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The Outcomes of Primary Debulking Surgery and Neoadjuvant Chemotherapy in Advanced Ovarian Cancer Rinaldy, Dino; Andrijono, Andrijono; Sutrisna, Bambang
Indonesian Journal of Obstetrics and Gynecology Volume. 4, No. 2, April 2016
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To compare the outcomes and survival rate of primary debulking surgery with neoadjuvant chemotherapy. Method: We selected advanced ovarian cancer patients from medical records. Subjects were allocated into groups of primary debulking surgery and neoajuvant chemotherapy by considering the inclusion and exclusion criteria. We analyzed the data using T test, Fisher’s exact, and chi-square. The survival rate was presented in Kaplan Meier curve, whereas the significance was tested with Logrank. We managed the data using STRATA software version 12. Result: We obtained 32 cases of primary debulking surgery group and 20 cases of the neoadjuvant chemotherapy group. Most of the subjects (44.2%) were 40-49 years old and 80.8% had delivered more than twice. The mean value of Ca-125 at admission was 3,594.8 u/ml (range 66.6 to 73,000 u/ml). Total of 31 subjects showed the serous histologic type (59.6%). There was no association between primary debulking surgery and neoadjuvant chemotherapy for the parameter of operative time, blood loss, organs injury, ICU stay, and hospital stay (p>0.05). Primary debulking surgery had a survival rate similar to neoadjuvant chemotherapy group (p=0.95). Conclusion: The perioperative outcomes of advanced ovarian cancer patients has similar result between primary debulking surgery and neoadjuvant chemotherapy. Primary debulking surgery has a survival rate similar to neoadjuvant chemotherapy group. [Indones J Obstet Gynecol 2016; 4-2: 111-115] Keywords: advanced ovarian cancer, neoadjuvant chemotherapy, primary debulking surgery

Incidence of Pelvic and Paraaortic Lymph Node Metastasis in Epithelial Ovarian Cancer at a Tertiary Care Center Andrijono, Andrijono; Risfiandi, Risa
Indonesian Journal of Obstetrics and Gynecology Volume 6. No. 1. January 2018
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To investigate the incidence of pelvic and paraaorticlymph node metastasis in epithelial ovarian cancer.Methods: This was a cross-sectional study. Data were collectedfrom medical records, and from the cancer registry 1539 medicalrecords were obtained. From there, 863 patients were operatedand 676 were not, and only 401 medical records were foundcomplete, and 306 samples were excluded because they have beentreated with NAC and underwent surgery, patients who underwentsurgery but the results is not the epithelium, and patients whounderwent surgery, but the results were benign or borderline. And95 patients who underwent primary surgery and lymphadenectomyonly 55 patients have results in lymphadenectomy. This study usesa calculation of sample size with categorial descriptions, withprecision of 3% then obtained a minimum sample size of 261patients.Results: According to the characteristics of the study subjectsabove, the results were stage I, II, III respectively 60%, 10.9%, and29%. The metastasized of the lymph node paraaortic 9.1%, andpelvic/paraaortic 20% pelvic/paraaortic23.6%. Based on thedegree of differentiation the results were good differentiation30.9%, moderate differentiation 23.6%, and poor differentiation45.5%. We found that paraaortic lymph node metastasis weremost frequent at stadium III (43.8%). In relationship betweenlymph node metastasis with differentiation of epithelial ovariancancer, the most frequent epithelial ovarian cancer were one withpoor differentiation in pelvic/paraaortic lymph node with the sumof 69.2%. From analysis, there is significant difference betweenserous hystologic subtype with mucinosum subtype in pelviclymph node, significant difference between serous hystologicsubtype and clear cell in paraorta or pelvic lymph node andbetween the serous histology subtype and mucinous as well.Conclusion: Lymph node metastasis incident of ovarian epithelialcancer in paraaorta amounts 20%, pelvic 9.1% and pelvic orparaaortic 23.6%. Higher the stadium, the lymph node involvementswill be higher as well (pelvic and paraaortic). In stadium 1of mucinous subtype with well differentiation has minimal lymphnode involvement so we can be more selective in considering therisk and benefit of lymphadenectomy.[Indones J Obstet Gynecol 2018; 6-1: 60-63]Keywords: lymph node metastasis, ovarian cancer

