Using the Collaborative Staging System for Collecting AJCC TNM Stage Overview

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Using the Collaborative Staging Systemfor
CollectingAJCC TNM StageOverview
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CS Developed by Collaboration of Surveillance
Organizations
Collaborative Staging System
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What is Collaborative Stage?

• Collaborative Stage is a cancer staging data
  system used to collect data to derive AJCC TNM
  Stage and Summary Stage
• Primary data on T, N, and M are entered by the
  registrar
• TNM categories and Stage group, plus Summary
  Stage are derived from the primary data

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Why Collaborative Stage?

• Enhance efficiency and accuracy of cancer staging
  data collection
• Accommodate collection and use of non-anatomic
  prognostic and predictive factors
• Unify the data collection for reporting to NCDB,
  State Registries and SEER (previously used
  separate data systems)

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Current Status

• All cancer registries in the US, including all
  approved programs, currently collect AJCC TNM
  stage using the Collaborative Staging System
• 2008 changes make NO change in the requirement or
  workload of collecting Collaborative Stage Data

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Principles of Collaborative Staging System

• Cancer registrar collects primary data
• Enters primary data on T, N and M
• Includes information how data identified (e.g.
  clinical or pathologic)
• Additional stage modifying factors as required by
  disease site
• Computer derives and reports TNM categories and
  Stage Group

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Collaborative Staging SystemData Use

• Derive TNM categories and stage group for use by
  hospital / cancer program
• Transmit primary data and derived stage to
  central registries
• NCDB State registry SEER (where applicable)
• Data elements may be exported to other prognostic
  systems / nomograms

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Collaborative StagingSchema
Collect Core Staging Data Store raw, tagged
data Collaborative Staging System
Data Repository
Derive AJCC TNM categories Stage group
Derive Summary Stage 1977 and 2000
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CS Data Input and Output

• 9 core data items collected
• 6 descriptive (size, extension, nodes, mets)
• 3 evaluation how was T, N or M defined
• Clinical vs. Pathologic
• Up to 6 site-specific
• Outputs 3 staging systems output
• AJCC TNM 6th edition
• Summary Stage 1977
• Summary Stage 2000

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CS Schemas

• 94 disease schemas
• Histology-specific schema
• Lymphoma, Kaposi sarcoma, melanoma, etc.
• Some sites have multiple schema
• Pancreas Head Body and Tail Other
• Conjunctiva Carcinoma Melanoma
• Larynx Glottis Supraglottis Subglottis NOS

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CS Data Elements
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Collaborative Stage Data Elements Collected by
Registry - Summary

• Tumor Size
• Extension (e.g. depth invasion)
• Method of evaluating T
• Nodes Lymph node descriptor (e.g. number sites)
• Number nodes examined
• Number nodes positive
• Method of evaluating N
• Mets Distant mets present at time of diagnosis?
• Method of evaluating M
• SSFs Stage modifying factors specific to that
  disease site (up to 6, most sites use no SSF)

Method of Evaluation Clinical or pathologic
information
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Collaborative Stage SchemaElements Used to
Derive Stage
Registrar records
Computer derives
T elements c/p N elements c/p M element c/p
c/p T c/p N c/p M TNM Stage Group
Site Specific Factors (e.g. tumor markers)
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Collecting T - Tumor
Registrar records
Computer derives
CS Tumor size (3 digits)
c/p T
CS Extension (2 digits)
T Method of evaluation (1 digit)
Method of Evaluation Clinical or pathologic
information
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Collecting N - Node
Registrar records
Computer derives
CS Lymph Nodes (2 digits)
LN Method of evaluation (1 digit)
c/p N
Regional LN Positive (2 digits)
Regional LN Examined (2 digits)
Method of Evaluation Clinical or pathologic
information
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Collecting M - Metastases
Registrar records
Computer derives
CS Metastases present at time of diagnosis (2
digits)
c/p M
Mets Method of evaluation (1 digit)
Method of Evaluation Clinical or pathologic
information
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Site-Specific Factors

• Collection of other data for staging
• Tumor markers (e.g. PSA ER/PR CEA)
• Modifiers for anatomic staging (e.g. lymph node
  modifiers in breast cancer)
• Used only as needed
• System has 6 fields for SSF
• 55 of disease sites use SSF

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CS Tumor Size - Melanoma
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CS Extension - Melanoma
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CS SSF - Melanoma
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CS Software

• Algorithms for deriving stage developed at CDC
• Validated by Working Group
• Incorporated into all registry software systems
  in U.S.

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Collaborative Staging SystemImplementation in
Registries

• CS implemented for all cases diagnosed starting
  Jan 1, 2004
• Used in cancer registries in the US Canada
• Study show data as or more accurate than
  physician staging
• Efforts to develop software to extract CS
  elements from synoptic pathology reports

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Conclusions

• Collaborative Staging System in use in all
  registries. Current 2008 changes in staging data
  collection make no changes in the use of
  Collaborative Stage
• Coupled with collection of clinical stage on all
  patients, the 2008 changes will strengthen the
  quality of data and improve the efficiency of
  data collection for registrars.

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AJCC Web Site

• http//cancerstaging.org