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BREASTS PREDICT
TOOLS
PERANANNYA DALAM
MEMBANTU MENGAMBIL
KEPUTUSAN UNTUK PASIEN
KANKER PAYUDARA

Pembimbing:
dr. Putu Anda Tusta Adiputra,
Sp.B(K)Onk

Gusti Ayu Putu Giti Livia Devi

1702612164

DALAM RANGKA MENJALANI KEPANITERAAN KLINIK MADYA

DI DEPARTEMEN ILMU BEDAH
FAKULTAS KEDOKTERAN UNIVERSITAS UDAYANA
DENPASAR
2019
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PENDAHULUAN

penyakit sistemik yang berhubungan erat dengan genetik dan

variasi molekular dari sel tumor, stem sel mamal, lingkungan mikro,
serta imun sistem penderita

jumlah kasus 41.523 (30.7%) pada tahun 2011

PENATALAKSANAAN & BREASTS PREDICT

PROGNOSIS data yang akurat TOOLS

algoritma matematika dan komputasi

menggunakan parameter klinis berdasarkan data hasil klinis penderita
dan patologi kanker payudara yang telah terdaftar

Wazir U, Mokbel K, Carmichael A, dan Mokbel K. Are Online Prediction Tools a Valid Alternative to Genomic Profiling in the Context of Systemic Treatment of ER Positive Breast Cancer? Cellular & Molecular Biology Letters. 2017;22(20):1-7.
Wazir U, Mokbel K. Emerging Gene Based Prognostic Tools in Early Breast Cancer: First Steps to Personalised Medicine. World Journal of Clinical Oncology. 2014;5(5):795-799.
Wong HS, dkk. The Predictive Accuracy of PREDICT: A Personalized Decision Making Tools for Southeast Asian Women with Breast Cancer. Medicine. 2015;94(8):593-600.
 + PARAMETER
KLINIS DAN PATOLOGIS

SEER Staging
TNM Staging
(Surveillance, Epidemiology, dan End Results )

Local (In Situ/Invasif)

Stadium 0 (In Situ)
National Cancer Institute Regional (Keterlibatan N)
Stadium I –IV (Invasif)
Metastasis

Kasangian AA, dkk. The Prognostic Role of Tumor Size in Early Breast Cancer in the Era of Molecular Biology. PLoS ONE.2017;12(12):1-12.
National Breast and Ovarian Cancer Center. The Pathology Reporting of Breast Cancer: A Guide for Pathologists, Surgeons, Radiologists, and Oncologists. NBOCC. 2008;3:1-52.
Hammer C, Fanning A, dan Crowe J. Overview of Breast Cancer Staging and Surgical Treatment Options. Cleveland Clinic Journal of Medicine.2008;75:1-4.
Lips EH, dkk. Breast Cancer Subtyping by Immunohistochemistry and Histological Grade Outperforms Breast Cancer Intrinsic Subtypes in Predicting Neoadjuvant Chemotherapy Response. Breast Cancer Res Treat. 2013;140:63-71.
Malhotra GK, Zhao X, Band H, dan Band V. Histological, Molecular, and Functional Subtypes of Breast Cancer. Cancer Biology & Therapy. 2010;10(10):955-960.
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Kasangian AA, dkk. The Prognostic Role of Tumor Size in Early Breast Cancer in the Era of Molecular Biology. PLoS ONE.2017;12(12):1-12.
National Breast and Ovarian Cancer Center. The Pathology Reporting of Breast Cancer: A Guide for Pathologists, Surgeons, Radiologists, and Oncologists. NBOCC. 2008;3:1-52.
Hammer C, FanningA, dan Crowe J. Overview of Breast Cancer Staging and Surgical Treatment Options. Cleveland Clinic Journal of Medicine. 2008;75:1-4.
 + PROGNOSIS
lebih baik
sel kanker terlihat kecil, seperti sel
normal, dan pertumbuhannya lebih lambat
GRADE TUMOR
Grade 1 Grade 2 Grade 3
(Rendah) (Sedang) (Tinggi)

STADIUM KANKER
Stadium Stadium Stadium Stadium
Stadium 0
I II III IV

PROGNOSIS
lebih baik

Kasangian AA, dkk. The Prognostic Role of Tumor Size in Early Breast Cancer in the Era of Molecular Biology. PLoS ONE.2017;12(12):1-12.
Shah R, Rosso K, dan Nathanson SD. Pathogenesis, Prevention, Diagnosis, and Treatment of Breast Cancer. World Journal of Clinical Oncology. 2014;5(3):283-298.
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PENATALAKSANAAN
KANKER PAYUDARA

PEMBEDAHAN KEMOTERAPI
Total/Simple
mengangkat sebagian atau Neoadjuvant
Skin Sparing
seluruh payudara yang Adjuvant
terserang kanker, Nipple Sparing
dilakukan pada kanker Radical
payudara stadium awal,
yaitu I dan II Modified Radical
Double terapi tambahan,
dilakukan
BCS/Lumperctomy
bersamaan dengan
modalitas terapi
lainnya

