Perbedaan Kadar CEA Dan CA 19-9 Dalam Serum Berdasarkan Differensiasi Sel Pada Kanker Kolorektal

  Lampiran 1: Surat Persetujuan Komite Etik

  Lampiran 2

LEMBAR PENJELASAN KEPADA CALON SUBJEK PENELITIAN

  Selamat pagi/siang Bapak/Ibu/sdr/i, pada hari ini, saya dr. Ester Silalahi akan melakukan penelitian yang berjudul “ Kadar CEA dan CA 19-9 dalam

  Serum berdasarkan Differensiasi Sel pada Kanker Usus Besar”.

  Penelitian ini bertujuan untuk mengetahui perbedaan kadar serum CEA dan CA 19-9 berdasarkan hasil biopsi jaringan Patologi Anatomi (Histopatologi) setelah dilakukan peneropongan usus besar. Dari hasil CEA dan CA 19-9 serta hasil Histopatologi maka dapat dilihat perbedaannya. Sehingga dengan pemeriksaan kadar CEA dan CA 19-9 pada kanker usus besar dapat memprediksi tingkat differensiasi sel. Pada Bapak/Ibu/sdr/i yang bersedia mengikuti penelitian ini dimintakan mengisi surat persetujuan ikut dalam penelitian, mengikuti wawancara, pemeriksaan peneropongan usus besar dan biopsi jaringan oleh ahlinya dengan persiapan khusus seperti pengosongan usus, pemberian obat pelancar BAB, puasa mulai malam sampai selesai dilakukan peneropongan usus besar, serta pemeriksaan laboratorium berupa pemeriksaan darah sebanyak 5 cc oleh ahlinya.

  Dampak yang terjadi sewaktu dilakukan peneropongan usus besar adalah rasa sakit tetapi akan ada tindakan pencegahan dengan pemberian obat sebelumnya. Efek samping yang berat bila timbul akan saya laporkan kepada Komite Etik Penelitian FK USU. Dalam kaitan ini akan ada pengawasan dari atasan kami di bagian Gastroenterohepatologi Departemen Ilmu Penyakit dalam. Segala biaya pemeriksaan peneropongan usus, histopatologi jaringan, dan laboratorium menjadi tanggung jawab peneliti. Bila masih terdapat pertanyaan, maka Bapak/Ibu dapat menghubungi saya: Nama : dr. Ester Morina Silalahi Alamat : Jl. Rakyat Pasar II Gg. Sekolah No. 15 Medan Telepon/HP : 085275284298

  Atas kerjasama Bapak/Ibu/Sdr/i, saya ucapkan terima Peneliti

  (dr. Ester Morina Silalahi)

  Lampiran 3

LEMBAR PERSETUJUAN SETELAH PENJELASAN

(INFORMED CONSENT)

  Saya yang bertandatangan di bawah ini: Nama : Alamat : Umur : Jenis Kelamin : Laki-laki/ Perempuan No Telp : Setelah mendapat penjelasan dari peneliti tentang kebaikan dan keburukan prosedur penelitian ini, saya menyatakan bersedia ikut serta dalam penelitian tentang “ Kadar CEA dan CA 19-9 Dalam Serum Berdasarkan Differensiasi

  

Sel Pada Kanker Kolorektal”. Apabila sewaktu-waktu saya mengudurkan diri

dari penelitian ini, kepada saya tidak dituntut apapun.

  Demikian surat persetujuan bersedia ikut dalam penelitian ini saya buat untuk dapat dipergunakan seperlunya.

  Medan, 2013

   Saksi Peneliti (_________________ ) (_________________ )

  Lampiran 4 KERTAS KERJA PROFIL PESERTA PENELITIAN Tanggal : ………………………….

  MR : …………………………. No. Pemeriksaan lab : ……………..

  I. Anamnesa Pribadi Nama : …………………………………………………..

  Umur : ………………………………………………….. Jenis Kelamin : ………………………………………………….. Alamat : ………………………………………………….. No telp : …………………………………………………..

