Hubungan Indeks Tumor Budding dengan Grading pada Infiltrating Urothelial Carcinoma

Abstract

Background: Bladder cancer is the 11th most common cancer in the world and ranks fourteenth in Indonesia. Tumor grading should be reported for invasive carcinoma, because histopathological grading is one of the important prognostic factors in infiltrating urothelial carcinoma. In addition to some established prognostic factors, it is important to identify additional independent prognostics in infiltrating urothelial carcinoma. Tumor budding has been studied extensively and has been established as a prognostic factor in several types of carcinoma and has relevance to a much higher risk of local and recurrence and lower survival. Research on tumor budding is still very rarely carried out on infiltrating urothelial carcinoma and in Indonesia there is no published journal related to tumor budding in infiltrating urothelial carcinoma. Objective: To analyze the correlation of tumor budding index and grading as an independent prognostic factor for infiltrating urothelial carcinoma. Method: The study sample consisted of 36 samples from the paraffin blocks of the patients who had been diagnosed and reviewed by two pathologists as infiltrating urothelial carcinoma that met the inclusion and exclusion criteria. Tumor budding index was categorized as <10 buds (low grade) and ≥ 10 buds (high grade) with hematoxylin & eosin staining. Grading infiltrating urothelial carcinoma is divided into two as low grade and high grade and is assessed based on cell morphology. The correlation between tumor budding index and grading in infiltrating urothelial carcinoma will be analyzed statistically. Results: The largest number of ages was 56-65 years, with a mean age of 62 years. Male was found more than female. The highest grading is high grade (92.11%). There are 7 histopathological subtypes from 13 histopathological subtypes, the majority of samples are infiltrating urothelial carcinoma with squamous differentiation. LVI was found in 33 cases (57.1%), and PNI was found in 8 cases (21.4%). Budding tumors were mostly found with high grade buds at 92.10%. This study also showed a significant correlation between the tumor budding index and the grading of infiltrating urothelial carcinoma (p-value = 0.0001).

Latar Belakang: Kanker kandung kemih secara umum merupakan 11 penyakit kanker terbanyak di dunia dan menduduki urutan keempat belas di Indonesia. Grading tumor harus dilaporkan untuk karsinoma invasif, karena grading histopatologi merupakan salah satu faktor prognostik penting pada infiltrating urothelial carcinoma. Selain beberapa faktor prognostik yang telah ditetapkan, penting untuk mengidentifikasi prognostik tambahan yang independen pada infiltrating urothelial carcinoma. Tumor budding telah dipelajari secara luas dan telah ditetapkan sebagai faktor prognostik pada beberapa jenis karsinoma serta memiliki relevansi terhadap risiko kekambuhan lokal dan jauh yang lebih tinggi dan kelangsungan hidup yang lebih rendah. Penelitian tumor budding ini masih sangat jarang dilakukan pada infiltrating urothelial carcinoma dan di Indonesia belum ada jurnal yang dipublikasikan terkait tumor budding pada infiltrating urothelial carcinoma. Tujuan: Menganalisis hubungan indeks tumor budding dengan grading sebagai faktor prognostik yang independen pada infiltrating urothelial carcinoma. Metode: Sampel penelitian berjumlah 38 sampel yang berasal dari blok paraffin penderita yang telah didiagnosis dan direview ulang oleh dua ahli patologi sebagai infiltrating urothelial carcinoma yang memenuhi kriteria inklusi dan eksklusi. Index tumor budding dikategorikan sebagai < 10 buds (low grade) dan ≥ 10 buds (high grade) dengan pewarnaan hematoxylin & eosin. Grading infiltrating urothelial carcinoma dibagi menjadi dua, yaitu low grade dan high grade dan dinilai berdasarkan morfologi sel. Hubungan indeks tumor budding dengan grading pada infiltrating urothelial carcinoma diuji secara statistik. Hasil: Usia terbanyak 56-65 tahun, dengan rerata usia 62 tahun. Jenis kelamin laki-laki ditemukan lebih banyak daripada perempuan. Grading terbanyak adalah high grade (92,11%). Terdapat 7 subtipe histopatologi dari 13 subtipe histopatologi, mayoritas sampel merupakan subtipe infiltrating urothelial carcinoma with squamous differentiation. LVI ditemukan pada 33 kasus (57,1%), serta PNI ditemukan pada 8 kasus (21,4%). Tumor budding paling banyak dijumpai high grade buds sebesar 92,10%. Pada penelitian ini juga menunjukkan adanya hubungan signifikan antara indeks tumor budding dengan grading pada infiltrating urothelial carcinoma (p-value=0,0001).