeted therapies is associated with the improvements in overall survival of advanced non-small cell lung cancer (NSCLC) sufferers. However, tissue biopsy as the gold standard to determine tumor molecular status is not always feasible in advanced diseases. Liquid biopsy, a minimally invasive technique to obtain cytological and molecular assessment from patients allows real-time monitoring of tumors and identification of resistant mechanisms. Therefore, this preliminary study aimed to compare the molecular profile of advanced NSCLC from liquid and tissue biopsy.Methods: This cross-sectional study was conducted on patients with NSCLC undergoing diagnostic procedures at Dharmais National Cancer Center Hospital from January 2018 to December 2021. Tissue biopsy to check epidermal growth factor receptor (EGFR) mutations was performed on formalin-fixed paraffin-embedded (FFPE) tissue blocks. Analysis of mutations involved using a home-brew polymerase chain reaction (PCR) based on a high-resolution melting technique. Meanwhile, the liquid biopsy was performed using blood samples, and sequencing for circulating tumor DNA (ctDNA) was carried out with NGS.Results: : The results showed that among the 22 subjects enrolled in the study, tissue biopsy identified wild-type EGFR in 18 (81.8%), exon 19 mutations in 3, and exon 21 mutations (L861Q and L858R) in 3. Liquid biopsy found EGFR exon 19 deletions in 11 samples (50%), exon 21 mutations (L861Q and L858R) in 10, L861Q in 7, L8585 in 6, and wild type in 1 sample. Additionally, acquired EGFR mutations in exon 20 T790M were found in 5 samples.Conclusions: Liquid biopsy may be beneficial in patients for whom tissue biopsy cannot be performed or where tissue for molecular profiling is inadequate. This modality can also be used to detect molecular resistance in patients with advanced NSCLC.

A Comparison of Cancer Incidences Between Dharmais Cancer Hospital and GLOBOCAN 2020: A Descriptive Study of Top 10 Cancer Incidences

Background: : Cancer is one of the main causes of death and increased morbidity in every country in the world. According to Global Cancer Observatory (GLOBOCAN) 2020 data, it is estimated that 19.3 million new cancer cases and nearly 10.0 million cancer deaths occurred in the world in 2020. Based on the same data, it is estimated that 396,914 new cancer cases and nearly 234,511 cancer deaths are estimated to occur in Indonesia. Dharmais National Cancer Hospital (DNCH) as a national cancer center is a miniature of cancer data in Indonesia. For this reason, researchers want to compare whether the data on the number and types of cancer in DNCH are the same as those in GLOBOCAN 2020.Methods: This research is a descriptive analysis with secondary data collection methods taken from medical records. The sampling technique was total sampling, univariate data analysis, namely new cases of cancer patients for the January-December 2021 period which are 2,382 cases.Results: The results showed that the same order in both data was only found in the first, second, and seventh order, namely breast cancer, cervical cancer, and non-Hodgkin’s lymphoma, respectively. However, the percentage of new cases of breast cancer in RSKD is much higher (2.5-folds) than in GLOBOCAN.Conclusion: There are several differences between the data on new cancer cases in the two data, which can be caused because DNCH has complete facilities, both for diagnostic and curative purposes, and examinations such as IHC and bone scans are only available at certain hospitals and one of them is DNCH.

Multimodality Diagnosis of Laryngeal Cancer in “Dharmais” National Cancer Hospital (DNCH)