  II. Pemeriksaan Penunjang

  a. Laboratorium

• CEA : …………. µg/ml
• CA 19-9 : ……………. u/ml

  b. Foto Thorax : …………………………… c. USG Abdomen : …………………………...

  d. Kolonoskopi : ……………………………

  e. Histopatologi : ……………………………

  Lampiran 5

DAFTAR RIWAYAT HIDUP

I. Data Pribadi

  Nama : dr. Ester Morina Silalahi Tempat/Tgl Lahir : Medan/ 22 Oktober 1977 Suku/Bangsa : Batak/ Indonesia Agama : Kristen Protestan Alamat : Jl. Rakyat Pasar II Gg. Sekolah No. 15 Medan Status : Menikah Nama suami : dr. Ferdinand Siregar Anak : - Telpon Selluler : 085275284298

I. Pendidikan

  SD RK Setia Budi (1983-1989) SLTP RK Budi Murni Medan (1989-1992) SMA RK Budi Murni (1992-1995) Fakultas Kedokteran UKI Jakarta (1995-2002)

  PPDS Ilmu Peny. dalam Fakultas Kedokteran Universitas Sumatera Utara (2009 - sekarang) di Medan

II. Riwayat Pekerjaan

  PTT Puskesmas Taba Penanjung Bengkulu (2003-2005) PNS RSUD MukoMuko Bengkulu (2005-sekarang)

   Perkumpulan Profesi III.

  Anggota IDI Cabang Medan Perhimpunan Dokter Spesialis Penyakit Dalam Indonesia (PAPDI)

IV. Karya Ilmiah

  1. Antiphospholipid Syndrome With Recurent Abortion . The Mallaca Strait Haematology-Oncology Symposia 2011.

  2. Hipotiroidisme Yang Disebabkan Tuberkulosis. 4 th Endocrinology & Diabetes Forum Of Sumatera Region.

V. Partisipasi Dalam Kegiatan Ilmiah

  1. Peserta Festschrift Prof. Dr. Harun Rasyid Lubis, Sp.PD-KGH Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Sumatera Utara, Tiara Convention Centre Medan, 10 Nopember 2008.

  2. Peserta Pertemuan Ilmiah Ilmu Penyakit Dalam. Hotel Borobudur Jakarta, 23 – 25 Juli 2010

  3. Peserta Workshop Injeksi Kortikosteroid Intra Lesion and Visco Supplement dalam Rheumatology Update 2010, RSU. Prof. Dr. Boloni Medan, 30 Juli 2010

  4. Peserta Pelatihan Program Pengembangan Pendidikan Keprofesian Berkelanjutan Ultrasonografi Tahap Pertama bagi PPDS Ilmu Penyakit Dalam. Departemen Ilmu Penyakit Dalam FK USU dan PUSKI.

  Medan, 21-24 Maret 2011

  

th

  5. Peserta Simposium The 6 New Trend in Cardiovascular

  Management , JW. Marriott Hotel Medan, 23-25 Juni 2011

  6. Peserta Poster Presentation The 7 th National Convention of the Indonesian Society of Haematology and Blood transfusion (PHTDI), 8

• – 9 Oktober 2011 7. Peserta workshop Hemophilia and Supportive Treatment in Cancer.

  JW. Marriot Hotel Medan, 7 Oktober 2011

  8. Peserta Simposium “The New Option of Insulin Resistance Treatment

  in Type 2 Diabetes ”, Hermes Palace Hotel Medan, 20 November 2011

  9. Peserta Simposium “Rationale Strategy in the Management of Pancreatic B Dysfunction and Role of Oral Incretin Based Therapy in Type 2 Diabetes Mellitus”, Hotel J.W. Marriott Medan, 29 Januari 2012

  10. Peserta Workshop “Cancer Pain Management”, Hotel Grand Aston Medan, 10 Maret 2012 11. Peserta Simposium “Diabetes Update for Excellent”, Hotel J.W.

  Marriott, Medan 17 Maret 2012

  12. Peserta Simposium The New Direction in The Treatment of Type 2

  Diabetes Melitus “A New Novel DPP-4 Inhibitor For T2DM Treatment” , Hotel J.W. Marriott Medan, 1 April 2012

  13. Peserta Roadshow Hipertensi PB PAPDI “The Next Big Target in Hypertension: Controlling All Key BP Parameters” , Hotel J.W.

