KADAR VASCULAR ENDOTHELIAL GROWTH FACTOR-A (VEGF-A) SEBAGAI PREDIKTOR KEBERIIASILAN TERAPI KARSINOMA EPIDERMOID SERVIKS UTERI STADIUM LANJUT (VASCULAR ENDOTHELIAL GROWTH FACTOR-A LEVELS AS THE PREDICTOR OF ADVANCED EPIDERMOID CERVICAL CANCER RESPONSE THERAPY)

Abstract

Object : To evaluate the differences of VEGF-A concentrations on each radiation response group, from January 2004 to October 2004 at Obstetric and Gynecology Department, Medical Faculty of Diponegoro University/ Kariadi Hospital, and to determine the cutoff value for predicting the poor response. Methods : Forty three women with stage IIB and IIIB cervical carcinoma had radiation or chemoradiation. Serum VEGF-A concentrations which were assayed with enzyme immunoassay was taken before therapy. Histopathological response and VEGF-A serum concentrations were compared. Results : There was same result in histopathological radiation response for both therapy. Eight women (18.6%) who had poor response had higher levels of serum VEGF-A (339.65 vs 223.76 pg/ml, p < .001) than those with well response. Using cutoff value of 302.86 resulted in best sensitivity of 88%, best specificity of 97%, positive predictive value of 88%, and negative predictive value of 97%. The overexpressed serum VEGF-A levels (hazard ratio 7.8, p < .001) was predicting value of poor response. Conclusion : Women with poor response had overexpressed serum VEGF-A for both therapy. Serum VEGF-A might be a biomarker for radiation or chemoradiation response in advanced-stage cervical cancer and a predicting indicator of radiation response. Tujuan Penelitian ini bertujuan untuk mengetahui perbedaan kadar VEGF A pada setiap kelompok respons radiasi, pada penderita karsinoma epidermoid serviks uteri stadium lanjut yang mendapatkan terapi radiasi/ kemoradiasi di bagian Obstetri dan Ginekologi FK. Undip/ RS dr. Kariadi Semarang, antara bulan Januari — Oktober 2004. Serta menentukan nilai batas kadar VEGF-A pada respons radiasi jelek. Metode : Empat puluh tiga penderita karsinoma epidermoid serviks uteri stadium II B dan III B, mendapatkan terapi radiasi atau kemoradiasi. Kadar VEGF-A serum sebelum terapi diukur dengan metode HASA. Dibandingkan kadar VEGF-A serum pada setiap kelompok respons radiasi histopatologis. Basil : Terdapat presentase hasil respons radiasi yang sama pada kedua kelompok terapi. Delapan (18,6%) penderita dengan repons radiasi jelek mempunyai kadar VEGF-A serum yang lebih tinggi dibandingkan kelompok respons radiasi baik (339,65 dibanding 223,76 pg/ml, p < 0,001) Nilai batas kadar VEGF-A adalah 302,86 pg/ml dengan sensitivitas 88%, spefisitas 97%, dan nilai duga positif 88% serta nilai duga negatif 97% . Kadar VEGF-A > 302,86 pg/ml adalah prediktor untuk respons radiasi jelek (RR=7,8; p < 0,001). Kesimpulan : Wanita dengan respOns radiasi jelek mempunyai kadar VEGF-A yang tinggi pada kedua jenis terapi. VEGF-A serum dapat menjadi petanda respons terapi pada karsinoma serviks uteri stadium lanjut, dan sebagai prediktor keberhasilan terapi.