Background: Almost 95% of laryngeal cancers are squamous cell carcinoma. Most of them come from the supraglottic and glottic regions. Globally from 1990 to 2017, there was an increase in the incidence of laryngeal cancer by 58.67%. Patients with suggestive grievances of laryngeal cancer symptoms are usually advised to do a further examination. The use of multimodality diagnosis is helpful for the diagnosis of cancer. Diagnostic procedures in diagnosing laryngeal cancer can be made by history and physical examination, clinical (laryngoscopy), and supporting examination (radiology and biopsy). This study aims to determine the distribution of the demographic (gender, age, domicile, marital status, and educational level), clinical distribution (voice changes, respiratory disorders, pain, dizziness, cough, lump on the neck, and others), and modalities of diagnosis (anamnesis, clinical examination, radiology, and biopsy) in laryngeal cancer.Methods: Descriptive study and a routine data-based study was conducted by collecting data on cancer patients who were diagnosed with laryngeal cancer from 2003 to 2007 by the microscopic either in Dharmais National Cancer Hospital (DNCH) or other hospitals. The study sample was 53 out of a total of 68 cases of laryngeal cancer who had been diagnosed with malignancy histopathologically at DNCH or in other hospitals with epithelial or non-epithelial types with completed medical records. Results: The glottic region is the most common subsite, that is, 52.8%, and squamous cell carcinoma (SCC) is the most common histopathological type of laryngeal cancer. In most of the cases, either males or females presented with a change in the voice of 68.8% and 80% respectively. In 6 out of 12 cases have not been examined microscopically before, while 7.5%.of the cases have done the diagnostic procedure completely in DNCH. Conclusions: The most common subsite and histopathological type of laryngeal cancer is glottis and SCC. The most common clinical feature in both sexes is voice changes. Most cases have not been examined according to the standard diagnosis procedure completely.

Cisplatin-induced Nephrotoxicty and its Predisposing Factors for Unrecovered Kidney Injury: A Report from Indonesia National Cancer Center

BACKGROUND: Cisplatin-induced nephrotoxicity is the most common and devastating side effects which affects long-term outcome. It may be reversible in some patients but may also cause permanent kidney injury. AIM: This research aims to evaluate risk factors of cisplatin nephrotoxicity and unrecovered kidney function at national cancer hospital in Indonesia. METHODS: This is a retrospective and cohort study conducted at Dharmais National Cancer Hospital, Jakarta, Indonesia. All cancer patients aged 18 years old and above, who received cisplatin-based regimen as the first-line chemotherapy and completing all cycles with at least four cycles, were included in the study. Demographic data were collected and kidney function was evaluated using estimated glomerular filtration rate (eGFR) before, 3 times during chemotherapy, 1 and 3 months after the last dose. RESULTS: A total of 177 patients were included in the analysis, with mean age of 45.80 ± 11.75 years old, majority diagnosed with nasopharynx cancer (58.8%), and have baseline eGFR of 102.76 ± 20.68 mL/min 1.73m2. Nephrotoxicity is occurred in 80 (45.2%) patients with 27 (15.3%) toxicity occurred after the first cycle. Age above 50, hypertension and non-steroidal anti-inflammatory drugs (NSAID) use associated with increased risk of cisplatin-induced nephrotoxicity. Nephrotoxicity risk factors include age above 50 (OR 4.18, 95% CI 2.11–8.28; p < 0.0001), hypertension (OR 2.03, 95% CI 1.03–4.01; p = 0.040), and NSAID use (OR 2.34, 95% CI 1.22–4.93; p = 0.025). Risk factors of patients who unrecovered above 75% eGFR baseline were hypertension (OR 0.47, 95% CI 0.17–0.56; p = 0.001) and gender (OR 0.018, 95% CI 0.03–0.95; p = 0.043). CONCLUSION: Nephrotoxicity occurs in 45.2% patients throughout cisplatin-based chemotherapy cycles. Risk factors of nephrotoxicity includes age above 50, hypertension, and NSAID while hypertension and female gender are risk factor for not recover above 75% eGFR baseline after cisplatin cycles.

Factors Affecting 2-Year Survival in Patients With Non–Small Cell Lung Cancer Brain Metastases: Evidence from Indonesia’s National Cancer Center, Jakarta, Indonesia

