Penentuan Model Prediktif Metastasis Tulang dan Prognosis Kanker Prostat Menggunakan Alkalin Fosfatase dan Skor Gleason
Authors: Merung Marcella , Toreh Christof , Astram Ari , Langi Fredrik G. 
Published: October 2023

Abstract: To date, assessment of the prognostic ability based on the relationship between alkaline phosphatase (ALP) to the Gleason score has not been reported. This study aimed to compare ALP with Gleason score as a predictor of prostate cancer prognosis. This was a hospital-based cross sectional study conducted from January 1, 2019 to December 31, 2021. Prostate cancer patient information included demographics, disease history, clinical characteristics, laboratory and radiology tests, and histopathology results. The results showed that the majority had a poor degree of differentiation (Gleason score: 8-10), which was 85.5%. High serum prostate specific antigen (PSA) levels were associated with the scores. The results of ALP were normal in 59.4%, increased in 34.4%, and decreased in 6.3% of patients. The multivariate regression analysis showed that every 10 U/L increase in ALP in the blood of prostate cancer patients on average was associated with a worse prognosis characterized by an increase in Gleason score of about 0.06 points (95% CI 0.03-0.09; p=0.002). In conclusion, serum alkaline phosphatase can be a predictive factor of bone metastases in prostate cancer with a cut value of 102 IU/L. Each increase of 10 IU/L of serum ALP is associated with a worse prognosis in prostate cancer while the Gleason score cannot be a predictive indicator of bone metastases in prostate cancer.
Keywords: alkaline phosphatase; prostate specific antigen; Gleason score; prognostic predictor

Abstrak: Penilaian kemampuan prognostik kanker prostat berdasarkan hubungan alkalin fosfatase (ALP) dengan skor Gleason sampai saat ini belum pernah dilaporkan. Tujuan penelitian ini untuk membandingkan kadar ALP dengan skor Gleason sebagai prediktor prognosis kanker prostat. Penelitian ini menerapkan desain potong lintang berbasis rumah sakit dari 1 Januari 2019 hingga 31 Desember 2021. Informasi pasien kanker prostat mencakup demografik, riwayat penyakit, karakteristik klinik, hasil pemeriksaan laboratorium dan radiologi, serta data histopatologi. Hasil penelitian memperlihatkan proporsi terbesar memiliki tingkat diferensiasi buruk dengan skor Gleason: 8-10 sebesar 85,5%. Data tingginya kadar prostate specific antigen (PSA) serum berhubungan dengan skor Gleason. Pada penelitian ini ALP dengan hasil normal 59,4%, meningkat 34,4%, menurun 6,3%. Hasil analisis regresi multivariat menunjukkan setiap 10 U/L kenaikan ALP dalam darah pasien kanker prostat rata-rata berhubungan dengan prognosis lebih buruk ditandai oleh peningkatan skor Gleason sekitar 0,06 poin (95% CI 0,03-0,09; p=0,002). Simpulan penelitian ini ialah ALP dapat menjadi faktor prediksi metastase tulang pada kanker prostat dengan nilai potong 102 IU/L. Setiap peningkatan 10 IU/L ALP serum berhubungan dengan prognosis yang lebih buruk pada kanker prostat sedangkan skor Gleason tidak dapat menjadi indikator prediksi metastase tulang pada kanker prostat.
Kata kunci: alkaline fosfatase; prostate specific antigen; skor Gleason; prediktor prognosis