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INDONESIA
Indonesian Journal of Cancer
Published by National Cancer Center-Dharmais Cancer Hospital
ISSN : 19783744     EISSN : 23556811     DOI : https://www.doi.org/ 10.33371
Core Subject : Health, Science,
Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Public Health
Indonesian Journal of Cancer is a peer-reviewed and open-access journal. This journal is published quarterly (in March, June, September, and December) by Dharmais Cancer Hospital - National Cancer Center. Submissions are reviewed under a broad scope of topics relevant to experimental and clinical cancer research. Articles are original research that needs to be disseminated and written in English. All submitted manuscripts will go through the double-blind peer review and editorial review before being granted acceptance for publication. The journal publishes original research articles, case reports, and review articles under the following categories: cancer management, cancer prevention, cancer etiology, epidemiology, molecular oncology, cancer diagnosis and therapy, tumor pathology, surgical oncology, medical oncology, radiation oncology, interventional radiology, as well as early detection.
Arjuna Subject : Kedokteran - Onkologi
Articles 562 Documents
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Cerebral Tuberculomas Mimicking A Brain Tumor: Report of Two Cases Gill, Arwinder Singh; Firdaus, Muhammad; Sugiarto, Yosafat Kurniawan; Rayhani, Farilaila; Andriani, Rini; Faried, Ahmad
Indonesian Journal of Cancer Vol 18, No 1 (2024): March
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v18i1.1084

Abstract

Introduction : Cerebral tuberculoma, a seldom encountered and severe manifestation of tuberculosis (TB), arises from the dissemination of Mycobacterium tuberculosis through the bloodstream. Its symptoms and radiological characteristics lack specificity, often resulting in diagnostic errors. Management predominantly involves medical intervention, with the treatment duration for cerebral tuberculoma ranging from 6 to 36 months. In specific instances, surgical intervention may be advised. Case presentation: We reported two cases of cerebral tuberculoma occurring in patients who presented with seizures, with space-occupying lesions evident on magnetic resonance imaging of the brain. There were no symptoms of concurrent extra cranial TB. Surgery was performed on both of the cases and anti-TB treatment began as soon as the diagnosis was made with corticosteroid as adjuvant treatment. Conclusion: : A combination of clinical, radiological, and histopathological examination is needed to confirm the diagnosis and determine the appropriate therapy. If ICP is increased as a result of the lesion and medical therapy has failed, surgical excision is required.
Survival of Lung Adenocarcinoma Patients with Tyrosine Kinase Inhibitor Therapy Based on EGFR Mutation Status in Tumor and Plasma Samples Haryati, Haryati; Arganita, Fidya Rahmadhany; Oktaviyanti, Ika Kustiyah
Indonesian Journal of Cancer Vol 17, No 4 (2023): December
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v17i4.995

Abstract

Background:The prognosis for epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) is greatly improved when treated with tyrosine kinase inhibitor (TKI). In this context, EGFR mutation status should be determined at the diagnosis stage but circulating tumor DNA (ctDNA) has been increasingly used for molecular profiling. Therefore, this study aimed to establish the correlation between the presence of ctDNA before TKI therapy and subsequent clinical outcomes Methods: A total of 18 patients with NSCLC who received EGFR-TKI therapy were enrolled. EGFR mutations were simultaneously identified in tumor samples and plasma ctDNA, as well as information regarding overall survival (OS) and progression-free survival (PFS). Result: These case studies showed that 14 of 18 patients (77.8%) with concordance results detected EGFR-positive mutations on ctDNA examination and histopathology from plasma and tumor samples, respectively. The median PFS was similar at 7.5 months in both groups, while the median OS was shorter in patients with EGFR-detected in ctDNA (17 vs. 25.5 months) after TKI-targeted therapy. Conclusion: The identification of EGFR mutations in plasma ctDNA was a promising, effective, and minimally invasive alternative to tumor biopsy. The existence potentially reflected the disease burden and showed a poor prognosis.
Enhancing Pediatric Cancer Survival in Indonesia: The Role of CAR T Cell Therapy Azhar, Muhammad Al; Aisyi, Mururul
Indonesian Journal of Cancer Vol 18, No 2 (2024): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v18i2.1238