Background: Brain metastases are a common complication in a wide range of cancers but are ubiquitous among patients with lung cancer. Limited data are available on the survival of patients with lung cancer and brain metastases in Indonesia. In this study, we aimed to identify the factors that might contribute to and predict survival in patients with non–small cell lung cancer (NSCLC) that resulted in brain metastases. Methods: This retrospective study on patients with NSCLC and brain metastases was conducted using data available from the medical records of the Dharmais National Cancer Hospital, Jakarta, Indonesia. The study outcome was survival time, which was associated with sex, age, smoking status, body mass index, number of brain metastases, tumor location, systemic therapy, and other therapies. Descriptive statistics, median survival, Kaplan-Meier graphs, and Cox regression were analyzed using SPSS version 27. Results: We included 111 patients with NSCLC and brain metastases in this study. The median patient age was 58 years. Long survivorship was observed among women (median: 95.4 weeks; P < .0003), patients with epidermal growth factor receptor (EGFR) mutations (median: 41.8 weeks; P < .0492), those who received chemotherapy (median: 58 weeks; P < .000), and those who received a combination of surgery and whole brain radiotherapy (WBRT; median: 64.7 weeks; P = .0174). Multivariate analysis showed consistent results for the following factors: sex, EGFR mutations, systemic therapy, and surgery plus WBRT. Conclusions: Female sex and EGFR mutations in patients with NSCLC and brain metastases are associated with a high survival rate. Patients who have NSCLC with brain metastases will benefit from treatment with EGFR tyrosine kinase inhibitors, chemotherapy, and surgery plus WBRT.

Early Experience of Oncological Reconstructive Surgery at Dharmais National Cancer Center

Background: Oncological reconstructive surgery is a new paradigm in which it combines oncologic principles with reconstruction techniques. This study aims to present patients’ characteristics who had undergone oncological reconstructive surgery at the Department of Surgical Oncology, Dharmais National Cancer Center. Methods: This descriptive study identified patients’ characteristics who underwent oncological reconstructive surgery, their cancer types, and their therapies. All data were obtained from surgery registration and medical records from January 2019 to January 2020. Data were then presented in number and percentage.Results: A total of 174 patients had undergone oncological reconstructive surgery within one year. The mean age of all patients was 48.2 ± 16.7 years old. Most patients were female (72.1%), with breast cancer making up most cases (43.7%). Most of the participants also underwent mastectomy (42.1%), which was later followed by various reconstruction types. Sixty patients received free tissue transfer with microsurgery (34.4%), of which head and neck cancer constituted most cases. In addition, the most common donor site for the free flap was the Anterolateral Thigh (41.7%). Of all 174 patients, 75.2% presented with locally advanced cancer, and 17.8% had metastatic cancer. Within one year of follow-up, the survival rate was 87.4%, while local recurrence was 3%. Conclusions: The oncological reconstructive surgery approach plays a therapeutic and reconstructive role, and such might be the preferred method of choice for patients presenting with advanced-stage cancer

Demography and Outcome of Cancer Patients with COVID-19: A Retrospective Cohort Study in Dharmais National Cancer Center Indonesia

Introduction: Cancer patients have an increased risk of morbidity and mortality due COVID-19 partly due to their immunocompromised status. We aimed to investigate the associations of clinicopathological factors and survival outcomes in cancer patients with COVID-19. Methods: This was a retrospective cohort study comprised of cancer patients treated in Dharmais National Cancer Center, Indonesia. Main inclusion criteria were pathologically confirmed malignancy with positive results of RTPCR COVID-19 tests. Results: A total of 16,511 visitors had visited and registered for RTPCR test in Dharmais National Cancer Center from May 2020 to January 2021. Logistic regression showed that male gender (p-value = 0.019; OR = 1.732), haematological type of malignancy (p-value <0.001; OR = 3.073), patients not underwent cancer therapy (p-value = 0.008; OR = 0.485), low RTPCR Ct values (p-value = <0.001; OR = 3.340), poor performance status (p-value = <0.001; OR = 8,194), and disease severity (p-value = <0.001; OR = 5.448) were associated with mortality. Conclusion: Overall mortality rate in Dharmais cancer patients (25%) was higher than other cancer patients treated in other hospitals in Asia. Moreover, the mortality rate was similar across all age groups. Poor survival in young age might be explained by the fact that median age of cancer patients was 46 years old. In addition to male gender, cancer patients with low Ct values and having delayed cancer treatment were vulnerable groups of having poor outcomes when diagnosed with COVID-19. Long-term follow-up is required to examine the survival rate in cancer patients with COVID-19.