  Marriott Medan, 28 April 2012

  14. Peserta Seminar dan Lokakarya Sehari: Comperhensive Management

  of Nausea-Vomiting and Acid Related Diseases , 5 Mei 2012

  15. Peserta Workshop Terapi Insulin “Update on Diagnosis and

  

Management of Comment Clinical Problems ”, Dies Natalis 60 Tahun

  Fakultas Kedokteran USU, Hotel Santika Dyandra Convention Hall,

  11 September 2012

  16. Panitia Simposium Kongres Nasional XV Perhimpunan Dokter Spesialis Penyakit Dalam Indonesia (KOPAPDI XV), Hotel J.W.

  Marriott dan Hotel Grand Aston Medan, 12-15 Desember 2012

  17. Peserta Simposium Kongres Nasional XV Perhimpunan Dokter Spesialis Penyakit Dalam Indonesia (KOPAPDI XV), Hotel J.W.

  Marriott dan Hotel Grand Aston Medan, 12-15 Desember 2012

  18. Peserta Workshop USG PAD, FEDS V, Hotel Grand Aston Medan, Februari 2013

  19. Peserta ACS Symposia Roadshow: A to Z on ACS Management, Hotel Swiss Bell Medan, Juni 2013

  Lampiran 6 HASIL STATISTIK Karakteristik Klinis Subjek Penelitian Jenis kelamin Cumulative Frequency Percent Valid Percent Percent

  Valid Laki-laki

  22

  55.0

  55.0

  55.0 Perempuan

  18

  45.0 45.0 100.0 Total 40 100.0 100.0

  Kolonoskopi Cumulative Frequency Percent Valid Percent Percent

  Valid CARCINOMA COLON

  2

  5.0

  5.0

  5.0 ASCD CARCINOMA COLON

  3

  7.5

  7.5

  12.5 DESC CARCINOMA

  1

  2.5

  2.5

  15.0 COLOREKTI CARCINOMA

  1

  2.5

  2.5

  17.5 RECTOSIGM CARCINOMA RECTUM

  5

  12.5

  12.5

  30.0 CARCINOMA

  1

  2.5

  2.5

  32.5 REKTOSIGM CARCINOMA REKTUM

  20

  50.0

  50.0

  82.5 CARCINOMA SEKUM

  1

  2.5

  2.5

  85.0 CARCINOMA SIGMOID

  4

  10.0

  10.0

  95.0 CARCINOMARECTUM

  2

  5.0 5.0 100.0 Total 40 100.0 100.0

  De fferensi asi Sel Cumulative Frequency Percent Valid P ercent Percent

  Valid MODE RATE DIFF

  6

  15.0

  15.0

  15.0 POORLY DIFF

  6

  15.0

  15.0

  30.0 W ELL DIFF

  28

  70.0 70.0 100.0 Total 40 100.0 100.0

  Rerata Kadar CEA berdasarkan Differensiasi Sel Descriptives CEA 28 64.229 92.7642 17.5308 28.258 100.199 .6 453.0

  6 38.040 72.6834 29.6729 -38.237 114.317 2.2 185.6 6 8.433 5.4184 2.2120 2.747 14.120

  2.9

  16.4 40 51.931 84.0705 13.2927 25.044 78.818 .6 453.0 WELL DIFF MODERATE DIFF POORLY DIFF Total N Mean Std. Deviation Std. Error Lower Bound Upper Bound

  95% Confidence Interval for Mean Minimum Maximum

  Test of Homogeneity of Variances CEA 1.740

  2 37 .190 Levene Statistic df1 df2 Sig.

