CA 125 DAN RISK OF MALIGNANCY INDEX (RMI)2 SEBAGAI PREDIKTOR KEGANASAN TUMOR OVARIUM TIPE EPITEL

Abstract

Keganasan ovarium memiliki angka morbiditas dan mortalitas yang tinggi karena umumnya ditemukan pada stadium lanjut. Penelitian ini bertujuan untuk mengetahui spesifitas dan sensitivitas CA 125 dan RMI2 dalam menentukan keganasan kista ovarium jenis epitel. Kadar CA 125 dan RM12 kemudian dilihat histopatologinya sebagai gold standard. Penelitian ini merupakan uji diagnostik, dilakukan di RSUP dr. Hasan Sadikin Bandung periode April s.d. September 2017. Sampel berjumlah 90 dengan 47 berkategori jinak dan 43 berkategori ganas berdasarkan hasil histopatologinya. Analisis data dilakukan secara univariat dan bivariat. Data kategorik diuji dengan uji chi-square atau uji Exact Fisher. Data numerik digunakan uji-t tidak berpasangan atau uji Mann Whitney. Sensitivitas dan spesifisitas data numerik disajikan dalam kurva Receiver Operating Characteristic (ROC). Berdasarkan kurva ROC maka diperoleh nilai area under curve (AUC). Hasil penelitian menunjukkan nilai median CA 125 kelompok ganas dibanding kelompok jinak (142,2 vs 61,030) bermakna secara statistik p = 0,000 (nilai p < 0,05), cut off point CA 125 adalah 99,9 U/mL dengan nilai sensitivitas 76,7% dan nilai spesifisitas 61,7%. Nilai median RMI2 kelompok ganas lebih besar dibandingkan dengan kelompok jinak (1676,8 vs 125) bermakna secara statistik p = 0,000 (nilai p < 0,05), cut off point RMI2 pada penelitian ini adalah 212,7 dengan sensitivitas 86% dan spesifisitas 70,2%. Nilai sensitivitas RMI2 dengan cut off point 200 adalah 88% dan spesifisitas 63,87%. Kesimpulan penelitian ini adalah CA125 adalah biomarker yang berguna untuk memprediksi keganasan ovarium, dengan nilai cut off point 99,9 ng/mL. Hal ini sangat berguna bila digunakan kombinasi CA 125 dengan hasil pemeriksaan Ultrasonografi (USG) dan status menopause atau dikenal dengan Risk Malignancy Index (RMI2 cut off point > 200 ) dengan sensitivitas 86%, spesifisitas 63,87% dan akurasi 74,4%.   The malignancy of ovarian cancer has high level of morbidity and mortality due to the fact that it is commonly found in advanced stage. This research is aimed to find out the specificity and sensitivity of C125 and RMI2 in determining the malignancy of epithelial ovarian cysts. The level of CA 125 and RM12 is then histopathology-measured as a gold standard. This research is a diagnostic study conducted in Hasan Sadikin Hospital Bandung during April until September 2017. Sample consists of 90 patients with 47 patients belong to low-malignancy group and 43 patients belong to high-malignancy group based on its histopathology. Data analysis is conducted by using univariate and bivariate. Categorical data is tested by using chi-square or Exact Fisher. Numeric data is tested by using unpaired t test or Mann Whitney. Sensitivity and specificity of numeric data is displayed in Receiver Operating Characteristic (ROC) curve. The ROC curve shows the value of area under curve (AUC). The result shows that the median of CA125 of the high-malignancy group compared to the low-malignancy group is (142,2 vs 61,030) which statistically means p = 0,000 (value p < 0,05), cut off point CA125 is 99,9 U/mL with sensitivity value 76,7% and specificity value 61,7%. The median of RMI2 of high-malignancy group is bigger compare to the low-malignancy group (1676,8 vs 125) which statistically means p = 0,000 (value p < 0,05), cut off point RMI2 of this research is 212,7 with sensitivity value 86% and specificity value 70,2%. The sensitivity value of RMI2 with cut off points 200 is 88% and the specificity value is 63,87%. This research concludes that CA125 is a useful biomarker to predict the malignancy of ovarian cancer with cut off point 99,9ng/mL. It will be very useful if it is combined with CA125 with Ultrasonography (USG) examination and menopause status or known as Risk Malignancy Index (RMI cut off point > 200) with sensitivity 86%, specificity 63,87% and accuracy 74,4%.