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All Journal Medical Journal of Indonesia Jurnal Farmasi Klinik Indonesia The New Ropanasuri Journal of Surgery Jurnal Ilmu Bedah Indonesia Indonesian Journal of Cancer Acta Neurologica Indonesia
Yulian, Erwin D.
Departemen Bedah Onkologi
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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The Role of Neutrophil-to-Lymphocyte Ratio (NLR) as a Predictor of Lymph Node Metastasis in Papillary Thyroid Carcinoma Patients in Cipto Mangunkusumo Hospital Yulian, Erwin Danil; Andrian, Christopher Rico
Indonesian Journal of Cancer Vol 19, No 4 (2025): December
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v19i4.1398

Abstract

Background: Pre-treatment inflammatory parameters based on blood tests can serve as prognostic predictors in cancer, one of which is an elevated neutrophil-to-lymphocyte ratio (NLR). However, the role of NLR as a predictor of lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) remains controversial. This study was conducted to evaluate the role of NLR as a predictor of LNM in patients with PTC.Method: This cross-sectional analytical study was conducted at RSUPN Dr. Cipto Mangunkusumo from March to September 2024. The research utilized secondary data from the medical records of PTC patients. The receiver operating characteristic (ROC) curve was employed to determine the NLR cut-off value. Bivariate analysis was performed using the Chi-Square test, and multivariate analysis was conducted using multiple logistic regression. A p-value of 0.05 was considered statistically significant.Results: A total of 75 subjects were included in the study. ROC analysis showed an area under the curve (AUC) of 0.656. An NLR cut-off value of 2.34 yielded significant results (p = 0.03; OR = 3.15; 95% CI: 1.22–8.14) with sensitivity and specificity of 64%. Tumor size (p = 0.019), extrathyroidal extension (p 0.001), and papillary thyroid carcinoma variants (p = 0.002) were significantly associated with LNM. Patients with tumor sizes 4 cm had a lower risk of LNM (OR 0.28; 95% CI: 0.11–0.75). After adjusting for confounding variables, multivariate analysis revealed that subjects with high NLR had a 6.17-fold increased risk of LNM (aOR = 6.17; 95% CI: 1.68–22.64). Conclusion: Preoperative NLR in PTC patients is significantly associated with LNM. Tumor size, extrathyroidal extension, and aggressive variants of papillary thyroid carcinoma are significantly associated with LNM and influence the relationship between NLR and LNM.
Evaluation of Vimentin-Positive Circulating Tumor Cells in Breast Cancer and Their Association with Pre and Post-chemotherapy Yulian, Erwin Danil; Utami, Sri Anidyo; Wulandari, Dewi; Kekalih, Aria; Idhil, Andi Nurul Isri Indriany
Indonesian Journal of Cancer Vol. 20 No. 1 (2026): March
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i1.1479

Abstract

Background: Breast cancer is the most common cancer among women worldwide, leading to 670,000 deaths globally in 2022. Epithelial-mesenchymal transition (EMT) plays a role in the metastasis of breast cancer. The EMT process begins with the invasion of cancer cells into surrounding tissues, intravasation into blood vessels, circulating tumor cells (CTCs), evasion of the immune process, and extravasation to a new location. Epithelial cells undergoing EMT are characterized by an increase in mesenchymal markers such as vimentin, which indicates migration of breast cancer cells. Previous studies have shown that EMT contributes to resistance to chemotherapy. This study aims to evaluate pre and post-chemotherapy of vimentin-positive CTCs in breast cancer patients and the association with chemotherapy. Methods: A prospective cohort study at Dr. Cipto Mangunkusumo General Hospital and Koja Hospital, Jakarta, from March to June 2024. This study obtained vimentin-positive CTCs pre- and post-chemotherapy and clinicopathological factors in 24 breast cancer patients. The inclusion criteria were patients diagnosed with breast cancer with histological subtype invasive carcinoma of no special type, and patients were eligible for chemotherapy and continued to receive first-line chemotherapy. Vimentin-positive CTCs were evaluated by using the FITC immunofluorescence technique with a BD FACSLyric flow cytometer. The association between the vimentin-positive CTCs pre- and post-chemotherapy was analysed by using the Wilcoxon test. The Mann-Whitney test was used to analyse the association between the delta number of vimentin CTCs and clinicopathological factorsResults: Total vimentin CTCs pre- and post-chemotherapy were measured in 24 patients. The delta vimentin-positive CTCs were calculated as the difference between total vimentin-positive CTCs pre-chemotherapy minus total CTCs post-chemotherapy. A significant association was observed between the vimentin-positive CTC levels pre- and post-chemotherapy (p = 0.009). Clinicopathological factor analysis showed no significant association between delta CTCs. Conclusions: The vimentin-positive CTC level in breast cancer patients was significantly reduced post received chemotherapy. Due to the small sample size, this study may have limited statistical power. This study suggests further research on vimentin-positive CTCs as predictor factors for chemotherapy response in breast cancer patients.
Factors affecting the Survival of Soft Tissue Sarcoma Patients of the Extremities at Cipto Mangunkusumo Hospital, Indonesia Yulian, Erwin D; Sinaga, Kezia M.; Kartini, Diani; Kekalih, Aria
The New Ropanasuri Journal of Surgery Vol. 8, No. 2
Publisher : UI Scholars Hub

