Hubungan Ekspresi Vegf dengan Respon Kemoterapi Neoadjuvan Ifosfamide-Cisplatin pada Kanker Serviks Stadium Ib-Iia

Abstract

Objective: To asses the relationship between VEGF expression and neoadjuvant chemotherapy response in stages IB-IIA cervical cancer. Methods: The descriptive and case series study, conducted in the Obstetric and Gynecology Department, Faculty of Medicine of Sumatera Utara University, Adam Malik General Hospital, and Pathology Anatomy Department, Adam Malik General Hospital started January until February 2017. 51 paraffin-embedded of cervical biopsy tissues from the stages IB-IIA cervical cancer’s patients pre-chemotherapy neoadjuvant ifosfamide-cisplatin were collected consecutively and analyzed the VEGF expression. Response to treatment was evaluated based on clinical examination and RECIST criteria. Kolmogorov-Smirnov test performed to analyze statistically. Confidence interval is 95% and p value <0.05 is significance statistically. Result: 20 complete response patients (39.2%) and 31 incomplete response patients (60.8%) were found from 51 patients. The stronger VEGF expression were found in larger cervical mass (> 4 cm), higher stadium (IIA), and incomplete response of neoadjuvant chemotherapy. By Kolmogorov-Smirnov test was found there is significant relationship between VEGF expression and chemotherapy neoadjuvant response in stage IB-IIA cervical cancer. Conclusion: Pre-chemotherapy VEGF expression may provide early assessment of neoadjuvant chemotherapy response that guide anti-angiogenic regimen administration in targeted therapy of stage IB-IIA cervical cancer.

Tujuan: Untuk mengetahui hubungan ekspresi VEGF dengan respon kemoterapi neoadjuvan pada kanker serviks stadium IB-IIA. Metode: Penelitian deskriptifdengan rancangan case-series dilakukan di Departemen Obstetri dan Ginekologi FK USU RSUP H. Adam Malik, dan Departemen Patologi Anatomi RSUP H. Adam Malik Medan mulai bulan Januari sampai Februari 2017. Sebanyak 51 blok parafin dari biopsi jaringan serviks pasien kanker serviks stadium IB-IIA sebelum menjalani kemoterapi neoadjuvan ifosfamide-cisplatin dikumpulkan secara konsekutif dan dilakukan penilaian imunohistokimia ekspresi VEGF. Respon kemoterapi dinilai berdasarkan pemeriksaan klinis dan kriteria RECIST. Analisa data menggunakan uji Kolmogorov-Smirnov. Interval kepercayaan 95% dan p<0.05 bermakna secara statistik. Hasil: Dari 51 blok parafin diperoleh 20 blok parafin (39.2%) dengan respon komplit dan 31 blok parafin (60.8%) dengan respon tidak komplit. Peningkatan ekspresi VEGF dijumpai pada ukuran tumor yang lebih besar (> 4 cm), stadium yang lebih tinggi (stadium IIA), dan respon kemoterapi yang tidak komplit. Dengan uji Kolmogorov-Smirnov diperoleh adanya hubungan yang signifikan antara ekspresi VEGF dengan respon kemoterapi neoadjuvan pada kanker serviks stadium IB-IIA. Kesimpulan: Ekspresi VEGF sebelum kemoterapi neoadjuvan dapat dijadikan penilaian awal terhadap respon kemoterapi neoadjuvan sehingga menjadi dasar dalam pemberian anti-angiogenesis pada targeted therapy kanker serviks stadium IB-IIA nantinya.