National Breast and Ovarian Cancer Center. The Pathology Reporting of Breast Cancer: A Guide for Pathologists, Surgeons, Radiologists, and Oncologists. NBOCC. 2008;3:1-52.
Hammer C, FanningA, dan Crowe J. Overview of Breast Cancer Staging and Surgical Treatment Options. Cleveland Clinic Journal of Medicine. 2008;75:1-4
Shah R, Rosso K, dan Nathanson SD. Pathogenesis, Prevention, Diagnosis, and Treatment of Breast Cancer. World Journal of Clinical Oncology. 2014;5(3):283-298.
Leary AF, Sirohi B, dan Johnston SRD. Clinical Trials Update: Endocrine and Biological Therapy Combinations in the Treatment of Breast Cancer. Breast Cancer Research. 2007;9(5):1-10.
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RADIOTERAPI TERAPI HORMONAL TERAPI BIOLOGI

terapi endokrin bekerja

proses penyinaran dengan dengan cara meghambat digunakan jika terdapat
sinar X dan gamma pada atau menghentikan ekspresi protein tertentu
daerah yang terkena kanke kemampuan hormon jaringan kanker serta pada
esterogen dalam penderita kanker payudara
menstimulus pertumbuhan yang resistan terhadap
kanker terapi hormonal

National Breast and Ovarian Cancer Center. The Pathology Reporting of Breast Cancer: A Guide for Pathologists, Surgeons, Radiologists, and Oncologists. NBOCC. 2008;3:1-52.
Hammer C, FanningA, dan Crowe J. Overview of Breast Cancer Staging and Surgical Treatment Options. Cleveland Clinic Journal of Medicine. 2008;75:1-4
Shah R, Rosso K, dan Nathanson SD. Pathogenesis, Prevention, Diagnosis, and Treatment of Breast Cancer. World Journal of Clinical Oncology. 2014;5(3):283-298.
Leary AF, Sirohi B, dan Johnston SRD. Clinical Trials Update: Endocrine and Biological Therapy Combinations in the Treatment of Breast Cancer. Breast Cancer Research. 2007;9(5):1-10.
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ALAT PREDIKSI
KANKER PAYUDARA

Profil
Molekular
genome
sequencing

sistem klasifikasi baru dengan

menggunakan marker molekular seperti
ER (Esterogen Receptor), PR
(Progesterone Receptor), gen HER2,
status ki-67, dan p53

Wazir U, Mokbel K, Carmichael A, dan Mokbel K. Are Online Prediction Tools a Valid Alternative to Genomic Profiling in the Context of Systemic Treatment of ER Positive Breast Cancer? Cellular & Molecular Biology Letters. 2017;22(20):1-7.
Wazir U, Mokbel K. Emerging Gene Based Prognostic Tools in Early Breast Cancer: First Steps to Personalised Medicine. World Journal of Clinical Oncology. 2014;5(5):795-799
Malhotra GK, Zhao X, Band H, dan Band V. Histological, Molecular, and Functional Subtypes of Breast Cancer. Cancer Biology & Therapy. 2010;10(10):955-960.
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Malhotra GK, Zhao X, Band H, dan Band V. Histological, Molecular, and Functional Subtypes of Breast
Cancer. Cancer Biology & Therapy. 2010;10(10):955-960.
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Profil
Parameter
Molekular
Klinis dan
genome
Patologis
sequencing

menilai risiko berulang, kemungkinan 10 tahun

penyintas, dan menjadi acuan dalam terapi adjuvan
dan neoadjuvan

Wazir U, Mokbel K, Carmichael A, dan Mokbel K. Are Online Prediction Tools a Valid Alternative to Genomic Profiling in the Context of Systemic Treatment of ER Positive Breast Cancer? Cellular & Molecular Biology Letters. 2017;22(20):1-7.
Wazir U, Mokbel K. Emerging Gene Based Prognostic Tools in Early Breast Cancer: First Steps to Personalised Medicine. World Journal of Clinical Oncology. 2014;5(5):795-799
Malhotra GK, Zhao X, Band H, dan Band V. Histological, Molecular, and Functional Subtypes of Breast Cancer. Cancer Biology & Therapy. 2010;10(10):955-960.
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KEUNTUNGAN KEKURANGAN

memprediksi risiko berulang dengan Perbedaan genome sequencing, sehingga

sensitivitas yang tinggi kurang keberagaman

dapat menilai tumor yang memiliki sensitivitas terlalu berlebihan dalam memprediksi 10
tertinggi terhadap kemoterapi dan prediktor tahun penyintas pada pasien yang berusia
terkuat dalam menilai respon terapi endokrin kurang dari 40 tahun

d a p a t m e n g h e m a t b i a y a d a l a m modal yang besar pada awal pengembangan