Survival and Side Effects of Cisplatin/Cyclophosphamide and Carboplatin/Paclitaxel Adjuvant Chemotherapy in Stage IC-IV Ovarian Cancer Markus, Unedo H; Winarto, Hariyono; Andrijono, Andrijono; Sutrisna, Bambang
Indonesian Journal of Obstetrics and Gynecology Volume. 3, no. 2, April 2015
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To compare the survival and side effects in epithelial ovarian cancer patients receiving adjuvant chemotherapy of cisplatin/ cyclophosphamide and carboplatin/paclitaxel. Method: We recruited epithelial ovarian cancer patients receiving cisplatin/cyclophosphamide (group A) or carboplatin/paclitaxel (group B) adjuvant chemotherapy after surgery. Chemotherapy was given for six cycles. Overall survival and side effects were assessed. Result: A total of 49 patients were recruited, consisting of 25 patients for group A and 24 patients for group B. In this study, the overall survival of stage IC-IV ovarian cancer patients was 37.3 months in group A (95%CI=31.86-43.46) and 35.5 months (95%CI= 13.93- 43.46) in group B (p

A Simple Ultrasound Examination as Diagnostic Tool for Malignant Ovarian Tumor Wigin, Christin; Andrijono, Andrijono
Indonesian Journal of Obstetrics and Gynecology Volume 4, No. 4, October 2016
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To know the diagnostic value of simple ultrasound examination to detect malignant ovarian tumor. Method: This study used cross-sectional design in gynecology outpatientclinic at Dr. Cipto Mangunkusumo Hospital. We recruited the patients with ovarian tumor undergoing surgery between March and July 2015. Samples were taken using consecutive sampling. Analysis was done using Chi-square test and logistic regression to find the relationship between ultrasound morphologic patterns with histopathologic findings, where the significant relationship was p value less than 0.05. Furthermore, a model derived from logistic regression was made to calculate the probability having ovarian malignancy. Result: There were 80 subjects which 58 subjects (72.5%) had benign tumor and 22 subjects (27.5%) had malignant tumor. Ultrasound examination result using  2 morphologic patterns gave malignant result in 53.8% subjects with the sensitivity of 100%, specificity of 82.8%, positive predictive value of 68.8%, and negative predictive value of 100%. The most important patterns were irregular internal cyst wall, multilocular, presence of papillary projection, and presence of solid component. The probability of subject having ovarian malignancy with  3 morphologic patterns was more than 88.9%. Conclusion: Simple ultrasound examination can be used to detect malignant ovarian tumor. [Indones J Obstet Gynecol 2016; 4-4: 222-226] Keywords: diagnostic, histopathology, morphology pattern; ovarian tumor; ultrasonography

CD133, CD44, and ALDH1A1 as cancer stem cell markers and prognostic factors in epithelial ovarian cancer Andrijono, Andrijono; Sutrisna, Bambang; Harahap, Alida Roswita; Kanoko, Mpu; Nuranna, Laila; Siregar, Budiningsih; Wulandari, Dewi; Pelupessy, Nugraha Utama
Medical Journal of Indonesia Vol 28, No 1 (2019): March
Publisher : Faculty of Medicine Universitas Indonesia

BACKGROUND Ovarian cancer is a heterogeneous disease, and most patients are diagnosed at an advanced stage. Epithelial ovarian cancer type II is characterized by rapid tumor growth and is genetically more labile than type I. This study was aimed to demonstrate the prognostic value of CSC by using the markers CD133, CD44, and ALDH1A1 in EOC.METHODS Clinicopathological and demographic data were collected from medical records. The markers CD133, CD44, and ALDH1A1 were examined with flow cytometry and immunohistochemistry. Cancer stem cell (CSC) marker expression in patients with ovarian cancer types I and II were related to chemotherapy and survival. In multivariate analysis, the prognosis model was tested for ten months.RESULTS The largest demographic consisted of patients aged ≥45 years, with stage I, poor differentiation, and type II, of which there were 40 samples (72.7%), 23 samples (41.8%), 30 samples (54.5%), and 16 samples (29.1%), respectively. There is a high correlation between the 10-month chemotherapy response and the 4 variables, i.e., age ≥45 years, type II, stage III–IV, and CD44, with an ROC of 80.75% and a post-test probability of 82.5%. Using the ROC curve, the highest chemoresistance score was 0.841, based on the combination of CSCs markers and clinicopathological factors, that is stage III–IV, age ≥45 years, poor differentiation, type II, negative CD133, high CD44, and high ALDH1A1.CONCLUSIONS CSC (CD133, CD44, and ALDH1A1) markers and clinicopathological factors are prognostic of epithelial ovarian cancer.