Abstract

Pediatric cancer poses a major health challenge globally, especially in low-middle-income countries like Indonesia. The survival rate of pediatric cancer in many high-income countries (HICs) reaches 90%, while it only ranges from 5 to 60% in LMICs. Over 80% of children with cancer live in low-middle-income countries, indicating the urgency to improve the survival rate of pediatric cancer in LMICs [1]. In Indonesia, the prevalence of pediatric cancer was 43.5% in 2020, making it the highest among Southeast Asian countries [2]. According to Dharmais Cancer Hospital (2024), the national cancer referral center for all of Indonesia, the 5-year survival rate of high-risk pediatric acute lymphoblastic leukemia is only 48.8% (unpublished data).One key factor contributing to the low survival rate of pediatric cancer in Indonesia is the lack of effective therapy options, especially for high-risk and relapsed or refractory patients. Several therapeutic approaches, such as immunotherapy, have been widely used in HICs but are still not very popular in Indonesia. CAR (Chimeric Antigen Receptor) T-cell therapy is one of the most promising immunotherapeutic approaches to treat pediatric cancer. Implementing CAR T Cell therapy in Indonesia offers promising prospects for improving the survival rates of pediatric cancer patients.CAR T cell therapy utilizes the body's immune system to specifically target and eliminate cancer cells. This innovative therapy entails extracting a patient's T cells, genetically modifying them to express chimeric antigen receptors specific to tumor-associated antigens, and then reinfusing them into the patient. Once infused, these engineered T cells recognize and eliminate cancer cells bearing the targeted antigen, thereby offering a highly targeted and potentially curative treatment option [3]. This innovative therapy has demonstrated remarkable success in treating certain hematologic malignancies, including pediatric leukemia. The most extensively studied case in childhood patients involves CAR T cells that target CD19, a B cell surface receptor [4].CAR T cell therapy holds great promise for improving survival rates among pediatric cancer patients in Indonesia. Children with refractory or relapsed leukemia, such as B-cell acute lymphoblastic leukemia (B-ALL), who have exhausted standard treatment options, can benefit from CAR T cell therapy. Most relapsed or refractory pediatric cancer patients in Indonesia do not have effective therapy options to treat the disease. CAR T cell therapy emerges as a novel therapy that can significantly improve the survival of this subset of patients. Numerous studies have documented high remission rates (ranging from 70% to 90%) in adults and children diagnosed with refractory B-ALL [4]. A study by Maude et al. [5] reported high remission rates and durable responses in young adults and children with refractory or relapsed B-ALL treated with CAR T cells. Similarly, Park et al. [6] demonstrated long-term remissions and improved survival in pediatric leukemia patients receiving CAR T cell therapy. Several groups also have observed the persistence of CAR T cells and sustained remission lasting over six months in the majority of patients examined [4]. Efforts have been made to implement CAR T cells in Indonesia. Dharmais Cancer Hospital, as a National Cancer Center in Indonesia, has initiated this effort by collaborating with iCarTAB Biomed Inc., a China-based CAR T cell manufacturer with one of its manufacturing sites located in Malaysia. However, this approach involves sending patients' blood samples that have been processed through leukapheresis to Malaysia for CAR T cell manufacturing, followed by the shipment of the manufactured cells back to Indonesia for administration to patients. This process is impractical and incurs intangible costs such as transportation and cryopreservation, ultimately making it more expensive for patients. Regulatory issues related to the shipment of cells across borders in the region and early preparation of patients for CAR T cell therapy soon after relapse before they succumb to treatment-related mortality or relapse-related complications are also challenges that need to be addressed [7]. Reflecting on the abovementioned issue, CAR T cell therapy adoption in Indonesia faces significant challenges. Limited healthcare infrastructure, including specialized facilities for cell therapy manufacturing and administration, poses logistical hurdles. Moreover, cost remains a major barrier, as CAR T cell therapy is often expensive and inaccessible to many patients in Indonesia. Furthermore, the lack of local expertise in cellular immunotherapy may impede the successful implementation of CAR T cell therapy programs.Efforts to address these challenges and maximize the potential of CAR T cell therapy in Indonesia are essential. This requires a multi-faceted approach involving investment in healthcare infrastructure, including establishing specialized centers equipped for CAR T cell therapy manufacturing and administration. Two alternative models have been proposed for manufacturing CAR-T cell therapy: centralized and de-centralized models [8]. In the centralized manufacturing model, point of manufacturing and point of care are located in different geographical areas, while decentralized manufacturing focuses on establishing point of care and manufacturing in close proximity. A decentralized manufacturing model might be the best approach to be implemented in LMICs like Indonesia. Building hospital-based cellular therapy manufacturing reduces the need for transportation and cryopreservation. The decentralized system's geographic proximity improves communication between manufacturing and treatment teams, facilitating the creation of customized products based on a patient's phenotype. This setup also reduces administration time and the risk of delays and mix-ups compared to centralized manufacturing, making hospital-based cellular therapy manufacturing a potentially more cost-effective option [8].In addition, initiatives to reduce the cost of therapy through partnerships with pharmaceutical companies, government subsidies, or philanthropic endeavors can improve affordability and access. Furthermore, capacity-building initiatives aimed at training local healthcare professionals in cellular immunotherapy techniques are essential for ensuring the successful implementation and sustainability of CAR T cell therapy programs in Indonesia. Collaboration between local institutions, international organizations, and industry stakeholders can facilitate knowledge transfer and technology transfer, fostering indigenous expertise in this cutting-edge treatment modality.CAR T cell therapy represents a transformative approach to improving survival rates among pediatric cancer patients in Indonesia. By harnessing the power of immunotherapy, specifically tailored to target cancer cells, CAR T cell therapy offers hope for children with refractory or relapsed leukemia who have limited treatment options. Through continued research, collaboration, and investment in healthcare infrastructure, CAR T cell therapy potentially could greatly improve the prognosis and quality of life for pediatric cancer patients in Indonesia.
Diffused Pulmonary Uptake of Tc-99m Methylene Diphosphonate Bone Scan in Patient with Prostate Cancer without Blood Test and Correlative/Cross-Sectional Imaging Abnormalities: A Case Report Imaniar, Junan; Suh, Minseok; Dewi, Ayu Rosemeilia; Tuti, Yustia
Indonesian Journal of Cancer Vol 18, No 1 (2024): March
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v18i1.1063

