Rasio Neutrofil Limfosit, Kesintasan Tiga Tahun Karsinoma Nasofaring Stadium Lokal Lanjut dan Lanjut

Rahmat Cahyanur, Hayatun Nufus, Cosphiadi Irawan

Abstract

Pendahuluan. Karsinoma nasofaring (KNF) merupakan jenis keganasan kepala dan leher yang paling banyak terjadi di Indonesia dengan angka kematian akibat KNF di Indonesia merupakan yang tertinggi kedua setelah Cina. Inflamasi telah diteliti berkaitan dengan perjalanan penyakit kanker. Rasio neutrofil limfosit atau neutrophil lymphocyte ratio (NLR) menggambarkan keseimbangan antara efek merugikan supresi respons imun terhadap kanker oleh neutrofil dan efek menguntungkan respons imun adaptif oleh limfosit. Penelitian ini bertujuan untuk mengetahui hubungan antara NLR terhadap kesintasan pasien KNF stadium lokal lanjut dan lanjut.

Metode. Studi kohort retrospektif ini menggunakan data rekam medis pasien KNF stadium lanjut dan lokal lanjut yang berobat jalan di poliklinik hematologi-onkologi medik RSUPN dr. Cipto Mangunkusumo tahun 2015 hingga 2018. Perbedaan kesintasan tiga tahun antara pasien KNF dengan dan tanpa metastasis, serta NLR tinggi dan rendah dianalisis dengan metode Kaplan-Meier. Sementara itu, analisis multivariat Cox regression dilakukan untuk melihat adjusted hazard ratio (HR) setelah dibandingkan dengan usia, jenis kelamin, stadium T, stadium N, NLR, serta status metastasis pasien.

Hasil. Terdapat 143 subjek dalam penelitian ini dengan 49 (34,3%) mengalami metastasis. Terdapat perbedaan kesintasan antara kelompok metastasis dan non-metastasis (p=0,001) dengan kesintasan tiga tahun pada kelompok metastasis sebesar 24,5%. NLR memiliki nilai AUC 0,600 (IK 95% 0,502—0,698; p=0,049). Nilai titik potong optimal NLR ditentukan sebesar 4,7 dengan sensitivitas 56,00%; spesifisitas 62,37%; PPV 59,81%; dan NPV 58,64% dalam memprediksi kesintasan pasien. Berdasarkan nilai tersebut (≥4,7), terdapat perbedaan proporsi antara kelompok metastasis dan non-metastasis (63,3% vs. 33,0%; p=0,001). Pada analisis multivariat, didapatkan bahwa kelompok subjek dengan metastasis (HR 3,349; IK 95% 1,909—5,874; p<0,001) berkaitan dengan kesintasan yang buruk.

Simpulan. Tidak terdapat hubungan antara nilai NLR dengan kesintasan tiga tahun pada pasien KNF. Proporsi subjek dengan NLR tinggi lebih banyak pada kelompok metastasis dibandingkan dengan tanpa metastasis. Status metastasis berhubungan dengan kesintasan tiga tahun.

 

Kata Kunci: karsinoma nasofaring, kesintasan, rasio neutrofil limfosit

 

Neutrophil Lymphocyte Ratio, Three Year Survival of Locally Advanced and Advanced Nasopharyngeal Carcinoma

Introduction. Nasopharyngeal carcinoma (NPC) is the most prevalent head and neck malignancy in Indonesia, as NPC-related mortality in Indonesia is the second-highest in Asia after China. Inflammation has been studied to be associated with cancer progression. Neutrophil lymphocyte ratio describes the balance between the unfavorable suppression of immune response against cancer by neutrophils and the beneficial effect of adaptive immunity by lymphocytes. This study aimed to determine the relationship between NLR and the survival of locally advanced and advanced NPC patients.

Methods. A retrospective cohort study was conducted using the medical records of NPC patients treated at the hematology clinic RSCM from 2015 to 2018. The difference in 3-year survival between NPC patients with and without metastasis, also high and low NLR, was analyzed with the Kaplan-Meier method. At the same time, multivariate Cox regression analysis was used to obtain adjusted hazard ratios (HR) after comparing with patients’ age, gender, T stage, N stage, NLR level, and metastasis status.

Results. There were 143 patients included in this study; a total of 49 (34.3%) had metastasis. There was a significant difference in survival between those with and without metastasis (p=0.001), with 3-year survival of 24.5% in patients with metastasis. The AUC of NLR was 0.600 (CI 95% 0.502—0.698; p=0.049). The optimal cut-off value determined for NLR was 4.7 with a sensitivity of 56.00%, specificity of 62.37%, PPV of 59.81%, and NPV of 58.64% in predicting survival. Based on that value (≥4,7), there was a significant difference in proportion between those with and without metastasis (63.3% vs. 33.0%, p=0.001). Multivariate analysis showed that metastasis (HR 3.349, CI 95% 1.909—5.874, p<0.001) was associated with poorer survival.

Conclusions. There was no association between NLR and 3-year survival in NPC patients. The proportion of subjects with high NLR was found higher in those with metastasis. Metastasis status was associated with 3-year survival.

Keywords

Nasopharyngeal carcinoma, neutrophil lymphocyte ratio, survival

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