Repurposing FIB-4 index as a predictor of mortality in patients with hematological malignancies and COVID-19.

In this study, we aimed to investigate whether FIB-4 index is useful in predicting mortality in patients with concurrent hematological malignancies and COVID-19. We also aimed to determine the optimal cut-off point for the prediction. This is a single-center retrospective cohort study conducted in Dharmais National Cancer Hospital, Indonesia. Consecutive sampling of adults with hematological malignancies and COVID-19 was performed between May 2020 and January 2021. COVID-19 screening test using the reverse transcriptase polymerase chain reaction (RT-PCR) of nasopharyngeal samples were performed prior to hospitalization for chemotherapy. FIB-4 index is derived from [age (years) × AST (IU/L)]/[platelet count (109/L) × √ALT (U/L)]. The primary outcome of this study is mortality, defined as clinically validated death/non-survivor during a 3-months (90 days) follow-up. There were a total of 70 patients with hematological malignancies and COVID-19 in this study. Median FIB-4 Index was higher in non-survivors (13.1 vs 1.02, p<0.001). FIB-4 index above 3.85 has a sensitivity of 79%, specificity of 84%, PLR of 5.27, and NLR of 0.32. The AUC was 0.849 95% CI 0.735-0.962, p<0.001. This cut-off point was associated with OR of 16.70 95% CI 4.07-66.67, p<0.001. In this study, a FIB-4 >3.85 confers to 80% posterior probability of mortality and FIB-4 <3.85 to 19% probability. FIB-4 >3.85 was associated with shorter time-to-mortality (HR 9.10 95% CI 2.99-27.65, p<0.001). Multivariate analysis indicated that FIB-4 >3.85 (HR 4.09 95% CI 1.32-12.70, p = 0.015) and CRP> 71.57 mg/L (HR 3.36 95% CI 1.08-10.50, p = 0.037) were independently associated with shorter time-to-mortality. This study indicates that a FIB-4 index >3.85 was independent predictor of mortality in patients with hematological malignancies and COVID-19 infection.

Clinical Characteristic of Thoracic Malignancy Patients with Coronavirus Disease 2019 Related to Mitigation Strategy in Dharmais National Cancer Center Hospital, Indonesia

Aim: To describe the clinical data and disease severity of thoracic malignancy patients with COVID-19 and its relation to the mitigation process at the Dharmais National Cancer Center, Indonesia.&#x0D; Methods: Total 5256 cancer patients registered from May 2020 to March 2021. There were 681 cancer patients diagnosed with COVID-19. Forty-five thoracic malignancy patients were enrolled. Data from medical records were obtained at the Dharmais Cancer Hospital, then analyzed using SPSS version 25. Comparative result was considered significant, as p-value &lt; 0.05.&#x0D; Results: There were 12.9% of total patients registered infected by COVID-19, which 6% with thoracic malignancy dominated by Non-small cell lung carcinoma (57.8%). Patients who have asymptomatic (31.1%), mild (13.3%), and moderate COVID-19 disease (8.9%) were alive. Patient with severe disease (46.7%) tend to deteriorate. Neutrophilia (mean 78.0%), lymphopenia (mean 13.0%), high neutrophil to lymphocyte ratio (mean 13.1), hyperuricemia (mean 31.6 mg/dL), high fibrinogen (mean 521.7 mg/dL), and high d-dimer (mean 3821.6 ng/mL) were significantly associated with disease severity (p-value &lt; 0.05).&#x0D; Conclusions: Only small number of cancer patients affected by COVID-19 and mostly do not progress to severe disease, showing the strict mitigation strategy was successful. Severe disease patients have a poor prognosis, with neutrophilia, lymphopenia, high neutrophil to lymphocyte ratio, hyperuricemia, high fibrinogen, and high d-dimer may be valuable for predicting poor prognosis.

Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as mortality predictor of advanced stage non-small cell lung cancer (NSCLC) with COVID-19 in Indonesia.