Survival and Side Effects of Cisplatin/Cyclophosphamide and Carboplatin/Paclitaxel Adjuvant Chemotherapy in Stage IC-IV Ovarian Cancer Markus, Unedo H; Winarto, Hariyono; Andrijono, Andrijono; Sutrisna, Bambang
Indonesian Journal of Obstetrics and Gynecology Volume. 3, no. 2, April 2015
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To compare the survival and side effects in epithelial ovarian cancer patients receiving adjuvant chemotherapy of cisplatin/ cyclophosphamide and carboplatin/paclitaxel. Method: We recruited epithelial ovarian cancer patients receiving cisplatin/cyclophosphamide (group A) or carboplatin/paclitaxel (group B) adjuvant chemotherapy after surgery. Chemotherapy was given for six cycles. Overall survival and side effects were assessed. Result: A total of 49 patients were recruited, consisting of 25 patients for group A and 24 patients for group B. In this study, the overall survival of stage IC-IV ovarian cancer patients was 37.3 months in group A (95%CI=31.86-43.46) and 35.5 months (95%CI= 13.93- 43.46) in group B (p

Effect of Smoking on Advanced Stage Cervical Cancer Patient Survival Pradipta, Bram; Andrijono, Andrijono; Fuady, Ahmad
Indonesian Journal of Obstetrics and Gynecology Volume. 3, No. 3, July 2015
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: The researchers aim to investigate the relationship between smoking habit and other factors as prognostic factors of cervical cancer. Method: We performed a retrospective and prospective cohort study with subjects that are stage IIB-IVB cervical cancer patients in Dr. Cipto Mangunkusumo Hospital followed up from August 2009 to April 2014. The subjects’medical records were reviewed, and patients were interviewed about their current condition by telephone. Questions asked include smoking habit, spouse’s smoking habit, and mortality status. Patients that could not be contacted by phone were excluded from the study. Statistical analysis was done using Stata 10. Result: Out of 390 cervical cancer patients stage IIB-IVB in 2009, there were 270 patients (69.2%) that were included in the inclusion criteria. Most of the patients are 40-59 years old (82.2%) and are nonsmokers (91.8%). The most frequent clinicopathological characteristic is IIIB (63.3%) and squamous cell carcinoma (71.9%). The 5- year survival rate is 22.6%. There is no statistical significance between advanced stage cervical cancer survival with the patients’ or patients’ husbands’ smoking habit. Conclusion: In our study, smoking habits do not aggravate survival rate of advanced stage cervical cancer patients but further research must be done with more sample. Stage, and tumor size both by physical examination and ultrasound can be used as the prognostic factor. [Indones J Obstet Gynecol 2015; 3: 170-176] Keywords: Brigmann Index, cervical cancer, smoking, survival

The Outcomes of Primary Debulking Surgery and Neoadjuvant Chemotherapy in Advanced Ovarian Cancer Rinaldy, Dino; Andrijono, Andrijono; Sutrisna, Bambang
Indonesian Journal of Obstetrics and Gynecology Volume. 4, No. 2, April 2016
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To compare the outcomes and survival rate of primary debulking surgery with neoadjuvant chemotherapy. Method: We selected advanced ovarian cancer patients from medical records. Subjects were allocated into groups of primary debulking surgery and neoajuvant chemotherapy by considering the inclusion and exclusion criteria. We analyzed the data using T test, Fisher’s exact, and chi-square. The survival rate was presented in Kaplan Meier curve, whereas the significance was tested with Logrank. We managed the data using STRATA software version 12. Result: We obtained 32 cases of primary debulking surgery group and 20 cases of the neoadjuvant chemotherapy group. Most of the subjects (44.2%) were 40-49 years old and 80.8% had delivered more than twice. The mean value of Ca-125 at admission was 3,594.8 u/ml (range 66.6 to 73,000 u/ml). Total of 31 subjects showed the serous histologic type (59.6%). There was no association between primary debulking surgery and neoadjuvant chemotherapy for the parameter of operative time, blood loss, organs injury, ICU stay, and hospital stay (p>0.05). Primary debulking surgery had a survival rate similar to neoadjuvant chemotherapy group (p=0.95). Conclusion: The perioperative outcomes of advanced ovarian cancer patients has similar result between primary debulking surgery and neoadjuvant chemotherapy. Primary debulking surgery has a survival rate similar to neoadjuvant chemotherapy group. [Indones J Obstet Gynecol 2016; 4-2: 111-115] Keywords: advanced ovarian cancer, neoadjuvant chemotherapy, primary debulking surgery

