Lisnawati Lisnawati

Development of a Predictive Model for Therapy Response in Advanced-Stage Cervical Cancer Using Apparent Diffusion Coefficient (ADC) Value and Quantitative T2 Tumor on MRI: Correlation with Survivin Expression

The aims of this study are to optimize Magnetic Resonance Imaging (MRI) as a predictive modality for therapy response in advanced-stage cervical cancer and to identify predictors of this response in relation to survivin expression. This case-control study was conducted from January 2023 to May 2024, with total 35 subjects. The target population comprised patients with stages IIB to IIIC2 (FIGO 2018) cervical cancer. MR examination was performed three times: pre therapy, in the mid cycle of external radiation (20-30Gy), and 2 months after complete therapy. The study analyzed relations between age, tumor size, nodal metastasis, ADC and T2 parameters on MR, and survivin levels, with final therapeutic response. The predictive model for final therapy response was developed using four variables: patient age, tumor size, nodal metastasis, and the T2 tumor-to-muscle ratio on MRI #2. The scoring system showed the minimum total score was 0 and the maximum total score was 6. The cut-off score on this predictive model is score 3 to differentiate between the prediction of good or poor response with the sensitivity of 92,86% and a specificity of 85,71%. This study found that T2 tumor-to-muscle ratio (T2 t/m ratio) on MR in the mid-cycle external radiation is a potential predictive factor of final therapy response on advanced-stage cervical cancer. A predictive model for assessing the final response could effectively incorporate clinical and MR parameters, including patient age, tumor size, nodal metastasis findings on MR, and Ratio T2 t/m on MR in the mid-cycle external radiation.

Role of CD44 and CD24 Expression on 2-years Disease Free Survival in Patients with Advanced Epithelial Ovarian Carcinoma

Ovarian cancer is one of the most common cancers with a high mortality rate worldwide. Despite optimal surgical therapy and chemotherapy, recurrence is still common. Cancer stem cells expressing CD44 and CD24 are thought to be contributing factors in recurrence. A cohort retrospective study with survival analysis was carried out on advanced ovarian cancer patients who underwent optimal debulking surgery followed by 6 cycles of chemotherapy at Cipto Mangunkusumo General Hospital and Fatmawati General Hospital from January 2019 to March 2023. Immunohistochemical examination was performed on tumor tissue with CD44 and CD24 expression were assessed using the H-Score method then determined the cut off-point expression level using the ROC curve. Furthermore, the relationship between these expression levels with the disease-free survival was assessed using the survival curve. There were 48 subjects who were included in the study. There were high expression levels of CD44 in 47.9% and CD24 in 50% of cases. High CD44 expression had mean and median survival of 13.2 ± 1.8 and 11 months (HR 5.05, 95% CI 1.84- 13.85). High CD24 expression had mean and median survival of 13.5 ± 2.4 and 7 months (HR 7.73, 95% CI 2.58 - 23.15). The combination of the two high expressions had mean and median survival of 10.44 ± 1.88 and 7 months. High expression of CD44 and CD24 will shorten the disease-free survival of patients with advanced ovarian cancer.