7.1 Simpulan
Penelitian ini mendapatkan kesimpulan bahwa terdapat adanya korelasi positif antara ekspresi Cyclooxygenase-2 dan Microvessel density pada undifferentiated carcinoma nasopharynx.
7.2 Saran
Adanya korelasi Cyclooxygnase-2 dan Microvessel density yang positif pada undifferentiated carcinoma nasopharynx, maka pemberian penghambat COX-2 akan dapat dipertimbangkan pada penderita dengan ekspresi COX-2 positif dan/atau MVD> 4,5.
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80 Lampiran 1. Penilaian ekspresi COX-2 dan CD 31
1. Penilaian ekspresi Cox-2 dibuat berdasarkan analisis persentase sel tumor yang positif dan intensitas pewarnaan. Berdasarkan persentase sel ganas yang menunjukkan overekspresi Cox-2 maka dibagi menjadi 3 skor (0-3) yaitu: 0 (tidak terwarnai), 1 (<10% sel dari seluruh sel ganas terwarnai), 2 (10-50% sel dari seluruh sel ganas terwarnai), 3 (>50% sel dari seluruh sel ganas terwarnai). Berdasarkan intensitas sel-sel ganas yang menunjukkan overeksprei COX-2 maka dibagi menjadi 3 skor (0-3) yaitu: 0 (negatif), 1 (lemah), 2 (sedang), 3 (kuat) (Tan dan Putti, 2005).
Interpretasi ekspresi COX-2 dari sel tumor, sesuai dengan penelitian sebelumnya digunakan skor immunoreaktif, diperoleh dengan mengalikan skor % sel ganas yang mengekspresikan COX-2 dengan skor intensitas. Skor imunoreaktif 4 atau lebih dinilai sebagai ekspresi COX-2 positif, skor imunoreaktif kurang dari 4 dinyatakan sebagai COX-2 negatif (Tan dan Putti, 2005).
2. Untuk penghitungan microvessel density, pulasan CD31 dinilai pada pembesaran lemah (40x) untuk area yang menunjukkan peningkatan pembuluh darah (hot spots).
Pada area hotspot dilihat pada pembesaran kuat 400x dengan mikroskop cahaya binokuler CX-21.Empat lapang pandang pada 1 slide dipilih untuk mewakili area seluas 1 mm2. Intratumoral dan peritumoral microvessel (pembuluh darah dengan diameter ˂ 50µm tanpa lapisan muscular) dihitung jumlah microvessel pada masing-masing empat lapang pandang dengan cara digeser, dan hasilnya digabungkan untuk
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mendapatkan microvessel/mm2 (Taweevisit et al., 2010). Interpretasi MVD rendah dan tinggi ditentukan dengan analisis menggunakan kurva ROC.
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No No CM
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Lampiran 5
Uji Normalitas Data Umur, COX-2, dan CD 31
Cox-2 CD_31 Umur
N 31 31 31
Normal Parametersa Mean 6.03 8.68 49.52
Std. Deviation 2.869 6.720 11.636
Most Extreme Differences Absolute .237 .127 .100
Positive .150 .127 .100
Negative -.237 -.098 -.097
Kolmogorov-Smirnov Z 1.317 .708 .558
Asymp. Sig. (2-tailed) .062 .697 .915
a. Test distribution is Normal.
Lampiran 6
Analisis Deskriptif Jenis Kelamin dan Umur
Jenis_Kelamin
Frequency Percent Valid Percent Cumulative Percent
Valid Laki-laki 26 83.9 83.9 83.9
Correlations
Cox_2 CD_31
Cox-2 Pearson Correlation 1 .868**
Sig. (2-tailed) .000
N 31 31
CD_31 Pearson Correlation .868** 1
Sig. (2-tailed) .000
N 31 31
**. Correlation is significant at the 0.01 level (2-tailed).
Lampiran 8
Kurva ROC Data CD 31
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Area Under the Curve Test Result Variable(s):CD_31
Area Std. Errora Asymptotic Sig.b
Asymptotic 95% Confidence Interval Lower Bound Upper Bound
.914 .056 .054 .804 1.024
The test result variable(s): CD_31 has at least one tie between the positive actual state group and the negative actual state group. Statistics may be biased.
a. Under the nonparametric assumption b. Null hypothesis: true area = 0.5
Coordinates of the Curve Test Result Variable(s):CD_31
Positive if Less Than or Equal Toa Sensitivity 1 - Specificity
-1.00 .000 .000
The test result variable(s): CD_31 has at least one tie between the positive actual state group and the negative actual state group.
a. The smallest cutoff value is the minimum observed test value minus 1, and the largest cutoff value is the maximum observed test value plus 1. All the other cutoff values are the averages of two consecutive ordered observed test values.