Abstract

Introduction: Bone scan using Tc-99m methylene diphosphonate (MDP) is a commonly used procedure for evaluating bone metastasis in cancer patients. Extra-osseous pulmonary uptake in bone scans is mostly an incidental finding and occurs in a multitude of disorders. Clinicians should be alert to any findings on clinical or complementary diagnostic tools. We presented a case of prostate cancer male patients who demonstrated diffuse pulmonary uptake on Tc-99m MDP bone scan without any blood test and correlative/cross-sectional imaging abnormality Case Presentation: An 80-year-old male with adenocarcinoma of the prostate with a Gleason score of 6 (3+3). The PSA level was 0.009. The patient had a history of recurrent atrial fibrillation (AF), postural dizziness, HTN, Gout, and chronic renal failure, but all of these comorbidities were under control. The patient underwent a bone scan to annually check for the presence of bone metastases. Three hours after administering 740 MBq Tc-99m MDP intravenously. The reports didn’t show any increased uptake that would indicate metastases in the bones. Instead, diffuse bilateral pulmonary uptake and a mild increase in cardiac uptake were present. On the same day, a computed tomography (CT) scan of the thorax revealed 3 micro-nodules in the right upper lung that were described as benign lesions, and a chest X-ray confirmed normal results. The patient’s laboratory results were within normal range, and there were no clinical lung symptoms or complaints. Considering the patient history of persistent AF, chronic renal failure, and a complaint of postural dizziness, the bone scan finding may indicate involvement of amyloidosis. The relationship between amyloidosis and cancer was also widely noted. Conclusions: Tc-99m MDP may play a role in evaluating amyloidosis involvement in an uncommon place such as the lungs. Future research should focus on analyzing diagnostic options in the patient’s condition in this situation. Keywords: cancer, diffused pulmonary uptake, amyloidosis, bone scan
Molecular and Host Lifestyle Factors Associated with Persistent Human Papillomavirus Infection and Progression into Cervical Cancer: A Literature Review Yo, Edward Christopher; Nuryanto, Kartiwa Hadi
Indonesian Journal of Cancer Vol 18, No 2 (2024): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v18i2.1068

