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All Journal The New Ropanasuri Journal of Surgery Indonesian Journal of Cancer
Yusak Kristianto
Universitas Kristen Maranatha
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Comparison of Japanese Classification with the TNM System in the Assessment of Staging in Sigmoid and Rectal Cancer Patients at dr. Cipto Mangunkusumo and Fatmawati General Hospital: A Preliminary Study Putranto, Agi S.; Kristianto, Yusak; Wangge, Grace
The New Ropanasuri Journal of Surgery Vol. 1, No. 1
Publisher : UI Scholars Hub

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Abstract

Introduction. Lymph node metastasis of colorectal cancer is an independent prognostic factor and used as a guideline for adjuvant therapy. Paralleled to this, TNM staging system has been used widely and nowadays referred to a gold standard of colorectal cancer staging. So far, such a system classifies the staging based on the numbers of positive lymph node involvement. Japanese classification was another kind of system do that categorize based on the distribution of lymph nodes involved (i.e. paracolic/rectal, intermediate, root of mesenteric artery). Method. This was a preliminary study analyzed of 15 subjects with sigmoid and rectal cancer underwent surgery at dr. Cipto Mangunkusumo and Fatmawati General Hospital between September and October 2015. We studied the specimen for histopathological evaluation focused on the numbers of positive lymph nodes and the distribution of lymph node metastasis. Staging was carried out using both of TNM system and Japanese classification, and these variables were subjected to agreement analysis. Results. We found more than twelve lymph nodes from each sample. Based on TNM staging system, there are seven subjects on stage II, three subjects with stage IIIb and five subjects with stage IIIc, meanwhile based on Japanese Classification, there were seven subjects with stage II, one subjects with stage IIIa and seven subjects with stage IIIb. Analysis of agreement between both of classifications resulted in coefficient Kappa of 49.3% (moderate category) with p-value of 0.04. Conclusion. Our preliminary study showed that agreement between both of classifications to specify sigmoid and rectal staging is in moderate category. Japanese classification is feasible to be used. Agreement accuracy may be obtained with a bigger sample.
The Accuracy of Immunoscore and Neutrophil Lymphocyte Ratio in Predicting 5 years Recurrence of Stage I-III Colorectal Cancer Kristianto, Yusak; Jeo, Wifanto Saditya
Indonesian Journal of Cancer Vol 19, No 1 (2025): March
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v19i1.1240

Abstract

Background: It is estimated about 30-50% of colorectal cancer (CRC) patients experience recurrence even after definitive therapy. Immune-based tests, such as immunoscore (IS) and Neutrophil-Lymphocyte Ratio (NLR) are independent predictors of CRC recurrence and survival. NLR examination is more affordable, simple, and feasible compared to oncological panel examination IS. To this date, there have been no studies measuring the accuracy of both in predicting recurrence rates in CRC.Methods: This retrospective cohort study was conducted at Siloam Kebon Jeruk Hospital and Mochtar Riady Comprehensive Cancer Centre (MRCCC) from July to December 2023, utilizing secondary data from medical records of stage I-III CRC patients, focusing on NLR and IS results, and outcomes. Statistical analysis comprised descriptive analysis, accuracy test, and hypothesis testing (bivariate) using the Statistical Package for the Social Sciences (SPSS) version 25. NLR cut-off value was computed using the ROC curve. The comparison of NLR and IS test values was assessed through a comparison of ROC area (AUC). Measure of agreement between the two tests (NLR and IS) was done using Kappa statistics.Results: Out of 80 CRC patients, 26 patients experienced recurrence (32.5%), mostly in the first two years (53%), while 54 patients did not recur (67.5%). NLR (cut-off 6.6) showed sensitivity (46.2%), specificity (81.5%), and diagnostic accuracy value of 70%. Chi-square analysis indicated a significant relationship between NLR and recurrence (p-value = 0.020). IS showed sensitivity (7.7%), specificity (96.3%), and diagnostic accuracy value of 67.5%. Fisher’s Exact analysis showed no significant relationship between IS and recurrence (p-value = 0.592). The AUC value of both tests indicated that the accuracy to predict recurrence in CRC patients is not different/ same (p-value = 0.064). The Kappa statistic indicates a very high agreement between high IS and low NLR tests in predicting recurrence cases (p-value = 0.001).Conclusions: NLR and IS have the same weak accuracy in predicting stage I-III CRC recurrences, but NLR has a statistically significant association compared to IS. A combination of both tests showed a strong predictive role in tumor recurrence after curative surgery and can be applied in daily practice (postoperative surveillance).
Co-Authors Agoestino, Agoestino Evan Evan Grace Wangge, Grace Jeo, Wifanto Saditya Marta, Grace Putranto, Agi S. Yonathan, Christian