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Abstract

Introduction. The strategy for treating limb soft tissue sarcoma (STS) is challenging due to delayed diagnosis and the non-specific clinical picture, leading to the mortality of nearly 50% of newly diagnosed patients. Various therapeutic modalities have been applied to increase the survival of patients with extremity soft tissue sarcoma. However, clinicopathological factors can influence the survival rate and thus affect the effectiveness of therapy. This study aims to determine the numbers and factors influencing overall survival five years after treatment for patients with soft tissue sarcoma of the extremities at Dr. Cipto Mangunkusumo General Hospital (CMGH) in 2011-2015. Method. A prognostic study was run on patients with complete histopathology who underwent treatment during 2011-2015. Data analysis using the Kaplan-Meier method, cox regression test, and Cox regression with time-dependent variable. Results. A total of 42 were enrolled in the study. The median survival after therapy for patients was six years (3 months – 8.25 years), with a five-year survival of 52.4%. Factors affecting five-year survival were surgical procedures in limb-saving surgery (HR 0.852 95% CI 0.68 – 1.07, p = 0.163). Conclusion. The five-year survival rate of soft tissue sarcomas of the extremities was 52.4%. Overall survival is affected by higher-grade sarcoma, incomplete therapy, and worse clinical stage.
Recurrence Analysis of Pediatric Thyroid Carcinoma in Dr. Cipto Mangunkusumo General Hospital and its associated factors Yulian, Erwin D; Prawirodihardjo, Marlin MP
The New Ropanasuri Journal of Surgery Vol. 9, No. 1
Publisher : UI Scholars Hub

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Introduction. Thyroid cancer is the most common endocrine malignancy in children aged 0-14 years, frequently occurring in adolescents and young adults. The global incidence rate stands at 0.54 cases per 100,000 individuals. Pediatric patients exhibit higher recurrence rates compared to adults, although their mortality rates are low. Research exclusively for the pediatric population is still sparse in Indonesia. Thus, This study aimed to provide essential data on recurrence and mortality rates of pediatric thyroid cancer, along with an analysis of contributing factors. Method. This study is a retrospective cohort focusing on survival analysis. The research sample was drawn from the medical records registry of Cipto Mangunkusumo General Hospital (CMGH) from 2014 to 2020. Inclusion criteria encompassed all pediatric patients (0-18 years) diagnosed with thyroid cancer since January 1, 2014, and with confirmed thyroid cancer pathology results. Bivariate and multivariate analyses and recurrence event analyses proceeded. Results were considered significant at p <0.05. Results. Out of 35 pediatric subjects with thyroid cancer, complete data for analysis were available for 29 patients. The overall median age was 16 (5-18) years. No reported mortality was observed among the subjects. The median overall survival was 60.0 months (32.5-60.0). The overall recurrence rate was 25.0%. None of the factors studied age, sex, histopathology, therapy, and types of surgery affect recurrency (p >0.05). Conclusion. The recurrence rate among pediatric patients with thyroid cancer at CMGH is 25.0%, with a median disease-free survival of 96.0 months. No significant factors contributing to the increased risk of recurrence
Co-Authors Amilya Agustina Andrian, Christopher Rico Aria Kekalih Benyamin Makes Dewi Wulandari Diani Kartini Dyah Ayu Puspita Anggarsari Eka Susanto Esti Soetrisno Fachriza, Ihza Grace Wangge, Grace Hazmi, Mohammad Zul Henry Riyanto Sofyan Idhil, Andi Nurul Isri Indriany Iin Kurnia Irma Savitri Irwan Ramli Nugroho, Nyityasmono Tri Prawirodihardjo, Marlin MP Purnomo, H.S. Wahyu Purnomo, Henricus SW. Radius Kusuma Salim, Adrian Sinaga, Kezia M. Sonar Panigoro Suryadi, Andre S Tiara Aninditha Tiara Aninditha Utami, Sri Anidyo Yang, Andrew J. Zubaidah Alatas