  Multiple Comparisons Dependent Variable: CEA LSD

  26.1886 37.6315 .491 -50.060 102.437 55.7952 37.6315 .147 -20.453 132.044

• 26.1886 37.6315 .491 -102.437 50.060 29.6067 48.2954 .544 -68.249 127.462
• 55.7952 37.6315 .147 -132.044 20.453
• 29.6067 48.2954 .544 -127.462 68.249 (J) Defferensiasi Sel MODERATE DIFF POORLY DIFF WELL DIFF POORLY DIFF WELL DIFF

  MODERATE DIFF (I) Defferensiasi Sel WELL DIFF MODERATE DIFF POORLY DIFF

  Mean Difference (I-J) Std. Error Sig. Lower Bound Upper Bound 95% Confidence Interval

  Post Hoc Tests

Defferensiasi Sel

^{POORLY DIFF MODERATE DIFF WELL DIFF}

  Mean of U m ur (t ahun) ^{55 54 53} ₅₂

  51 ₅₀

49 Rerata Umur berdasarkan Differensiasi Sel

  28 50.18 14.962 2.828

  29

  Statistic df1 df2 Sig.

  Umur (tahun) 1.436 2 37 .251 Levene

  Mean Minimum Maximum Test of Homogeneity of Variances

  Total 76 WELL DIFF MODERATE DIFF POORLY DIFF N Mean Std. Deviation Std. Error Lower Bound Upper Bound 95% Confidence Interval for

  22

  55.22

  46.33

  40 50.78 13.911 2.200

  63

  62.24

  44.38

  37.10

  Descriptives Umur (tahun)

  71

  41

  66.88

  42.45

  6 54.67 11.639 4.752

  76

  22

  55.98

  6 49.67 11.978 4.890

  Uji Anova ANOV A Umur (tahun) Sum of

  Squares df Mean S quare F Sig. Between Groups 108.201 2 54.101 .269 .766 W ithin Groups

  7438.774 37 201.048 Total 7546.975

39 Rerata Kadar CEA pada Differensiasi Sel

  60.0 A E

  40.0 C of Mean

  20.0

0.0 WELL DIFF MODERATE DIFF POORLY DIFF

  Defferensiasi Sel

  Post Hoc Tests Descriptives CA 19-9

28 38.386 74.2104 14.0245 9.610 67.162

  4.2 402.9

6 23.733 12.9457 5.2851 10.148 37.319

  5.1

  36.8

6 22.550 8.2065 3.3503 13.938 31.162

  12.5

  34.0

40 33.813 62.3935 9.8653 13.858 53.767

4.2 402.9 WELL DIFF

  MODERATE DIFF POORLY DIFF Total N Mean Std. Deviation Std. Error Lower Bound Upper Bound

  95% Confidence Interval for Mean Minimum Maximum

  Test of Homogeneity of Variances CA 19-9 .729

  2 37 .489 Levene Statistic df1 df2 Sig.

  Post Hoc Tests _{Multiple Comparisons Dependent Vari able: CA 19-9 LSD} 14.6524 28.6312 .612 -43.360 72.665 _{15.8357 28.6312 .584 -42.177 73.848 -14.6524 28.6312 .612 -72.665 43.360 1.1833 36.7446 .974 -73.268 75.635 -15.8357 28.6312 .584 -73.848 42.177 -1.1833 36.7446 .974 -75.635 73.268} ^{(J) Defferensias i Sel MODERATE DIFF} _{POORLY DIFF WELL DIFF POORLY DIFF WELL DIFF MODERATE DIFF} ^{(I) Defferensias i Sel WELL DIFF} _{MODERATE DIFF POORLY DIFF} ^{Mean Di fference (I-J) Std. Error Sig. Lower Bound Upper Bound 95% Confidence Interval}

  Rerata Kadar CA 19-9 pada Differensiasi Sel

Defferensiasi Sel

^{POORLY DIFF MODERATE DIFF WELL DIFF Mean of C A 19- 9 40.0 35.0 30.0 25.0 20.0}

  Uji Chi-Square Defferensiasi Sel * CEA Crosstabulation CEA Abnormal

  Normal (< 5) (>= 5) Total Defferensiasi WELL DIFF Count

  8

  20

  28 Sel % within 28.6% 71.4% 100.0% Defferensiasi Sel

  % within CEA 61.5% 74.1% 70.0% % of Total 20.0% 50.0% 70.0% MODERATE DIFF Count

  2

  4

  6 % within 33.3% 66.7% 100.0% Defferensiasi Sel

  % within CEA 15.4% 14.8% 15.0% % of Total 5.0% 10.0% 15.0% POORLY DIFF Count

  3

  3

  6 % within 50.0% 50.0% 100.0% Defferensiasi Sel

  % within CEA 23.1% 11.1% 15.0% % of Total 7.5% 7.5% 15.0% Total Count

  13

  27

  40 % within 32.5% 67.5% 100.0% Defferensiasi Sel

  % within CEA 100.0% 100.0% 100.0% % of Total 32.5% 67.5% 100.0%

  Chi-Square Te sts As ymp. Sig.