Abstract

Background: Human papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) worldwide, especially among low- and middle-income countries. The virus can establish persistent infection in the cervical epithelium, thereby increasing the risk of progression into cervical cancer. Since cervical cancer is one of the leading causes of cancer death among women worldwide, it is important to understand more about persistent HPV infection and potential therapeutic targets to suppress it. This study aims to summarize current insight into various molecular and host lifestyle factors that contribute to persistent HPV infection and ultimately cervical cancer. Methods: This study adopts a literature review design by conducting a journal search through Google Scholar, PubMed, and ScienceDirect. The keywords used included “human papillomavirus”, “persistent infection”, “cervical cancer”, “immune evasion”, and “lifestyle”. Results: Several diverse mechanisms are believed to facilitate persistent HPV infection, which can be classified under molecular and host lifestyle factors. Molecular factors include compartmentalization of HPV replication and gene expression as well as immune evasion, whereas host lifestyle factors include alcohol consumption, smoking, multiple sexual partners, STI coinfection, and certain contraceptive agents. Conclusion: Persistent HPV infection acts as the intermediate phenotype before developing into cervical cancer. Understanding the molecular factors as well as host lifestyle factors underlying it can lead to more specific therapeutic options as well as better prevention and education programs. Future research is needed to better clarify the exact mechanisms underlying persistent infection. 
Exogenous Reactive Oxygen Species Augments SMAD4 Expression And TGF-β Paradox in Human Breast Cancer Roy, Avany Vinod; Padmanabhan, Renjini Ambika; Ramachandran, Rajesh
Indonesian Journal of Cancer Vol 18, No 3 (2024): September
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v18i3.1179

Abstract

Background: The Transforming growth factor-β (TGF-β) functions to induce apoptosis, cell cycle arrest, and differentiation is central to sustaining tissue homeostasis and maintaining genomic stability. TGF-β normally, an effective tumor-suppressor that restricts the uncontrolled division of cells augments the development and progression of human malignancies when cytostatic activities of TGF-β are resisted by genetic and epigenetic events caused by tumorigenesis. This dichotomic nature of TGF-β during oncogenesis termed as “TGF-β Paradox,” persists to be the most crucial and puzzling query regarding its physio-pathological function and the role of cellular antioxidant status is highly interrelated which warrants more studies on the role of endogenous reactive oxygen species (ROS) in deciding epithelial-mesenchymal transition (EMT) process. The objective of the study was to check whether enhanced ROS augments the TGF-β pathway facilitating EMT. Methods: In vitro toxicity assay was performed to assess the appropriate concentration of hydrogen peroxide (H2O2) imparting oxidative stress. Comet assay and   8-OHdG (8-hydroxy-2’-deoxyguanosine) enzyme-linked immunosorbent assay (ELISA) were performed to check the extent of DNA damage and adduct production respectively. Mitogen-activated protein kinase (MAPK) p38 ELISA and mRNA gene expression analysis of TGF-β and SMAD were done to verify the effect of H2O2 on these signaling. Results: The objective of the study was to check whether enhanced ROS augments the TGF-β pathway facilitating EMT. Along with morphological alterations, a dose-dependent decrease in cell viability was seen at 300µM of H2O2 compared to 75µM. DCFDA labeling discovered the dose-dependent gradation of intracellular ROS generation and this was correlated to increased cellular DNA damage and DNA adduct production which was increased linearly with increasing H2O2 as evident with comet test and 8-OHdG ELISA. Significantly reduced MAPK p38 activity revealed by indirect ELISA analysis suggests lessened suppression of cell growth. Conclusions: The study establishes that higher intracellular ROS will facilitate the TGF-β paradox leading to epithelial mesenchymal transition which can adversely affect therapeutic strategies targeting EMT 
A Qualitative Study To Explore the Impact of Having Children with Cancer and Parental Adjustment Nurhidayah, Ikeu; Nurhaeni, Nani; Allenidekania, Allenidekania; Gayatri, Dewi; Hendrawati, Sri
Indonesian Journal of Cancer Vol 18, No 1 (2024): March
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v18i1.1048

