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All Journal Medical Journal of Indonesia Indonesian Journal of Cancer
Yulian, Erwin Danil
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Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Public Health

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Relationship Between C-Reactive Protein-Albumin Ratio and Metastasis in Breast Cancer Hazmi, Mohammad Zul; Panigoro, Sonar Soni; Yulian, Erwin Danil; Nugroho, Nyityasmono Tri; Agustina, Amilya
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.v19i1.1224

Abstract

Background: Breast cancer is a type of malignancy with the highest number of cases in the world and Indonesia. The C-reactive protein-albumin ratio (RCA) is a simple, feasible, and objective breast cancer serum marker representing inflammatory and nutritional status. There are not many studies regarding the relationship between RCA and breast cancer metastasis, especially in the advanced-stage case population in Indonesia.Method: Study with a cross-sectional design in 180 breast cancer patients stage III and IV at Cipto Mangunkusumo Hospital, who were diagnosed in 2018 until 2023. Comparative analysis of the RCA values between the groups with and without metastasis was carried out using the Chisquare test. All statistical test results are considered significant if the p-value is 0.05.Results: A receiver-operating characteristic curve (ROC) is a graphical analytical technique used to assess the effectiveness of a binary diagnostic classification method. The ROC area under the curve (AUC) value was 0.713 (IC 95%; 0.638–0.789) and significance 0.001, with the RCA cut-off value was 0.515 with sensitivity 74.4% and specificity 67.8%. The high RCA proportion was 53.3%. There is a significant relationship (p-value 0,001) between RCA level and the risk of metastasis in breast cancer patients. Liver and lung metastases of breast cancer are the most frequent locations. Conclusion: The CRP-albumin ratio has a significant relationship with the incidence of metastasis in breast cancer
Five-year survival of triple-negative breast cancer and the associated clinicopathological factors: a study in an Indonesian tertiary hospital Yulian, Erwin Danil; Fachriza, Ihza
Medical Journal of Indonesia Vol. 32 No. 4 (2023): December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.oa.247161

Abstract

BACKGROUND Triple-negative breast cancer (TNBC) has a worse rate of recurrence, survival, and overall survival. This study aimed to find the survival of TNBC and its clinicopathological factors at Cipto Mangunkusumo Hospital. METHODS This study used survival analysis based on clinicopathology in 112 TNBC cases at Cipto Mangunkusumo Hospital, Jakarta, Indonesia, diagnosed from 2009 to 2019. Kaplan–Meier and log-rank tests were used for the analysis. Bivariate and multivariate analyses using Cox regression were performed to obtain the hazard ratios (HRs). RESULTS Most patients were diagnosed at the locally advanced stage (40.2%) compared to the early (33.0%) and metastatic stages (17.9%). The 5-year survival of TNBC was 81.2% with an HR value of 1.372 (p = 0.239) compared to luminal A. Bivariate analyses showed that the older age group with an HR of 6.845 (p = 0.013; CI 1.500–31.243), larger tumor size and extension (T) with an HR of 11.826 (p = 0.001; CI 2.707–51.653), broader regional lymph node involvement (N) with an HR of 8.929 (p = 0.019; CI 1.434–55.587), farther distant metastases (M) with an HR of 3.016 (p = 0.015; CI 1.242–7.322), more lymphovascular invasion with HR of 3.006 (p = 0.018; CI 1.209–7.477), and not operated-on cases with an HR of 9.165 (p<0.001; CI 3.303–25.434) significantly shortened the survival of TNBC. Multivariate analysis found that the only factor worsening the survival was not having surgery, with an HR of 6.175 (p<0.001; CI 1.518–34.288). CONCLUSIONS The 5-year survival rate of TNBC patients was 81.2%. Not having surgery was a clinicopathological factor that worsened survival outcomes in TNBC.
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.
Co-Authors Agustina, Amilya Andrian, Christopher Rico Aria Kekalih Dewi Wulandari Fachriza, Ihza Hazmi, Mohammad Zul Idhil, Andi Nurul Isri Indriany Nugroho, Nyityasmono Tri Sonar Soni Panigoro Utami, Sri Anidyo