Analisis Nilai Mean Platelet Volume pada Penderita Karsinoma Nasofaring yang Mendapat Kemoterapi di RSUP Haji Adam Malik Medan pada Tahun 2015 – 2017

Abstract

Latar belakang: Karsinoma nasofaring (KNF) merupakan salah satu keganasan kepala dan leher endemik di Cina Selatan dan Asia Tenggara dengan angka kelangsungan hidup rendah. Mean Platelet Volume (MPV) dilaporkan sebagai biomarker yang berkorelasi positif dengan karakteristik pasien keganasan sehubungan laju pertumbuhan dan invasi tumor ganas. Modalitas kemoterapi diketahui menurunkan kadar MPV yang dapat digunakan menjadi parameter prediksi respon kemoterapi serta efikasi terapeutik kemoterapi yang diberikan dan selanjutnya berhubungan dengan angka kelangsungan hidup penderita KNF. Tujuan penelitian: Mengetahui perbedaan nilai MPV pada penderita KNF pra kemoterapi dan paska kemoterapi berdasarkan tipe histopatologi. Metode penelitian: Penelitian kohort retrospektif menggunakan data sekunder hasil laboratorium kadar MPV pada rekam medis 138 penderita KNF pra kemoterapi dan paska kemoterapi (kemoterapi full-dose, konkomitan dan neoadjuvan) tiap siklus (siklus I – VI) untuk 3 tipe histopatologi (keratinizing SCC, non keratinizing SCC dan undifferentiated carcinoma) dari Januari 2015 – Desember 2017 di Divisi Onkologi Departemen T.H.T.K.L FK USU/RSUP H. Adam Malik Medan yang kemudian dianalisis dengan repeated ANOVA (p=0.05). Hasil: Tanpa melihat jenis histopatologi, penurunan kadar MPV terbesar terdapat pada jenis kemoterapi konkomitan, dengan rerata penurunan sebesar 0,60 (SD=0,38), diikuti oleh neoadjuvan sebesar 0,39 (SD=0,32) dan full-dose sebesar 0,36 (SD=0,42). Rerata penurunan MPV dari ketiga jenis kemoterapi berbeda secara signifikan (p=0,006). Perubahan kadar MPV pada jenis konkomitan berbeda bermakna bila dibandingkan dengan full-dose (p=0,034) dan neoadjuvan (p=0,002). Penurunan nilai MPV terbesar didapatkan pada pemberian kemoterapi konkomitan, baik terhadap tipe histopatologi keratinizing SCC, non keratinizing SCC dan undifferentiated carcinoma. Pada tipe histopatologi non keratinizing SCC, memiliki rerata perubahan nilai MPV yang berbeda bermakna (p=0,001) terhadap pemberian kemoterapi konkomitan bila dibandingkan dengan full-dose (p=0,026) dan neoadjuvan (p=<0,001), namun rerata perubahan nilai MPV tidak berbeda bermakna pada tipe histopatologi keratinizing SCC dan undifferentiated carcinoma.

Background: Nasopharyngeal carcinoma (NPC) is one of head and neck malignancies, endemic in Southern China and Southeast Asia with low survival rates. Mean Platelet Volume (MPV) is a biomarker positively related to characteristics of patients with malignancies regarding tumor growth and invasion. Chemotherapy acts as a modality decreasing MPV levels that can be used as a predictive parameter of chemotherapy response and its therapeutic efficacy, associated with survival rates of NPC patients. Objective: To demonstrate the differences between pre- and postchemoterapy MPV levels in patients with NPC based on histopathological findings. Methods: A retrospective cohort study in 138 patients with NPC treated with chemotherapy (full-dose, concomitant and neoadjuvant) using secondary data (laboratory findings: MPV levels) of pre- and postchemotherapy per cycle (I - VI) for 3 histopathological findings (keratinizing SCC, non keratinizing SCC and undifferentiated carcinoma) inserted in their medical records at Oncology Division, Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine Universitas Sumatera Utara/Haji Adam Malik General Hospital Medan, January 2015 - December 2017. All data were collected and analyzed by repeated ANOVA (p=0.05) afterwards. Results: By ignoring the histopathological types, the highest decrease in MPV level was found in concomitant chemotherapy, with a mean decrease of 0,60 (SD=0,38), followed by neoadjuvant chemotherapy, with a mean decrease of 0,39 (SD=0,32) and full-dose chemotherapy, with a mean decrease of 0,36 (SD=0,42). The mean decreases in MPV levels affected by those 3 chemoterapy types were significantly different (p=0,006). Changes in MPV levels affected by concomitant chemotherapy were significantly different compared with full-dose chemotherapy (p=0,034) and neoadjuvant chemotherapy (p=0,002). The highest decrease in MPV level was obtained in concomitant chemotherapy for all histopathological types (keratinizing SCC, non keratinizing SCC and undifferentiated carcinoma). In non keratinizing SCC, the mean decrease in MPV level was significantly different (p=0,001) towards concomitant chemotherapy compared with fulldose chemotherapy (p=0,026) and neoadjuvant chemotherapy (p=<0,001). However, the mean decreases in MPV levels for keratinizing SCC and undifferentiated carcinoma were insignificantly different.