Abstract

Background: Cancer diagnosis in children impacts not only the children themselves but also their parents, and the role of providing support during the treatment process is crucial. The illness’s complexity, the diagnosis process, and the course of treatment can have various effects on parents and family life. To cope with the challenges of caring for their chronically ill children, families adopt a normalization process to restore their routines. Therefore, this study aims to investigate the implications of a childhood cancer diagnosis on families and how parents normalize their daily lives in the face of this difficult situation. Methods: The study was a qualitative study conducted in a pediatric cancer shelter house in Bandung, Indonesia, from May to August 2018. Ten parents who had children with cancer were included in the study. Data were collected through interviews and thematically analyzed.  Results: This study yielded five themes: 1) parents’ negative feelings when children are first diagnosed with the illness, 2) various changes in the family’s life, 3) the impact on the family’s quality of life, 4) family’s extra effort to overcome the illness’s impact and 5) parents’ expectations for social support. Conclusions: Cancer in children has a significant impact on the lives of the entire family, particularly parents. Normalizing the lives of parents who have children with cancer entails several adaptation or adjustment tasks. Nurses can assist families in adapting by guiding how to deal with the changes they are experiencing and accepting this as the new normal. Nurses can help families normalize their daily routines, provide social support, improve coping strategies, increase family closeness, and identify the source of support from other families or the community.
Factors Influencing Distress and Coping Strategies Among Patients with Metastatic Spinal Tumor at Cipto Mangunkusumo General Hospital Agiananda, Feranindhya; Nugraeni, Tiara; Diatri, Hervita; Aninditha, Tiara; Kusumaningrum, Profitasari
Indonesian Journal of Cancer Vol 17, No 4 (2023): December
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v17i4.994

Abstract

Background: Patients with metastatic spinal tumor are experiencing various symptoms, including neurological deficits that cause distress and affects their quality of life. The vulnerability to distress is influenced by coping strategies. Therefore, this study aimed to investigate factors associated with distress and coping strategies in patients with metastatic spinal tumors at Cipto Mangunkusumo General Hospital. Methods: In a cross-sectional study conducted at Cipto Mangunkusumo General Hospital from September 2021 to May 2022, factors associated with distress and coping strategies in patients with metastatic spinal tumors were investigated. The analysis included a total of 104 subjects from both outpatient and inpatient settings. Distress levels and areas of concern were assessed using the Distress Thermometer (DT) questionnaire while coping strategies were evaluated through the Coping Orientation to the Problem Experienced (COPE) instrument. Bivariate and multivariable analyses were carried out to assess the relationship between sociodemographic factors, spinal tumor characteristics, specific areas of concern, coping strategies, and distress.Results: The results showed that 57.7% of metastatic spinal tumor patients experienced distress. In the 18-59 age group, motor disorders, sensory disturbances, autonomic disorders, treatment status, problem-focused coping (PFC), emotion-focused coping (EFC), and avoidance coping had significant associations with distress. However, the multivariable analysis showed that EFC (OR = 1.156, 95% CI: 1.024–1.304, p=0.019), avoidance coping (OR = 1.154, 95% CI: 1.005–1.326, p=0.042), and sensory disturbance (OR = 16.001, 95% CI: 1.472–173.960, p=0.023) were identified as risk factors for distress.Conclusions: Patients with metastatic spinal tumors who used emotion-focused coping, avoidance coping, and sensory disturbance faced significant risk factors for distress
The Epstein-Barr Virus (EBV) DNA Test as a Predictor of The Course of Nasopharyngeal Cancer Maharani, Putri; Kodrat, Henry
Indonesian Journal of Cancer Vol 18, No 2 (2024): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v18i2.1120

