Korelasi antara Imunoekspresi p53 dan Respons Kemoterapi Neoadjuvan Regimen Fluororasil, Adriamisin, dan Siklofosfamid pada Karsinoma Duktus Payudara Invasif

Abstract

Karsinoma duktus payudara invasif (KDPI) stadium IIIB perlu penanganan multimodalitas. Kemoterapi neoadjuvan (KN) diberikan untuk menurunkan ukuran dan stadium tumor agar dapat dilakukan operasi. Regimen KN yang biasanya digunakan yaitu fluororasil, adriamisin, dan siklofosfamid (FAS). Kemoterapi FAS bekerja dengan cara merusak deoxyribonucleic acid dan menginduksi apoptosis sel kanker. Terjadinya kelainan protein atau gen yang berhubungan dengan apoptosis (p53) diduga mempengaruhi respons kemoterapi tersebut. Tujuan penelitian ini untuk mengetahui korelasi imunoekspresi p53 dengan respons kemoterapi neoadjuvan FAS. Penelitian ini merupakan penelitian analitik potong lintang terhadap 40 kasus KDPI yang diberikan KN FAS di Rumah Sakit Dr. Hasan Sadikin Bandung periode Maret 2008–Februari 2009. Respons KN FAS dinilai berdasarkan ukuran massa tumor setelah pemberian FAS. Blok parafin penderita dibuat pulasan hematoksilin-eosin dan imunohistokimia dengan menggunakan mouse monoclonal antibody p53 protein (Novocastra), kemudian ditentukan tingkat imunoekspresi p53. Uji statistik dengan Somers’d dan Gamma untuk menguji korelasi antar variabel. Nilai p<0,05 secara statistik dianggap bermakna. Pada 40 kasus KDPI, 20 berespons dan 20 kasus tidak berespons terhadap KN FAS; 13 kasus terekspresi p53>75%, 14 kasus p53=10–75%, 7 kasus p53<10%, dan 6 kasus tidak terekspresi p53. Terdapat korelasi bermakna antara imunoekspresi p53 dan respons kemoterapi FAS (p=0,000). Simpulan, semakin tinggi ekspresi p53, semakin tidak berespons terhadap KN FAS. Imunoekspresi p53 dapat memprediksi respons KN FAS pada KDPI stadium IIIB. [MKB. 2012;44(1):13–8].

Kata kunci: Karsinoma duktus payudara invasif, imunoekspresi, p53

Correlation between p53 Immunoexpression and Fluorouracyl, Adriamycin and Cyclophosphamide Regimen Neoadjuvant Chemotherapy Responses in Invasive Ductal Breast Carcinoma

Invasive ductal breast carcinoma (IDBC) stage IIIB need multimodality treatment. Neoadjuvant chemotherapy (NC) is given to reduce the size and stage of tumor so that surgery can be performed. Neoadjuvant chemotherapy regimens generally used was fluorouracil, adriamycin and cyclophosphamide (FAC). FAC chemotherapy works by damaging deoxyribonucleic acid and induce apoptosis of cancer cells. Abnormalities of proteins or genes associated with apoptosis (p53) is believed to affect the chemotherapy response. This study was purpose to determine correlation between immunoexpression of p53 and response of neoadjuvant FAC chemotherapy in invasive ductal breast carcinoma. The study was a cross sectional analytic study of 40 IDBC cases given FAC NC at Dr. Hasan Sadikin Hospital Bandung between March 2008–February 2009. Response of FAC NC judged on the size of tumor mass following administration of FAC. Haematoxylin-eosin and immunohistochemistry stain using a mouse monoclonal antibody to p53 protein (Novocastra) was made from paraffin blocks of patients, then determined the immunoexpression levels of p53. Somers’d and Gamma statistical were used to test the correlation between variables. The p-value <0.05 was considered statistically significant. In 40 IDCB cases, 20 cases were responded and 20 cases did not respond to FAC NC; 13 cases expressed p53>75%, 14 cases p53 10–75%, 7 cases p53<10%, and 6 cases were not expresed p53; There was a significant correlation between immunoexpression of p53 and the response of FAC chemotherapy (p=0.000). In conclusions, the higher expression of p53, the lower response to NC FAC. Immunoexpression of p53 can predict the response of FAC NC on IDBC stage IIIB. [MKB.2012;44(1):13–8].

Key words: Immunoexpression, invasive ductal breast carcinoma, p53

DOI: http://dx.doi.org/10.15395/mkb.v44n1.209