  Value df (2-sided) a

  Pearson Chi-S quare 1.036 2 .596 Lik elihood Ratio .987 2 .610 Linear-by-Linear

  .938 1 .333 As soc iation N of V alid Cases

  40

a. 4 c ells (66.7%) have ex pec ted c ount les s than 5. The minimum expected count is 1.95.

  NPar Tests Mann-Whitney Test Ranks

CEA N Mean Rank Sum of Ranks

Defferensiasi Sel Normal (< 5)

  13 22.42 291.50 Abnormal (>= 5) 27 19.57 528.50 Total

  40

  b Te st S tatistics Defferensiasi Sel

  Mann-W hit ney U 150.500 W ilcox on W 528.500 Z

• .895 As ymp. Sig. (2-tailed) .371 _a Ex act Sig. [2*(1-tailed .475 Sig.)]

  a.

  Not correct ed for ties.

  b.

  Grouping V ariable: CEA Defferensiasi Sel * CA 19-9 Crosstabulation

CA 19-9

  1.0

  2.0 Total Defferensiasi WELL DIFF Count

  19

  9

  28 Sel Expected Count

  21.7

  6.3

  28.0 % within 67.9% 32.1% 100.0% Defferensiasi Sel

  % within CA 19-9 61.3% 100.0% 70.0% % of Total 47.5% 22.5% 70.0%

  MODERATE DIFF Count

  6

  6 Expected Count

  4.7

  1.4

  6.0 % within 100.0% .0% 100.0% Defferensiasi Sel

  % within CA 19-9 19.4% .0% 15.0% % of Total 15.0% .0% 15.0%

  POORLY DIFF Count

  6

  6 Expected Count

  4.7

  1.4

  6.0 % within 100.0% .0% 100.0% Defferensiasi Sel

  % within CA 19-9 19.4% .0% 15.0% % of Total 15.0% .0% 15.0%

  Total Count

  31

  9

  40 Expected Count

  31.0

  9.0

  40.0 % within 77.5% 22.5% 100.0% Defferensiasi Sel

  % within CA 19-9 100.0% 100.0% 100.0% % of Total 77.5% 22.5% 100.0%

  Keterangan: 1.0 : Kadar CA 19-9 < 37 U/ml , 2.0 : Kadar CA 19-9 > 37 U/ml Chi-Square Te sts As ymp. Sig.

  Value df (2-sided) a

  Pearson Chi-S quare 4.977 2 .083 Lik elihood Ratio 7.488 2 .024 Linear-by-Linear

  4.188 1 .041 As soc iation N of V alid Cases

  40 a. 4 c ells (66.7%) have ex pec ted c ount les s than 5. The minimum expected count is 1.35.

  Uji Kolmogorov-Smirnov Two-Sample Kolmogorov-Smirnov Test Frequencies CA 19-9 N Defferensiasi Sel

  1.0

  31

  2.0

9 Total

  40 a Test Statistics

  Defferensiasi Sel Most Extreme Absolute .387 Differences Positive

  .000 Negative

• .387 Kolmogorov-Smirnov Z 1.022 As ymp. Sig. (2-tailed) .247 a.

  Grouping Variable: CA 19-9 Uji Spearman Correlations

  Defferensiasi CEA CA 19-9 Sel Spearman's rho CEA Correlation Coefficient 1.000 .394* -.216

  Sig. (2-tailed) . .012 .181 N

  40

  40

  40 CA 19-9 Correlation Coefficient .394* 1.000 .005 Sig. (2-tailed) .012 . .977 N

  40

  40

  40 Defferensiasi Sel Correlation Coefficient

• .216 .005 1.000 Sig. (2-tailed) .181 .977 .

