Hubungan Overekspresi Topoisomerase Il Alfa dengan Over-ekspresi Her-2/neu dan Berbagai Derajat Histologik Karsinoma Duktal Invasif Tidak Spesifik Payudara - . Jane Kosasih, I Gusti Alit Artha (Majalah Patologi Indonesia, 2011)
ABSTRAK Latar Belakang Peranan enzim Topoisomerase II α (TOP2A) sebagai faktor prognostik dan faktor prediktif terapi antrasiklin pada kasus karsinoma duktal invasif tidak spesifik payudara telah banyak diteliti selama satu dekade terakhir ini. Namun masih ada kontroversi mengenai hubungan antara HER-2 dan TOP2A serta TOP2A dan derajat histologik. Maka penelitian ini bertujuan untuk mengetahui apakah ada hubungan bermakna antara overekspresi HER-2/neu dan TOP2A, serta apakah ada hubungan bermakna antara overekspresi TOP2A dengan derajat histologik karsinoma duktal invasif tidak spesifik payudara. Cara Penelitian potong lintang dilaksanakan di Bagian/SMF Patologi Anatomik FK UNUD/RSUP Sanglah Denpasar. Sampel penelitian yaitu sediaan blok parafin dari penderita karsinoma duktal invasif tidak spesifik payudara yang telah dilakukan pemeriksaan histopatologi di Laboratorium Patologi Anatomik FK-UNUD/RSUP Sanglah Denpasar dari tanggal 1 Januari 2007-31 Desember 2009 yang memenuhi kriteria inklusi dan eksklusi. Derajat histologik dan skor semi kuantitatif imunohistokimia untuk HER-2/neu dan TOP2A di nilai oleh dua orang pengamat secara membuta. Analisis hubungan antara overekspresi HER-2/neu dengan overekspresi TOP2A dan hubungan antara overekspresi TOP2A dengan derajat histologik tumor diuji dengan menggunakan Chi-square test (X2 test) menggunakan program SPSS 15.0 for windows. Hasil Selama periode 3 tahun (2007-2009) ditemukan sampel 93 kasus yang dapat dianalisis. Rata-rata umur penderita 47,57 tahun (rentang umur 22-81 tahun). Sebanyak 32 kasus (34,4%) menunjukkan overekspresi HER-2/neu. Dari 32 kasus dengan overekspresi HER-2/neu, 13 (40,6%) kasus menunjukkan overekspresi TOP2A. Terdapat hubungan antara overekspresi HER-2/neu dengan overekspresi TOP2A (p=0,018, OR=3,110, CI95% 1,189-8,132). Dari 24 kasus dengan overekspresi TOP2A, terdapat 19 (79,2%) kasus dengan derajat histologik tumor tinggi. Terdapat hubungan antara overekspresi TOP2A dengan derajat histologik tumor tinggi (p=0,020, OR=3,483, CI95% 1,168-10,386). Kesimpulan Overekspresi TOP2A memiliki hubungan bermakna dengan overekspresi HER-2/neu dan derajat histologik kasus karsinoma duktal invasif tidak spesifik pada payudara. Kata kunci: Karsinoma duktal invasif tidak spesifik payudara, Topoisomerase II α, HER-2/neu, derajat histologik. ABSTRACT Background The role of Topoisomerase II α (TOP2A) enzyme as a prognostic and predictive factor for antracycline therapy in invasive ductal carcinoma NOS of the breast has been studied since the last decade. However the relationship between HER2 and TOP2A exspresion and the relationship between TOP2A and histologic grade remains controversial. This study want to know if there is a correlation between HER-2/neu and TOP2A overexpression and if there is a correlation between TOP2A overexpression and histologic grade. Method This is a cross-sectional study conducted in the Department of Anatomical Pathology Faculty of Medicine Udayana University-Sanglah. Samples have been taken from paraffin blocks from invasive ductal carcinoma’s patients diagnosed in Department of Anatomical Pathology Faculty of Medicine Udayana University-Sanglah during 1 January 2007 to 31 December 2009 that fulfill inclusion and exclusion criteria. The histologic grade were determined based on H and E slides and HER2 and TOP2A immunoscore were blindly evaluafed semiquantitatively by 2 independent observers. The correlation between HER-2/neu overexpression and TOP2A overexpression, and the correlation between TOP2A overexpression and histologic grade has been tested by Chi-square test (X2 test) and data analysis use SPSS 15.0 for windows program. Results During 3 years (2007-2009), there were 93 cases as samples, that can be analyzed, with mean age was 47,57 years old (range 22-81 years). Thirty two cases (34,4%) showed HER-2/neu overexpression. From 32 cases with HER-2/neu overexpression, 13 (40,6%) cases showed TOP2A overexpression. There was a correlation between HER-2/neu overexpression and TOP2A overexpression (p=0,018, OR=3,110, CI95% 1,189-8,132). From 24 cases with TOP2A overexpression, there were 19 (79,2%) cases with high histologic grade of tumor. There was a correlation between TOP2A overexpression and high histologic grade of tumor (p=0,020, OR=3,483, CI95% 1,168-10,386). Conclusion TOP2A overexpression showed significant correlation with HER-2/neu overexpression and histologic grade in Invasive Ductal Carcinoma NOS. Keywords : Invasive Ductal Carcinoma NOS, Topoisomerase II α, HER-2/neu, histologic grade.