This study aimed to compare the mortality rate between advanced-stage non-small cell lung cancer patients (NSCLC) with and without COVID-19. This study also explores the possible laboratory characteristics used for prognostication in patients with NSCLC and COVID-19. Additionally, this study evaluated potential differences in laboratory values between the case and control groups. This is a single-center retrospective cohort study conducted in Dharmais National Cancer Hospital, Indonesia, enrolling patients with NSCLC undergoing chemotherapy or targeted therapy between May 2020 and January 2021. All patients with NSCLC and COVID-19 in these periods were enrolled into the case group. The control group was age-matched NSCLC patients without COVID-19 that was derived from the NSCLC cohort through randomization. There were 342 patients with NSCLC between May 2020 and January 2021. Twenty-seven (7.9%) of the patients were infected by COVID-19. To facilitate comparison, thirty-five age-matched controls with NSCLC were selected from the cohort. The mortality rate in patients with COVID-19 was 46.2%. Eleven patients (40.7%) had severe COVID-19, of which none survived. NLR >8.35 has a sensitivity of 83.3%, specificity of 92.9%, LR+ of 12, and LR- of 0.18. The AUC was 0.946 (95% CI 0.867-1.000), p<0.001. PLR >29.14 has a sensitivity of 75.0%, specificity of 71.4%, LR+ 2.62, LR- 0.35, and AUC 0.851 (95% CI 0.706-0.996), p=0.002. Both NLR and PLR were associated with shorter time-to-mortality in the unadjusted and adjusted model CONCLUSIONS: NLR and PLR are independent predictors of mortality in COVID-19 patients with NSCLC.

TPMT Genetic Variability and Its Association with Hematotoxicity in Indonesian Children with Acute Lymphoblastic Leukemia in Maintenance Therapy.

PurposeHematotoxicity monitoring in children with acute lymphoblastic leukemia (ALL) is critical to preventing life-threatening infections and drug discontinuation. The primary drug that causes hematotoxicity in ALL children is 6-mercaptopurine (6-MP). Genetic variability of the drug-metabolizing enzymes of 6-MP, thiopurine S-methyltransferase (TPMT), is one factor that might increase the susceptibility of children to hematotoxicity. The present study aimed to determine the variability in TPMT genotypes and phenotypes and its association with the occurrence of hematotoxicity in ALL children in maintenance therapy.Patients and MethodsA cross-sectional study was conducted at Cipto Mangunkusumo and Dharmais National Cancer Hospital, Jakarta, Indonesia, from June 2017 to October 2018. We included ALL patients, 1–18 years, who were receiving at least one month of 6-MP during maintenance therapy according to the Indonesian protocol for ALL 2013. Direct sequencing was used to determine TPMT*3A, *3B, and *3C genotypes, and LC-MS/MS analysis was performed to measure the plasma concentrations of 6-MP and its metabolites. Association analysis between the TPMT genotype and hematotoxicity was evaluated using the unpaired t-test or Mann–Whitney’s test.ResultsThe prevalence of neutropenia, anemia, and thrombocytopenia in ALL children during maintenance therapy was 51.9%, 44.3%, and 6.6%, respectively. We found a low frequency of TPMT*3C, which is 0.95%. No association was found between hematotoxicity and TPMT genotypes or age, nutritional status, serum albumin levels, risk stratification, the daily dose of 6-MP, and cotrimoxazole co-administration. However, hematotoxicity was associated with 6-methylmercaptopurine (6-MeMP) plasma concentrations and the ratio 6-MeMP/6-thioguanine (6-TGN). We also found no association between TPMT genotypes and TPMT phenotypes.ConclusionThe 6-MeMP/6-TGN ratio is associated with hematotoxicity in ALL children during maintenance therapy but is not strong enough to predict hematotoxicity.