memperkirakan prognosis alat prediksi

memprediksi 10 tahun penyintas -

Wazir U, Mokbel K, Carmichael A, dan Mokbel K. Are Online Prediction Tools a Valid Alternative to Genomic Profiling in the Context of Systemic Treatment of ER Positive Breast Cancer? Cellular & Molecular Biology Letters. 2017;22(20):1-7.
Wazir U, Mokbel K. Emerging Gene Based Prognostic Tools in Early Breast Cancer: First Steps to Personalised Medicine. World Journal of Clinical Oncology. 2014;5(5):795-799
Malhotra GK, Zhao X, Band H, dan Band V. Histological, Molecular, and Functional Subtypes of Breast Cancer. Cancer Biology & Therapy. 2010;10(10):955-960.
Shah R, Rosso K, dan Nathanson SD. Pathogenesis, Prevention, Diagnosis, and Treatment of Breast Cancer. World Journal of Clinical Oncology. 2014;5(3):283-298.
Shachar SS dan Muss HB. Internet Tools to Enhance Breast Cancer Care. NPJ. 2016;2:1-4.
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ALAT PREDIKSI
KANKER PAYUDARA ONLINE

mudah diakses dan ditemukan, tidak berbayar, dan

mudah dimengerti oleh pasien

variabel klinis dan patologis

usia, ukuran tumor, stadium, status ER, HER2, ki-67, jumlah

kelenjar limfa yang terlibat, metastasis, sudah menopause atau
belum, dan cara kanker terdeteksi

Wazir U, Mokbel K, Carmichael A, dan Mokbel K. Are Online Prediction Tools a Valid Alternative to Genomic Profiling in the Context of Systemic Treatment of ER Positive Breast Cancer? Cellular & Molecular Biology Letters. 2017;22(20):1-7.
Wazir U, Mokbel K. Emerging Gene Based Prognostic Tools in Early Breast Cancer: First Steps to Personalised Medicine. World Journal of Clinical Oncology. 2014;5(5):795-799.
Wong HS, dkk. The Predictive Accuracy of PREDICT: A Personalized Decision Making Tools for Southeast Asian Women with Breast Cancer. Medicine. 2015;94(8):593-600.
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NHS PREDICT
(http://www/predict.nhs.uk)

Wazir U, Mokbel K, Carmichael A, dan Mokbel K. Are Online Prediction Tools a Valid Alternative to Genomic Profiling in the Context of Systemic Treatment of ER Positive Breast Cancer? Cellular & Molecular Biology Letters. 2017;22(20):1-7.
Wong HS, dkk. The Predictive Accuracy of PREDICT: A Personalized Decision Making Tools for Southeast Asian Women with Breast Cancer. Medicine. 2015;94(8):593-600.
Shachar SS dan Muss HB. Internet Tools to Enhance Breast Cancer Care. NPJ. 2016;2:1-4.
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dapat memperkirakan 5-10

tahun penyintas, namun
belum dapat memperkirakan
risiko berulang pada
pasien secara akurat

Wazir U, Mokbel K, Carmichael A, dan Mokbel K. Are Online Prediction Tools a Valid Alternative to Genomic Profiling in the Context of Systemic Treatment of ER Positive Breast Cancer? Cellular & Molecular Biology Letters. 2017;22(20):1-7.
Wong HS, dkk. The Predictive Accuracy of PREDICT: A Personalized Decision Making Tools for Southeast Asian Women with Breast Cancer. Medicine. 2015;94(8):593-600.
Shachar SS dan Muss HB. Internet Tools to Enhance Breast Cancer Care. NPJ. 2016;2:1-4.
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Adjuvant!
(https://www.adjuvantonline.com/)

data SEER wanita berusia 36-69 tahun

- menilai risiko berulang dan

10 t a h u n p e n y i n t a s dari
pasien
- memperkirakan efikasi dari
terapi adjuvan

- data status HER2 pasien yang

tidak ada
- keuntungan penggunaan terapi
biologis (trastuzumab)

Wazir U, Mokbel K, Carmichael A, dan Mokbel K. Are Online Prediction Tools a Valid Genomic Profiling in the Context of Systemic Treatment of ER Positive Breast Cancer? Cellular & Molecular Biology Letters. 2017;22(20):1-7.
Alternative to Shachar SS dan Muss HB. Internet Tools to Enhance Breast Cancer Care. NPJ. 2016;2:1-4.
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SIMPULAN

BREASTS PREDICT
TOOLS terbukti dapat memperkirakan risiko berulang, 10
tahun penyintas, prediktor terkuat dalam menilai
respon terapi endokrin, prognosis, dan hemat biaya

dikembangkan menggunakan algoritma kurangnya keberagaman karena perbedaan genome

sequencing pada negara barat dan timur dan
matematika dan komputasi berdasarkan profil
diperlukan modal yang besar pada awal
molekular dari kanker serta didukung oleh pengembangan
parameter klinis dan patologis dari penderita
kanker payudara yang telah terdaftar
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TERIMA KASIH