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EVIDENCE-BASED MEDICINE

Smoking status and survival in the national comprehensive


cancer network non-small cell lung cancer cohort.

Disusun oleh :
ARLITAMIRZA DIAN P

(1102013043)

DARAYANI AMALIA

(1102013070)

KELOMPOK : A-11

FAKULTAS KEDOKTERAN
UNIVERSITAS YARSI
TAHUN 2016

1. SKENARIO
Seorang laki laki 55 tahun datang ke dokter dengan keluhan sesak nafas dan nyeri
dada yang semakin memburuk bila menarik nafas yang dalam, serta batuk berdarah sejak
6 bulan yang lalu. Selain itu, terdapat penurunan nafsu makan sehingga pasien
mengalami penurunan berat badan lebih dari 10 kg dalam waktu 6 bulan. Pasien memiliki
kebiasaan merokok sejak umur 15 tahun.
Pemeriksaan fisik regio dada: inspeksi normal, palpasi didapatkan pembesaran
kelenjar getah bening aksila kanan, perkusi didapatkan suara redup di interkosta 4 kanan,
auskultasi terdengar suara wheezing pada paru kanan tengah. Dokter mendiagnosis pasien
dengan efusi pleura.
Dilakukan aspirasi cairan pleura dan CT-Scan toraks. Hasil aspirasi: sitologi
abnormal yang mengarah keganasan. Hasil CT Scan Toraks: massa berukuran 3 x 4 x 3
cm3, mengenai limfonodus aksilla. Diagnosis akhir: non small cell lung cancer stadium
IV.
Pasien menanyakan apakah kebiasaan merokok dapat memperberat penyakitnya.
2. PERTANYAAN KLINIS
Foreground question :
Apakah kebiasaan merokok dapat mempengaruhi prognosis non small cell lung cancer ?
3. KOMPONEN PICO
1. Patient
Pasien dengan non small cell lung cancer
2. Intervention
Merokok
3. Comparison
Tidak merokok
4. Outcome
Survival rate pada pasien dengan non small cell lung cancer yang merokok lebih
rendah daripada yang tidak merokok.

4. TIPE PERTANYAAN
Prognostic

5. KATA KUNCI
Non Small Cell Lung Cancer AND prognostic AND smoking AND never smoking
6. PEMILIHAN SITUS
www.ncbi.nlm.nih.gov/pubmed
7. LIMITASI
5 tahun terakhir
8. HASIL PENCARIAN (29)
1. Poorer prognosis in Taiwanese female ever smokers with stage IV lung
adenocarcinoma who were readministered a tyrosine kinase inhibitor.
2. Identification of FGF19 as a prognostic marker and potential driver gene of lung
squamous cell carcinomas in Chinese smoking patients.
3. Passive Smoking and Breast Cancer - a Suspicious Link.
4. RAR2 hypermethylation is associated with poor recurrence-free survival in
never-smokers with adenocarcinoma of the lung.
5. Small-cell lung cancer detection in never-smokers: clinical characteristics and
multigene mutation profiling using targeted next-generation sequencing.
6. Estrogen adversely affects the prognosis of patients with lung adenocarcinoma.
7. Efficacy of first-line chemotherapy affects the second-line setting response in
patients with advanced non-small cell lung cancer.
8. Serum carcinoembryonic antigen levels before initial treatment are associated
with EGFR mutations and EML4- ALK fusion gene in lung adenocarcinoma
patients.
9. Prognostic and therapeutic implications of aromatase expression in lung
adenocarcinomas with EGFR mutations.
10. Subtype-specific KRAS mutations in advanced lung adenocarcinoma: a
retrospective study of patients treated with platinum-based chemotherapy.
11. Ion channel gene expression in lung adenocarcinoma: potential role in prognosis
and diagnosis.

12. Differences in clinical presentation of non-small cell lung cancer in neversmokers versus smokers.
13. Smoking status and survival in the national comprehensive cancer network nonsmall cell lung cancer cohort.
14. Genome-wide unmasking of epigenetically silenced genes in lung
adenocarcinoma from smokers and never smokers.
15. Genetic susceptibility to lung cancer and co-morbidities.
16. Tobacco Smoking and Lung Cancer: Perception-changing facts.
17. Genome-wide association study of genetic predictors of overall survival for nonsmall cell lung cancer in never smokers.
18. ROS1 fusions in Chinese patients with non-small-cell lung cancer.
19. KIF5B-RET fusions in Chinese patients with non-small cell lung cancer.
20. The presence of mutations in epidermal growth factor receptor gene is not a
prognostic factor for long-term outcome after surgical resection of non-smallcell lung cancer.
21. Fibroblast growth factor receptor 1 gene amplification is associated with poor
survival and cigarette smoking dosage in patients with resected squamous cell
lung cancer.
22. The impact of a negative history of smoking on survival in patients with nonsmall cell lung cancer detected with clinic-based screening programs.
23. Prognostic implications of genetic variants in advanced non-small cell lung
cancer: a genome-wide association study.
24. Predictors of survival in never-smokers with non-small cell lung cancer: a largescale, two-phase genetic study.
25. Association of KRAS and EGFR mutations with survival in patients with
advanced lung adenocarcinomas.
26. Prognostic value of TP53, KRAS and EGFR mutations in nonsmall cell lung
cancer: the EUELC cohort.
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27. Worse disease-free survival in never-smokers with ALK+ lung adenocarcinoma.


28. Circulating cell-free DNA in plasma of never smokers with advanced lung
adenocarcinoma receiving gefitinib or standard chemotherapy as first-line
therapy.
29. East meets West: ethnic differences in epidemiology and clinical behaviors of
lung cancer between East Asians and Caucasians.

9. ARTIKEL YANG DIPILIH


1. Smoking status and survival in the national comprehensive cancer network nonsmall cell lung cancer cohort.
10. VALIDITY
1. Apakah terdapat sampel yang representatif, terdefinisi jelas, dan berada pada kondisi
yang sama dalam perjalanan penyakitnya? YA

B. Apakah follow-up cukup lama dan lengkap ? YA


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C. Apakah kriteria outcome yang digunakan obyektif dan tanpa bias? Tidak dijelaskan
D. Apakah diidentifikasi kelompok dengan prognosis yang berbeda? YA
Apakah dilakukan adjustment untuk faktor-faktor prognostik yang penting? YA

11. IMPORTANCE
A. Bagaimana gambaran outcome menurut waktu?

B. Seberapa tepat perkiraan prognosis?

12. APPLICATION
A. Apakah pasien dalam penelitian ini serupa dengan pasien kita ? YA
B. Apakah simpulan kita terhadap hasil studi bermanfaat, apabila disampaikan kepada
pasien dalam tatalaksana pasien secara keseluruhan ? YA

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