The alpha-fetoprotein serum is still reliable as a biomarker for the surveillance of hepatocellular carcinoma in Indonesia

Background and aimsHepatocellular carcinoma (HCC), the most common type of liver cancer, is one of the leading causes of cancer-related death worldwide with an inferior prognosis. In Indonesia, the average life expectancy is less than 5 months, with most patients being in an advanced stage wherein the survival rate is very low. Early detection through surveillance program is very crucial. HCC guidelines worldwide have provided surveillance recommendation through the examination of α-fetoprotein (AFP) and ultrasound for patients at risk in developing HCC. However, there have been some controversies regarding the usage of AFP concerning its low sensitivity and specificity in detecting HCC. Therefore, the effectiveness of AFP in the surveillance of HCC patients and identifying the parameters most associated with the increase of AFP ≥ 10 ng/ml in Indonesia should be evaluated.MethodsWe analyzed medical records of HCC patients and those at high risk of developing HCC through cross-sectional study, including patients with cirrhosis and hepatitis B and C, from 2015 to 2017 who underwent treatment at the Cipto Mangunkusumo National General Hospital and Dharmais National Cancer Hospital, Indonesia.ResultsThe sensitivity and specificity of AFP in the surveillance of HCC in Indonesia with a cut-off of 10 ng/ml were 82.6 and 71.2%, respectively. The parameters most associated with the increase of AFP ≥10 ng/ml according to multivariate analysis were the etiology of hepatitis B, the stage of Barcelona Clinic Liver Cancer (BCLC) B and C, and the presence of cirrhosis, respectively.ConclusionAFP can still be used in the surveillance of HCC in Indonesia for its high sensitivity value.

Spontaneous Regression of Divided Nevus of the Eyelid Evaluated by Dermoscopy : Is it Hypopigmentation After Regression or Vitiligo

Background: Divided nevus, also known as &ldquo;kissing nevus ,&rdquo; is a rare form of congenital melanocytic nevus that occurs on opposing margins of upper and lower eyelids. A paucity of literature on this rare anomaly exists , with most being case reports and series. Moreover, regression of this lesion was rarely reported. Case Illustration : We present a rare case of congenital divided nevus of the eyelid that regressed after eight years, confirmed with dermoscopy. A six -year-old boy presented to the Dharmais National Cancer Hospital with two pigmented macules on the upper and lower right eyelid since birth. A year ago, the lesions started gradually disappearing and were replaced by a hypopigmented area . We evaluated the clinical and dermoscopic findings for two consecutive years. The dermoscopy showed pseudopigment networks, surrounded by a hypopigmented area resembling a halo. The pigmented lesions cleared with no residual lesions. Discussion : The dermoscopic findings of the patient resemble a solar lentigo characterized by pseudopigment networks, a feature caused by the relatively flattened rete ridge on the face. The hypopigmented area reflects a regression process, like the halo nevus, and is accompanied by leukotrichia of the eyelashes, a feature usually found in patients with vitiligo. Regression of the divided nevus is related to an autoimmune process. A similar mechanism was also found in vitiligo. Since no atypical findings were present in this patient, we recommend only observation. Conclusion : Divided nevus is a rare case. We present a case of congenital divided nevus of the eyelid that regressed spontaneously. Clinical and dermoscopic findings of hypopigmented regression area were similar with vitiligo, which might share similar pathological mechanisms. &nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Keywords: divided nevus, eyelid, regression, dermoscopy, vitiligo

The Potential of Plasminogen Activator Inhibitor-1 as Prognostic Factor of Advanced Breast Cancer

Background: Advanced breast cancer causes problems in morbidity, mortality, quality of life, and low survival rate. Hence, a biomarker to predict the progression of cancer is needed. Plasminogen activator inhibitor-1 (PAI-1) has been known as one of the prognostic factors. However, in vivo studies indicated that PAI-1 has controversial roles. Whether PAI-1 suppresses or promotes the development of cancer, is still being the question. The study aims to examine the role of PAI-1 in predicting the survival rate and its association with clinicopathologic factors in advanced breast cancer. Materials and Methods: The historical cohort analytic method in advanced breast cancer patients was conducted at Dharmais National Cancer Center Hospital. Clinical data were obtained from patients’ medical records. The expression of PAI-1 was assessed through immunohistochemistry assay staining of breast cancer tissue using antibody PAI-1 Santa Cruz Biotechnology, Inc., PAI-1 C-9 sc5297. Survival analysis was done to obtain the prognostic data. Moreover, its association with clinicopathologic factors was analyzed. Results: Fifty-eight subjects were included in this study. There was a significant association between the expression of PAI-1 and survival rate (hazard ratio [HR] = 4.08, 95% confidence interval [CI] = 1.75 - 9.50, p = 0.001). The Kaplan-Meier method indicated significant differences in survival rate between subjects with high expression of PAI1 and those with low expression in advanced breast cancer (p = 0.001). PAI-1 expression had a sensitivity of 84.7% and specificity of 60% based on immunohistochemical score cut off of 90. Furthermore, the expression of PAI-1 showed no significant association with clinicopathological factors except for histopathology grade. (Relative risk [RR] = 1.5, 95%, CI = 1.2 - 1.8, p = 0.047). Conclusion: Advanced breast cancer patients with high expression of PAI-1 have better survival. PAI-1 expression is not associated with clinicopathological factors, except for the histopathological grade.