  N

  40

  40

  40 *. Correlation is s ignificant at the 0.05 level (2-tailed).

  Gambar Korelasi Antara Kadar CEA dengan Differensiasi Sel Defferensiasi Sel ^{3 2.5 2 1.5 1} CE A ^{500.0 400.0 300.0} _200.0 100.0 _0.0 ^{R Sq Linear = 0.061}

  Gambar Korelasi Antara Kadar CA 19-9 dengan Differensiasi Sel Defferensiasi Sel ^{3 2.5 2 1.5 1} CA

  1

  9 -9 ^{500.0 400.0 300.0} _200.0 100.0 _0.0 ^{R Sq Linear = 0.012}

  Lampiran 7 MASTER TABEL No Umur JK Kolonoskopi Differensiasi Sel CEA CA 19-

  61 P Carcinoma Rektum

  64 P Carcinoma Sigmoid

  Moderate diff 2,2 5,1

  12

  57 L Carcinoma Rektum

  Well diff 13,9 40,0

  13

  28 L Carcinoma Rektum

  Well diff 10,1 95,0

  14

  24 P Carcinoma Sigmoid

  Well diff 24,3 53,2

  15

  Well diff 453,0 18,2

  Well diff 6,3 4,2

  16

  40 L Carcinoma Rektum

  Well diff 112,0 23,8

  17

  30 L Carcinoma Rektum

  Well diff 1,2 6,0

  18

  50 P Carcinoma Rektum

  Poorly diff 16,4 17,9

  19

  38 P Carcinoma Rektum

  Well diff 6,8 23,4

  20

  11

  71 L Carcinoma Rektum

  9

  5

  1

  63 P Carcinoma Rektum

  Well diff 14,9 11,8

  2

  60 P Carcinoma Rektum

  Poorly diff 12,5 23,9

  3

  45 P Carcinoma Rektum

  Well diff 125,7 38,5

  4

  76 L Carcinoma Rektum

  Well diff 2,6 5,7

  62 L Carcinoma Rektum

  10

  Well diff 76,9 51,9

  6

  68 P Carcinoma Sigmoid

  Well diff 3,1 5,4

  7

  43 L Carcinoma Rektum

  Well diff 3,0 9,2

  8

  41 P Carcinoma Rektum

  Moderate diff 185,6 36,8

  9

  43 P Carcinoma Sigmoid

  Well diff 220,1 7,47

  66 L Carcinoma Well diff 58,2 38,3

  Sigmoid

  21

  69 L Carcinoma Well diff 69,5 402,89 Rektum

  22

  43 P Ca-Colon Well diff 0,6 20,1 Ascenden

  23

  55 L Ca-Colon Moderate diff 7,24 13,8 Descenden

  24

  22 P Carcinoma Well diff 1,2 12,9 Sekum

  25

  46 L Ca-Colon Well diff 3,3 12,1 Ascenden

  26

  43 P Carcinoma Well diff 23,3 34,0 Rektum

  27

  50 L Carcinoma Well diff 68,0 33,34 Rektum

  28

  63 L Carcinoma Well diff 1,9 20,3 Rektum

  29

  63 L Carcinoma Poorly diff 4,5 29,8 Rektum

  30

  54 P Carcinoma Moderate diff 5,2 33,5 Rektum

  31

  48 P Carcinoma Poorly diff 10,1 12,5 Rektum

  32

  63 P Carcinoma Well diff 82,3 7,9 Rektum

  33

  38 L Ca-Colon Well diff 81,7 15,9 Descenden

  34

  40 L Carcinoma Well diff 100,2 39,2 Rektum

  35

  71 L Carcinoma Moderate diff 4,7 19,2 Rektum

  36

  61 L Carcinoma Well diff 72,9 7,3 Rektum

  37

  29 L Ca-Colon Poorly diff 4,2 17,2 Descenden

  38

  45 P Carcinoma Well diff 92,5 39,9 Rektum

  39

  50 L Carcinoma Well diff 92,2 30,9 Rektum

  40

  48 L Carcinoma Poorly diff 2,9 34,0 Sigmoid