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 Penyakit 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)
III. Perkumpulan Profesi
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 DIFFMODERATE 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 20.0Uji 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