EBM
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TUGAS EVIDENCE BASED MEDICINESkenarioSeorang anak laki-laki 17
tahun, datang ke poli THT dengan keluhan benjolan di leher kiri
sebesar telur ayam sejak dua bulan sebelumnya, benjolan tidak
merah, terasa nyeri bila ditekan. Benjolan tidak cepat membesar.
Terdapat keluhan hidung kiri tersumbat, penciuman berkurang dan
riwayat mimisan dua kali, tidak banyak dan berhenti sendiri.
Terdapat penurunan pendengaran pada telinga kiri dan tidak ada
keluhan keluar cairan dari telinga. Terdapat penurunan pendengaran
pada telinga kiri dan tidak ada keluhan keluar cairan dari telinga.
Pada aurikula sinistra didapatkan liang telinga lapang, membran
timpani utuh, refleks cahaya negatif. Dari pemeriksaan
nasoendoskopi terdapat massa pada nasofaring. Pada regio colli
sinistra terdapat pembesaran multipel kelenjar getah bening dengan
ukuran 2 cm x 1 cm x 1cm dan 4 cm x 4 cm x 2 cm terfiksir, terdapat
nyeri tekan dan tidak hiperemis.
Pertanyaan (foreground question)Bagaimanakah prognosis dapat
diprediksi dengan melihat keterlibatan kelenjar getah bening
(Retropharyngeal Lymph Node) yang terlibat (N0 & N1) PICO
Population: Pasien anak laki-laki dengan keluhan benjolan di leher
kiri Intervention: Menilai prognosis dengan keterlibatan kelenjar
getah bening (N1) Comparison: Menilai prognosis tanpa keterlibatan
kelenjar getah bening (N0) Outcomes: keteribatan kelenjar getah
bening dapat digunakan sebagai prognostic factor untuk melihat
survival pasien dari penyakit Ca NasopharingPencarian bukti
ilmiahAlamat website: www. clincancerres.aacrjournals.orgKata
kunci: Carcinoma AND Nasopharyngeal AND Lymph Node AND Prognosis
AND metastasisLimitasi: Januari 2007 Desember 2011Hasil Pencarian:
1387Dipilih artikel berjudul:Retropharyngeal Lymph NodeMetastasis
in Nasopharyngeal Carcinoma: Prognostic Value and Staging
CategoriesREVIEW JURNALPendahuluanTo investigate the incidence,
prognostic value, and staging categories of retropharyngeal lymph
node (RLN) metastasis in nasopharyngeal carcinoma (NPC).
MetodaA retrospective reviewof the data from 749 biopsy-proved
nonmetastatic NPC patients. All patients had undergone
contrast-enhanced computed tomography and had radiotherapy as their
primary treatment.
HasilThe incidence of RLN metastasiswas 51.5%.After adjusting
for tumor (T) andnode (N) classifications, a borderline significant
difference of distantmetastasis-free survival (DMFS) rates was
observed between patients with or without RLN metastasis. In N0
disease, the presence of RLN metastasis was a significant
independent predictor for overall survival (OS), loco-regional
relapse-free survival, and DMFS in multivariate Cox modeling
analysis. No significant difference was observed in all end points
between patients with unilateral and bilateral RLN metastasis. The
hazard ratios of death and distant failure for N0 with RLN
metastasis were similar to N1. The survival curve of OS and DMFS
for N0 disease with RLN metastasis had approximated that of N1
disease. The survival curve of OS for T1 disease with RLN
metastasis was approximately the same as T2 disease. However, the
survival curve of DMFS for T1 disease with RLN metastasis was
approximately the same as in T3 disease.
KesimpulanRLN metastasis has a tendency to affect the DMFS rates
of patients with NPC. Retropharyngeal node involvement has a
negative effect on the prognosis of N0 disease. RLN metastasis
should be classified as N1.
