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All Journal Medical Journal of Indonesia The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia
C Rinaldi A Lesmana
Divisi Hepatobilier, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia, RSUPN Cipto Mangunkusumo, Jakarta
Medicine & Pharmacology

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Treatment for Intermediate-Stage Hepatocellular Carcinoma: Current Practice and Outcome in Real World Study Hasan, Irsan; Loho, Imelda Maria; Lesmana, Cosmas Rinaldi A.; Gani, Rino Alvani; Siregar, Lianda; Waspodo, Agus Sudiro; Lesmana, Laurentius A
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 23, No 1 (2022): VOLUME 23, NUMBER 1, April 2022
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (434.834 KB) | DOI: 10.24871/231202224-28

Abstract

Background: Intermediate-stage hepatocellular carcinoma (HCC) is a very heterogeneous disease. The first line treatment for this group is transarterial chemoembolization (TACE), however, in clinical practice, not all patients are suitable for TACE. We aim to evaluate current treatment practice and outcome of patients with intermediate-stage HCC.Methods: HCC patients database from 2013 to 2016 in Cipto Mangunkusumo Hospital and Dharmais Cancer Hospital were retrospectively analyzed. Patients with intermediate-stage HCC were included in this study.Results: A total of 456 patients were diagnosed with HCC, but only 151 (33.1%) patients with intermediate-stage HCC were included. Men outnumbered women in a ratio of 3:1. The most common etiology for HCC was hepatitis B virus (HBV) infection, which accounted for 55% of patients. Fifty-two patients (34.4%) were treated with TACE as first-line treatment. Sixty-seven patients (44%) were given best supportive care due to ineligibility for TACE. Frequency of TACE varied from one to eleven times. Overall median survival was 617 days (1.7 years). One-year survival for patients undergoing TACE and liver resection was 47% and 60%, respectively. We did not compare the survival between any treatment groups because the number of patient in each group is not sufficient to be statistically analyzed.Conclusion: Only 34.4% of patients with intermediate-stage HCC was treated with TACE as first-line treatment. An improvement in the treatment strategy should be done for HCC patients in Indonesia.
Sarcopenia is Associated with Poor Performance Status in Indonesian Patients with Hepatocellular Carcinoma Koncoro, Hendra; Hasan, Irsan; Lesmana, C Rinaldi; Aditama, Humala Prika; Salamah, Thariqah; Rizka, Aulia; Wahyudi, Edy Rizal; Shatri, Hamzah; Teng, Wei
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 23, No 1 (2022): VOLUME 23, NUMBER 1, April 2022
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (614.006 KB) | DOI: 10.24871/231202217-23

Abstract

Background: Sarcopenia has a notable impact on the prognosis of hepatocellular carcinoma (HCC). The prevalence of sarcopenia in patients with HCC is relatively high, with studies reporting rates between 39% and 41.7%. A substantial proportion of individuals diagnosed with HCC also exhibit muscle wasting and reduced muscle function. This study aims to determine the prevalence of sarcopenia in Indonesian patients with HCC (based on the Japanese Socuety of Hepatology (JSH) JSH criteria) and to examine its correlation with poor performance status.Methods: We performed a cross-sectional study of 85 HCC patients between January and October 2021). The skeletal muscle index at L3 (L3 SMI) was measured on CT scans (applying JSH cut-offs for sarcopenia). Clinical data, including Eastern Cooperative Oncology Group (ECOG) performance status, were collected. Bivariate analyses and logistic regression were performed to identify factors associated with sarcopenia.Results: A total of 85 HCC patients (median age: 52 years) were included in the analysis. Sarcopenia was observed in 49.4% of the cohort. Bivariate analysis revealed a statistically significant association between sarcopenia and an ECOG performance status of 2+ (p = 0.003), as well as a MELD-Na score of ≥15 (p = 0.023). In multivariate analysis, poor ECOG-PS remained independently associated with sarcopenia (adjusted OR 4.17; 95% CI 1.50–11.56, p = 0.006).Conclusion: Sarcopenia is highly prevalent among Indonesian HCC patients, and it is strongly associated with poor ECOG performance status. 
Effect of matrix metalloproteinase-9 inhibitors in hepatitis B virus replication Kalista, Kemal Fariz; Harimurti, Kuntjoro; Immanuel, Suzanna; Iskandriati, Diah; Lesmana, Cosmas Rinaldi Adithya; Ibrahim, Fera; Gani, Rino Alvani
Medical Journal of Indonesia Vol. 34 No. 4 (2025): December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.oa.257895

