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Using the Collaborative Staging System for Collecting AJCC TNM Stage Overview

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Lymphoma, Kaposi sarcoma, melanoma, etc. Some sites have multiple schema ... Not used for melanoma. CS Software. Algorithms for deriving stage developed at CDC ... – PowerPoint PPT presentation

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Title: Using the Collaborative Staging System for Collecting AJCC TNM Stage Overview


1
Using the Collaborative Staging Systemfor
CollectingAJCC TNM StageOverview
2
CS Developed by Collaboration of Surveillance
Organizations
Collaborative Staging System
3
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

4
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)

5
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

6
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

7
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

8
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
9
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

10
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

11
CS Data Elements
12
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
13
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)
14
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
15
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
16
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
17
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

18
CS Tumor Size - Melanoma
19
CS Extension - Melanoma
20
CS SSF - Melanoma
21
CS Software
  • Algorithms for deriving stage developed at CDC
  • Validated by Working Group
  • Incorporated into all registry software systems
    in U.S.

22
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

23
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.

24
AJCC Web Site
  • http//cancerstaging.org
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