Hubungan antara Ekspresi VEGF dan Kepadatan Mikrovaskular dengan Stadium, Derajat Histopatologik, dan Ketahanan Hidup Penderita Karsinoma Payudara ER Positif dan ER Negatif - . Kukuh Sugi Laksana, Irianiwati, Harijadi (Perhimpunan Dokter Spesialis Patologi Indonesia (IAPI), 2015)
ABSTRAK Latar belakang ER dan VEGF berperan penting pada angiogenesis karsinoma payudara. Status ER merupakan faktor prediktif terapi anti hormonal. Karsinoma payudara ER negatif kurang berespon terhadap terapi anti hormonal dan berhubungan dengan prognosa buruk. Kompleks estrogen dan ER dapat memacu angiogenesis melalui VEGF dan mempengaruhi MVD. Status hormonal (ER) dan angiogenesis mempengaruhi terapi dan prognosis. Sampai saat ini peran angiogenesis pada karsinoma payudara dan hubungannya dengan stadium, derajat histopatologis, dan ketahanan hidup penderita belum jelas. Tujuan Mengetahui hubungan antara ekspresi VEGF dan kepadatan mikrovaskular dengan stadium, derajat histopatologis, dan ketahanan hidup penderita karsinoma payudara dengan ER positif dan ER negatif. . Metode Desain penelitian ini adalah observasional cross sectional dengan data retrospektif sebanyak 50 kasus karsinoma duktal infiltratif payudara. Sediaan blok parafin dipulas imunohistokimia dengan MoAb anti ER, VEGF, dan VWF. Status ER di kelompokkan menjadi ER positif dan ER negatif. Kepadatan mikrovaskular ditentukan berdasarkan banyaknya mikrovasa yang sel endotelnya mengekspresikan VWF pada lima area hot spot. Hubungan antara ekspresi VEGF, kepadatan mikrovaskular terhadap ukuran, status kelenjar getah bening, metastasis, dan derajat histopatologis dengan ER positif dan negatif di analisa menggunakan korelasi Spearman dan Chi-Square, sedangkan hubungannya dengan ketahanan hidup dianalisa dengan tes logistik regresi dan metode Kaplan-Meier. Hasil Tidak didapatkan hubungan antara ekspresi VEGF dengan ukuran tumor, status kelenjar getah bening, metastasis dan derajat histopatologis pada karsinoma payudara ER positif dan ER negatif. Ekspresi VEGF berhubungan dengan status metastasis. Tidak didapatkan hubungan antara kepadatan mikrovaskular dengan ukuran tumor, status kgb, metastasis, dan derajat histopatologis pada karsinoma payudara ER positif dan ER negatif. Tidak didapatkan hubungan antara VEGF dan kepadatan mikrovaskular dengan ketahanan hidup pada karsinoma payudara ER positif dan ER negatif, sedangkan status kelenjar getah bening berhubungan dengan ketahanan hidup penderita karsinoma payudara. Kesimpulan Ekspresi VEGF dan kepadatan mikrovaskular tidak berhubungan dengan beberapa parameter klinikopatologis karsino-ma payudara ER positif dan ER negatif, tetapi berhubungan dengan metastasis dan keterlibatan limfonodi berhubungan dengan ketahanan hidup. Kata kunci : reseptor estrogen kanker payudara, VEGF, VWF, derajat histopatologis, ketahanan hidup. ABSTRACT Background Estrogen receptor on VEGF is a key point in angiogenesis of breast carcinoma. Estrogen is a predictive factor for anti hormonal therapy. ER negative breast carcinoma is more responsless to anti hormonal therapy and poor overall survival. Estrogen and ER Complex induce angiogenesis by VEGF and microvascular density (MVD). In breast cancer, ER and angiogenesis influence therapy and prognosis. The role of angiogenesis in breast cancer ER +/- and their correlation with histopathological grade, and survival were not affirmatively knowed. Aim To investigate the correlation expression VEGF and MVD with stage, histopathological grade, and survival in breast cancer with ER +/- . Methods The method of the study is cross sectional with retrospective data, consists of 50 cases of invasive duct carcinoma. Staging was established based on tumor size, lymph status, and metastasis. Histopathological grade was classified into well, moderate, and poor. Survival was established from fist diagnosis (2003) until the end of study (December 2010). Specimens from paraffin embedded tissue were stained with monoclonal antibody against ER, VEGF, and VWF. Expression of ER in the nuclear cell more than 10 % was established as ER positive. The expression of VEGF was counted based on the amount of positive stained in cytoplasm per 100 cancer cells in five high power field while expression of VWF was determined on the amount of endothel positive stained of micro vessels at five hot spot areas. The correlation among VEGF, MVD and tumor size, lymph node status, metastasis, and histolopathological grade to breast carcinoma with ER positive and ER negative was be analyzed with Spearman and Chi-Square test, and survival was be analyzed with logistic regression test and Kaplan-Maier method. Results There were no correlation between VEGF with tumor size, lymph node status, metastasis, and histopathological grade on ER positive and negative. Expression VEGF have correlation with metastasis breast carcinoma. There were no correlation between MVD with tumor size, lymph node status, metastasis, and histopathological grade on ER positive and negative. There were no correlation between VEGF and MVD with survival on ER positive and negative, but lymph node status have correlation with survival breast cancer. Conclusion Expression VEGF and MVD have no correlation with several clinicopathologic parameter breast cancer with ER positive and ER negative, but expression VEGF have correlation with metastasis and lymph node status have correlation with survival breast cancer. Key word: breast cancer estrogen receptor, VEGF, VWF, histopathological grade, survival.