Abstract

BACKGROUND Hepatitis B virus (HBV) remains difficult to eradicate due to the persistence of covalently closed circular DNA (cccDNA). Matrix metalloproteinase-9 (MMP-9) enhances HBV replication, but the effects of its inhibition remain unexplored. This study aimed to investigate the effects of MMP-9 inhibitors on HBV replication markers. METHODS Primary hepatocyte cultures were obtained from the livers of 6 Tupaia javanica. Cultures were infected with HBV from human sera and divided into control and intervention groups. The intervention group received MMP-9 inhibitors at 1, 3, and 7 nM. The control group received phosphate-buffered saline. Levels of hepatitis B surface antigen (HBsAg), HBV DNA, cccDNA, MMP-9, interferon alpha and beta receptor subunit 1 (IFNAR1), and interferon beta (IFN-β) were measured in both groups before and 72 hours post-intervention. RESULTS MMP-9 inhibitor administration at 1, 3, and 7 nM consistently reduced HBsAg, HBV DNA, cccDNA, and MMP-9 levels, though not statistically significant. Median HBV DNA levels at 1, 3, and 7 nM were 7.05, 5.29, and 5.98 ×103 copies/ml, respectively. Mean cccDNA levels at 1, 3, and 7 nM were 14.15, 11.04, and 13.94 ×103 copies/ml, respectively. The 3 nM dose increased IFNAR1 levels, while the 7 nM dose increased IFN-β, but neither change was significant. Among the tested doses, 3 nM showed the most favorable effects despite the lack of significance. CONCLUSIONS MMP-9 inhibitor suppressed HBsAg, HBV DNA, cccDNA, and MMP-9 while increasing IFNAR1 and IFN-β in vitro.
Co-Authors Aditama, Humala Prika Adityo Susilo, Adityo Agus Sudiro Waspodo Alvin Nursalim Andri Sanityoso Andri Sanityoso Sulaiman Angga, Billy Aprilicia, Gita Ari Fahrial Syam Ari Fahrial Syam Ari Fahrial Syam Aulia Rizka, Aulia Baiq Kirana DN Mandasari Benny Philipi Billy Angga Bonar, Maruhum Bonar H Budianto, Iskandar Rahardjo, Dr C Martin Rumende Chyntia Olivia M. Jasirwan Chyntia Olivia Maurine Jasirwan, Chyntia Olivia Maurine Cleopas Martin Rumende Cleopas Martin Rumende Dadang Makmun Dewi Gathmyr DIAH ISKANDRIATI Diana Sunardi Djuartina, Tena, Dr E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Edy Rizal Wahyudi Fera Ibrahim Ginova Nainggolan Gita Aprilicia Gita Aprilicia Hanif, Muhammad Yusuf Hasan Maulahela Hendra Koncoro Hendra Koncoro Ho, Khek Yu Ignatius R Tenggara, Ignatius R Ikhwan Rinaldi Imelda Maria Loho Imelda Maria Loho, Imelda Maria Irsan Hasan Irsan Hasan Jasirwan, Chyntia Olivia M Juferdy Kurniawan Kemal F Calista Kemal Fariz Kalista Kemal Fariz Kalista Kemal Fariz Kalista, Kemal Fariz Kuntjoro Harimurti Laurentius A Lesmana Laurentius A Lesmana Laurentius A Lesmana, Laurentius A Lesmana, Laurentius Adrianto Levina S Pakasi Lianda Siregar Lutfie Lutfie, Lutfie Marcellus Simadibrata Maulana Suryamin, Maulana Muhammad Yusuf Hanif Nababan, Saut Horas H. Nadia Ayu Mulansari, Nadia Ayu Nikko Darnindro Pakasi, Levina S Paramitha, Maria Satya Perdana Aditya, Perdana Philipi, Benny Pratiwi, Yulia Estu Purwita Wijaya Laksmi Putra, Peter Brian Sutanto, Dr Rino A Gani Rino A. Gani Rino Alvani Gani Rino Alvani Gani Rino Alvani Gani Rino Alvani Gani Rino Alvani Gani Rino Alvani Gani Rino Alvani Gani Rudy Hidayat Saut HH Nababan Saut Horas H. Nababan Saut Horas Hatoguan Nababan Sepmeitutu, Iwandheny Suhendro Suwarto Suhendro Suwarto, Suhendro Sulaeman, Andri Sanityoso Suwangto, Erfen Gustiawan, Dr Suzanna Immanuel Syahrizal Syarif Tagor, Alvin Tahir, Andi Cahaya Taufiq Taufiq Taufiq Taufiq Teng, Wei Teressa, Maria THARIQAH SALAMAH, THARIQAH Triyanta Yuli Pramana Ummi Ulfah Madina, Ummi Ulfah Waldemar Simanjuntak Waldemar Simanjuntak Willy Brodus Uwan Willy Brodus Uwan, Willy Brodus Zulkifli Amin