Hubungan Ekspresi Imunohistokimia Fibroblast Activation Protein (Fap) dengan Grading Histopatologi dan Tumor-Stroma Ratio (Tsr) Pada Adenokarsinoma Kolorektal

Abstract

Colorectal adenocarcinoma is a malignancy of the large intestine (colon and rectum) of epithelial origin, ranks third in the world, and the second leading cause of cancer death. The prognosis can be assessed based on the reaction of the tumor microenvironment that plays a role in the stage of cancer development. Immunohistochemical examination of Fibroblast Activation Protein (FAP) as well as assessment of grading and how the ratio between the extent of tumor and stroma (Tumor- Stroma Ratio) has recently been one of the prognostic predictors of colorectal adenocarcinoma. Objective : To analyze the relationship of immunohistochemical expression of Fibroblast Activation Protein (FAP) with histopathological grading and Tumor-Stroma Ratio (TSR) in colorectal adenocarcinoma. Materials and Methods : 32 samples in the form of histopathological slides from surgical tissue with a diagnosis of colorectal adenocarcinoma, reviewed slides and assessed for grading and TSR scores, then performed immunohistochemical staining of Fibroblast Activation Protein (FAP) and assessed the expression, then analyzed for correlation between variables using the Somers'd correlation test. Results : The most histopathological grading distribution was low grade, the highest TSR was TSR-High, and the highest FAP expression found was strong expression. Based on the Somer's d correlation test, it was found that there was a significant correlation between FAP expression and grading (p=0.037) and there was no significant correlation between FAP expression and TSR (p=0.244). Conclusion : The tumor microenvironment is one of the prognostic predictor factors in colorectal adenocarcinoma patients, should be reported in the routine pathology report and further investigated how the stromal component and the role of FAP expression to open the possibility of other targeted therapies.

Adenokarsinoma kolorektal adalah keganasan usus besar (kolon dan rektum) yang berasal dari epitelial. Karsinoma kolorektal menempati urutan ketiga terbanyak di dunia, dan urutan kedua penyebab kematian akibat kanker. Prognosis karsinoma kolorektal bisa dinilai berdasarkan reaksi lingkungan mikro tumor yang berperan dalam tahap perkembangan kanker. Pemeriksaan imunohistomikia Fibroblast Activation Protein (FAP) serta penilaian grading dan bagaimana rasio antara luasnya tumor dan stroma (Tumor-Stroma Ratio) akhir-akhir ini merupakan salah satu faktor prediktor prognostik pada adenokarsinoma kolorektal. Tujuan : Menganalisis hubungan ekspresi imunohistokimia Fibroblast Activation Protein (FAP) dengan grading histopatologi dan Tumor-Stroma Ratio (TSR) pada adenokarsinoma kolorektal. Bahan dan Metode : 32 sampel berupa slide histopatologi dari jaringan operasi dengan diagnosis adenokarsinoma kolorektal, dilakukan review slide dan dinilai grading dan skor TSR oleh peneliti dan 2 (dua) orang ahli Patologi Anatomik, kemudian dilakukan pewarnaan imunohistokimia Fibroblast Activation Protein (FAP) serta dinilai ekspresinya kemudian dianalisis korelasi antar variabel menggunakan Uji Korelasi Somers’d. Hasil : Distribusi grading histopalogi terbanyak adalah low grade, TSR terbanyak adalah TSR-High, dan ekspresi FAP terbanyak dijumpai adalah ekspresi kuat. Berdasarkan uji korelasi Somer’s d didapatkan bahwa terdapat korelasi yang signifikan ekspresi FAP dengan grading (p=0.037) dan tidak terdapat korelasi yang signifikan antara ekspresi FAP dengan TSR (p=0,244). Simpulan : Lingkungan mikro tumor merupakan salah satu faktor predictor prognostik pada pasien adenokarsinoma kolorektal, harus dilaporkan dalam laporan rutin patologi dan diteliti lebih jauh bagaimana komponen stroma dan peranan ekspresi FAP untuk membuka kemungkinan terapi target lainnya.