Serum Level of Vascular Endothelial Growth Factor (VEGF) can be used to Assess Response of Radiation Therapy in Cervical Cancer Armanza, Ferry; Andrijono, Andrijono; Sutrisna, Bambang
Indonesian Journal of Obstetrics and Gynecology Volume. 2, No. 1, January 2014
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To compare the sensitivity and specificity of Squamous Cell Carcinoma (SCC) and Vascular Endothelial Growth Factor (VEGF) levels to assess the response of radiation therapy. Method: The study was conducted by the method of analytic observational cohort study in 24 patients with cervical cancer stage II-B and III-B in RSCM that met inclusion criteria. Examination of VEGF and SCC in serum samples was performed in the Prodia Laboratory Jakarta. The examination was conducted twice before and after radiation therapy. The subjects were treated by radiation therapy/chemoradiation according to standard procedures. After the completion of radiation was declared, the response of radiation therapy was conducted by clinical assessment. Result: Of the 24 subjects, we obtained a mean level of SCC pre-radiation was 23.43 ± 5.84 ng/ml and post-radiation was 2.19 ± 0.68 ng/ml. The mean VEGF pre-radiation was 790.41 ± 111.06 pg/ml and post-radiation was 497.47 ± 79.26 pg/ml. ROC curves of each tumor marker obtained SCC pre-radiation AUC 40%, p 0.53 (CI 0.18-0.68) and SCC post-radiation AUC 48.1%, p 0.91 (CI 0.21-0,75) can not be used as a diagnostic and prognostic factors of response to radiation therapy. VEGF pre-radiation produced an AUC of 17.5%, p 0.04 (CI 0.00-0.36), thus cannot be used as a prognostic factor for response to radiation therapy. VEGF after radiation produced an AUC of 92.5%, p 0.01 (CI 0.81-1.00), thus can be a diagnostic factor for response to radiation therapy. VEGF post-radiation with cut-off point 614.75 pg/ml had a sensitivity 80%, specificity 75%, NDP 94.12%, NDN 42.86%; RKP 3.2; RKN 0.26 and accuracy 79.16%. There is a significant correlation between the decrease of serum VEGF level post-radiation and a positive response of radiation therapy (p 0.01, CI 1.00-3.23). Conclusion: Examination of VEGF levels can be used to assess the response of radiation therapy with a sensitivity of 80% and specificity of 75%.  Keywords: cervical cancer, SCC, therapeutic response, VEGF

A Simple Ultrasound Examination as Diagnostic Tool for Malignant Ovarian Tumor Wigin, Christin; Andrijono, Andrijono
Indonesian Journal of Obstetrics and Gynecology Volume 4, No. 4, October 2016
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To know the diagnostic value of simple ultrasound examination to detect malignant ovarian tumor. Method: This study used cross-sectional design in gynecology outpatientclinic at Dr. Cipto Mangunkusumo Hospital. We recruited the patients with ovarian tumor undergoing surgery between March and July 2015. Samples were taken using consecutive sampling. Analysis was done using Chi-square test and logistic regression to find the relationship between ultrasound morphologic patterns with histopathologic findings, where the significant relationship was p value less than 0.05. Furthermore, a model derived from logistic regression was made to calculate the probability having ovarian malignancy. Result: There were 80 subjects which 58 subjects (72.5%) had benign tumor and 22 subjects (27.5%) had malignant tumor. Ultrasound examination result using  2 morphologic patterns gave malignant result in 53.8% subjects with the sensitivity of 100%, specificity of 82.8%, positive predictive value of 68.8%, and negative predictive value of 100%. The most important patterns were irregular internal cyst wall, multilocular, presence of papillary projection, and presence of solid component. The probability of subject having ovarian malignancy with  3 morphologic patterns was more than 88.9%. Conclusion: Simple ultrasound examination can be used to detect malignant ovarian tumor. [Indones J Obstet Gynecol 2016; 4-4: 222-226] Keywords: diagnostic, histopathology, morphology pattern; ovarian tumor; ultrasonography

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