Abstract

Background: Nasopharyngeal cancer (NPC) incidence has been largely found in Southern China and Southeast Asia and was associated with Epstein-Barr Virus (EBV). Some advanced-stage NPC may still rise to local recurrence or distant metastasis and higher plasma EBV DNA was still found in locally advanced nasopharyngeal cancer (LA-NPC) at 1 month or even 3 years after completing radiotherapy (RT). Even though EBV DNA has not been widely used in clinical practice, it could be an important value for determining treatment outcomes and risk of disease relapse.Methods: This review article gathered studies from the PubMed database from 2021 to 2022. Using various searching terms 434 articles were found and were narrowed down to 7 according to the inclusion criteria. The individual review was made for each article and endpoints such as overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and local recurrence-free survival (LRFS) were drawn.Results: Overall subjects for these studies ranged up to 2,354 LA-NPC patients (median of 1,073   subjects). All studies observed the pre-treatment and post-treatment EBV DNA and only two studies observed post-neoadjuvant chemotherapy (post-NAc). EBV DNA currently is the most reliable biomarker available for clinical purposes and its versatility can be useful, especially to value prognosis and to determine the course of treatment.Conclusions: Apart from survival outcomes, pre-treatment EBV DNA is considered good for predicting the overall prognosis. Meanwhile, post-induction chemotherapy (post-IC) or post-NAc EBV DNA is suitable for adjuvant therapy indicators, especially in LA-NPC. Even though the cut-off value for the tests was still varied across laboratories (ranging from 1,500 to 4,000), post-NAc and post-treatment might have some benefit to help predict any locoregional recurrence and distant metastasis, considering pre-treatment will not change the therapeutic course completely.
Neutrophil to Hemoglobin Lymphocyte Ratio (NHLR) as a Novel Biomarker is Superior to Neutrophil Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) as Predictors of Advanced Colorectal Cancer Purnomo, Heri; Handaya, Yuda; Setyawan, Nurcahya
Indonesian Journal of Cancer Vol 18, No 1 (2024): March
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v18i1.1099

Abstract

Background: Neutrophils, Hemoglobin, and Lymphocytes are biological markers that may be related to the colorectal cancer stage. Neutrophils to Hemoglobin-Lymphocytes Ratio (NHLR) is a new biomarker that will be tested with Neutrophil Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) as common biomarkers that have been shown to have predictive value with colorectal cancer stage. This study aims to prove NHLR as a new biomarker that can predict advanced colorectal cancer in terms of staging and site of cancer compared to NLR and PLR. Methods: This is a retrospective cross-sectional study. Data obtained from the medical records of colorectal cancer patients undergoing surgery at Dr Sardjito Hospital from 2020 until 2022. Results: 386 patients enrolled in the study, and 62 patients met the inclusion criteria. Twentyeight patients (45.16 %) were male, and 34 (54.84 %) were female. The mean age is 58.82 years. Bivariate analysis showed a significant relationship between NHLR, NLR, and PLR with colorectal cancer stage and significant differences between NHLR and NLR with early and advanced colorectal cancer, but not with PLR. There are also significant differences between NHLR, NLR, and PLR with colorectal cancer sites in the colon and rectum. Still, in locally advanced stages of colorectal cancer, there is no significant association between NLR and cancer sites. On the contrary, there are significant differences between colon and rectal cancer sites with NHLR and PLR. Conclusions: NHLR is superior to NLR and PLR in predicting the stage and site of advanced colorectal cancer.

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