Nilai Titik Potong Kadar Angiostatin Urin sebagai Prediktor Keganasan pada Tumor Ovarium Epitel

Abstract

Background: Molecular changes in ovarian cancer are recently observed as a biomarker of tumor growth, one of them is angiogenesis, in which tumor cannot increase their size without angiogenesis. Objective: To determine cut-off value of urinary angiostatin as a malignancy predictor for epithelial ovarian tumor. Method: This diagnostic research took place in Obstetric and Gynecology Department of Faculty of Medicine of Universitas Sumatera Utara, Adam Malik General Hospital, and Pirngadi General Hospital Medan, started from August 2015 until May 2016. Patients with ovarian tumor who had been planned to undergo an elective surgery were taken as samples (consecutive sampling). The research material of this study is 30 cc of mid-stream urine which was taken one day prior to surgery. Data analysis is using Mann Whitney test and Chi Square. Statistical analysis is done to determine the AUC value, cut-off value, sensitivity, specificity, positive predictive value, and negative predictive value of urinary angiostatin. Confidence interval is 95% and p-value <0,05 that is significance statistically. Results: From 80 subjects, there are 74 persons with epithelial ovarian tumor and 34 of them with malignant and another 40 persons with benign form of epithelial ovarian tumor. Mean value of urinary angiostatin in malignant epithelial ovarian tumor is 33.38 ± 20.77 ng/mL that is higher than what we found in benign epithelial ovarian tumor with 10.32 ± 9.85 ng/mL (p<0.05). AUC value is 83,3% (95% CI 73.7-92.9%; p<0.05) and cut off point of urinary angiostatin is ≥21.08 ng/mL with sensitivity 76.5%, specificity 77.5%, positive predictive value 74.3% and negative predictive value 79.5%. There is a relationship between the increase of urinary angiostatin with the event of malignant epithelial ovarian tumor with OR 11.194 (95% CI 3.78-33.15; p<0.05). Conclusion: Urinary angiostatin could be used as a diagnostic modality to screen a malignant epithelial ovarian tumor.

Latar Belakang: perubahan molekuler pada kanker ovarium belakangan diteliti sebagai biomarker pertumbuhan tumor, salah satunya adalah proses angiogenesis dimana tumor tidak dapat berkembang tanpa angiogenesis. Tujuan: mengetahui nilai titik potong kadar angiostatin urin sebagai prediktor keganasan pada tumor ovarium epitel. Metode: penelitian diagnostik yang dilakukan di Departemen Obstetri dan Ginekologi FK USU RSUP H. Adam Malik dan RSUD Dr. Pirngadi Medan, mulai bulan Agustus 2015- Mei 2016. Sampel penelitian adalah pasien tumor ovarium yang telah direncanakan operasi elektif (consecutive sampling) dengan mengambil urin porsi tengah sebanyak 30 ml satu hari sebelum operasi. Analisa data menggunakan uji Mann Whitney dan Kai kuadrat. Statistik analitik dilakukan untuk mengetahui nilai AUC,nilai titik potong, sensitivitas, spesifisitas, nilai duga positif, dan nilai duga negatif angiostatin urin. Interval kepercayaan 95% dan p<0,05 bermakna secara statistik. Hasil: Dari 80 subjek penelitian diperoleh 74 orang tumor ovarium epitel yaitu 34 orang tumor ovarium epitel ganas dan 40 orang tumor ovarium epitel jinak. Rerata kadar angiostatin urin tumor ovarium epitel ganas 33.38 ± 20.77 ng/ml lebih tinggi dari tumor ovarium epitel jinak 10.32 ± 9.85 ng/ml (p<0.05). Didapatkan nilai AUC 83.3% (95% IK 73.7-92.9%; p<0.05) dan cut off point angiostatin urin ≥21.08 ng/ml dengan sensitivitas 76.5%, spesifisitas 77.5%, nilai duga positif 74.3%, dan nilai duga negatif 79.5%. Diketahui adanya hubungan peningkatan kadar angiostatin urin dengan kejadian tumor ovarium epitel ganas dengan OR 11.194 (95% IK 3.78-33.15; p<0.05). Simpulan: angiostatin urin dapat dijadikan sebagai alat diagnostik untuk menapis tumor ovarium epitel ganas.