The prevalence of oral high-risk HPV infection in Indonesian oral squamous cell carcinoma patients.

The objective of this study was to report the integrated observations of high-risk HPV-related oral squamous carcinoma (OSCC) at our national referral center for cancer, the Dharmais National Cancer Hospital (DNCH), Jakarta, from 2003 to 2013. Seventy-eight formalin-fixed paraffin-embedded specimens obtained from OSCC cases were collected from 2003 to 2013 DNCH archives and were included in this high-risk HPV (HR-HPV) study. Seventy-nine DNA samples from the normal oral mucosa of healthy individuals were obtained from the Oral Biology Laboratory DNA archives from 2001 to 2005. Glyceraldehyde 3-phosphate dehydrogenase was used as a control to ensure the DNA integrity for the subsequent HPV DNA PCR detection. High-risk HPV16/18 DNA amplification was conducted by nested PCR using two pairs of primers that were designed specifically to identify the region of gene L1 HPV16 and the HPV16/18 region. A high prevalence of HPV16/18 was detected in OSCC cases (17.9%). HPV18 occurred more often than HPV16 (86%) among OSCC patients who were HPV positive. This result supports high HPV18 prevalence among Indonesian cervical cancer patients studied in 1995 and 2006. The prevalence of high-risk HPV remains low in the normal Indonesian population (3.8%), but HPV16 is consistently more frequently detected in non-cancer populations.

Overweight and obesity in patients with cancer: study in Dharmais National Cancer Hospital, Jakarta

Overweight and obesity in patients with cancer: study in Dharmais National Cancer Hospital, Jakarta

Characteristics and treatment response of chronic lymphocytic leukemia patients in Dharmais National Cancer Centre Hospital, Indonesia.

121 Background: Chronic lymphocytic leukemia (CLL) was a common hematological malignancy in America and Europe, but rarely found in Asia. Differences in clinical characteristics and treatment response were suspected. This study aimed to find out characteristics and treatment response of patient with CLL in Dharmais National Cancer Centre Hospital Indonesia. Methods: This was a retrospective cohort study of CLL patients in Dharmais Hospital during 2013-2015. Data were retrieved from medical record included patients’ demography, blood examination, bone marrow puncture, and immunophenotyping. Prognosis factors such as Rai and Binet staging system were studied. Results: A total of 36 CLL patients were retrieved. Most of patients (58.3%) were male. Median age was 58.5 years old. As much as 25.9% of patients were asymptomatic. There were 17 patients (47.2%) with negative CD5, and most of them (63.2%) had isolated splenomegaly (p = 0.019). Twenty patients (55.6%) were high-risk based on Rai staging group, but there were only 14 patients (38.9%) were high-risk based on Binet staging group. Positive CD13 was found in 30.6% patients and classified as high risk Rai (p &lt; 0.001) and Binet (p = 0.043) staging group. Treatment response was available in 12 cases, consisted of 8 (66.7%) partial responses, 3 (25.0%) progressive diseases, and 1 (8.3%) stable disease. Conclusions: Chronic lymphocytic leukemia is a rare disease in Indonesia. Patients tend to be younger and have worse prognosis. Many cases are categorized as high-risk and present without specific clinical symptoms. Early detection is challenging in the future for better management of CLL cases.