FCRA Annual Educational Conference Orlando Florida July 25 2017 Steven Peace CTR 1 Outline 2018 Transition from CS SSFs to Individual SiteSpecific Prognostic Factor Fields SSFs Locating SSFs in the AJCC Cancer Staging Manual 8 ID: 775666
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New Site-Specific Fields “Required for Staging” AJCC 8th ed.
FCRA Annual Educational Conference
Orlando, FloridaJuly 25, 2017Steven Peace, CTR
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Slide2Outline
2018 Transition from CS SSFs to Individual Site-Specific Prognostic Factor Fields (SSFs)Locating SSFs in the AJCC Cancer Staging Manual, 8th editionHistorical SSFs - Still Required for Staging - Moved into New FieldsNew Site Specific Fields - Shared Across Chapters – Moved into New FieldsNew Site Specific Prognostic Factor Fields - Required to Assign Stage GroupPending Site Specific Prognostic Factor Fields - Recommended for Clinical CareUsing the Site Specific Fields Required for Staging to Assign Stage GroupWhat if the Required SSF is missing? Can I still assign Stage Group?QC NOTE: Analytic Cases with No Attempt to Code SSFs Increasing in FrequencyPrognostic Factors Manual & TrainingQuestions
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Slide3Transition from CS SSFs to Individual Fields
TO
New Manual to Include ALL Site-Specific Fields
Description of Test, Instructions and Codes
ALL Previous CS SSFs in New FieldsALL NEW Required for Staging Fields - ApprovedNew Optional Prognostic Site-Specific Fields - Not Approved - Yet
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Slide4Required/Clinically Relevant/Investigational
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Slide5Tumor Marker or Genetic Alteration
Tumor Marker
Tumor Markers are indicators of cellular, biochemical, molecular or genetic alterations by which neoplasia can be recognized.Tumor markers detect the presence of tumor based on quantitative and/or qualitative measurements in blood or secretions found in cells, tissues or body fluids.These surrogate measures of the biology of the cancer provide insight in the clinical behavior of the tumor.Biochemical or immunologic counterparts of differentiation states of tumor.
Genetic Alteration
Cancer is a multigene disease that arises as a result of mutational and epigenetic changes coupled with activation of complex signaling intra and extra cellular networks.Alterations in 3 Classes of GenesProtoOncogenesTumor Suppressor GenesDNA Repair GenesResultant effects on death mechanisms embedded within cells coupled with dysregulation of cell proliferation events.
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Types of Mutations
Gene Rearrangement
Point Mutations
Gene Amplification
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http://www.nature.com/article-assets/npg/nrclinonc/journal/v4/n9/images/ncponc0908-f1.jpg
Comparison of the histopathology, molecular pathology, genetic, and gene-expression analysis methods used to
delineate breast cancer tumor subtypes and suggested current and future therapies in a historical context
Slide7Locating SSFs in AJCC Staging Manual, 8th ed.
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Chapter SpecificPrognostic Factors Section in ChapterRegistry Data Collection Variables Listed in Chapter
Slide8Site-Specific Fields Required for Staging
Each Chapter includes the Site-Specific Fields Required for Staging (if any)You MUST also document ALL Site-Specific Field Values/Results in TEXTYou MUST look for these tests and results – they are really important!Analytic Cases MUST include valid entries in these critical fieldsNon-Analytic Cases SHOULD include valid entries as availableFCDS will monitor overuse of 999 default valuesInclude same tests as CS SSFs for some cancersInstructions and Codes may differ from CSField Length and Location of DecimalSite-Specific Fields Manual PendingOther – age, LVI, LN +/exam, T Size
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CEA
HER2
ER/PR
CA 19-9
CA 125
MSI
PSA
Gleason
Mitotic Count
Specified Grade
Immuno-Phenotype
CytoGenetics
B Symptoms
Ki-67 Index
Slide9Sample New SSFs - Required for Staging
Slide10Historical SSFs - Still Required for Staging
New Fields
New Instructions
New Codes & Definitions
Improved Abstractor Notes
(not displayed here)
New Field Format – Alphabetical and Numerical
New Field Length – Where Is Your Decimal Point?
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Slide11New SSFs - Shared Across Chapters
AJCC Grade Clinical AJCC Grade Pathologic (16) Esophagus and Esophagogastric Junction(19) Appendix – Carcinoma(38) Bone (appendicular skeleton, spine, and pelvis)(40) Soft Tissue Sarcoma of the Head and Neck(41) Soft Tissue Sarcoma of the Trunk and Extremities(42) Soft Tissue Sarcoma of the Abdomen and Thoracic Visceral Organs(44) Soft Tissue Sarcoma of the Retroperitoneum(45) Soft Tissue Sarcoma – Unusual Histologies and Sites(48) BreastAJCC GIST Mitotic Count Clinical(43) Gastrointestinal Stromal TumorAJCC GIST Mitotic Count PathologicAJCC Oropharyngeal p16(10) HPV-Mediated (p16+) Oropharyngeal Cancer(11) Oropharynx (p16−) and HypopharynxRevised LVIAll
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Slide12New SSFs - Required to Assign Stage Group
AJCC Testis Serum Markers Clinical
(9) TestisAJCC Testis Serum Markers PathologicAJCC Esophagus and EGJ Tumor Epicenter(16) Esophagus and Esophagogastric JunctionAJCC Retinoblastoma Heritable Trait(68) RetinoblastomaRevised SSF25 (Lip/vermillion border)C00.0-upper lip, C00.1-lower lip, C00.2-lip NOS. Cancers of the external lip are staged using AJCC chapter 7. Cancers of the vermillion border are staged using AJCC chapter 15. Revised SSF25 (cervical node unknown primary)Occult Head/Neck1) patients with EBV-related cervical adenopathy are staged according to Chapter 9 (Nasopharynx); (2) patients with HPV-related cervical adenopathy are staged according to Chapter 10 (HPV-mediated oropharyngeal cancer (p16+)); (3) all other patients with EBV-unrelated and HPV-unrelated cervical adenopathy are staged according to Chapter 6AJCC CLL/SLL Absolute Lymphocyte Count (79) Hodgkin and Non-Hodgkin LymphomasAJCC CLL/SLL Adenopathy AJCC CLL/SLL OrganomegalyAJCC CLL/SLL AnemiaAJCC CLL/SLL Thrombocytopenia AJCC MM/Plasma Cell Serum β2-microglobulin(82) Multiple Myeloma and Plasma Cell DisordersAJCC MM/Plasma Cell Serum albuminAJCC MM/Plasma Cell LDH LevelAJCC MM/Plasma Cell FISH Results
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Slide13New SSFs - Required to Assign Stage Group
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Slide14New SSFs - Required to Assign Stage Group
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Slide15The “Complete List” of Required SS Fields
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Slide16Clinically Relevant Site Specific Prognostic Variables are in the AJCC Staging ManualNew Site Specific Fields not yet created to store these variablesALL are Pending ReviewNone are Required in 2018None are Optional in 2018No Instructions or Codes – Yet.
Lifestyle FactorsTobacco UseDepressionAlcohol
Virus ExposuresP16/HPVHIVHep B or Hep C
Overall Health StatusComorbidity(s)Overall HealthPerformance StatusZubrod/ECOGKarnofsky
Other Anatomic InfoLocation of Positive Lymph Node(s)Size of Positive NodeExtranodal ExtensionPerineural InvasionTumor ThicknessDepth of InvasionSurgical Margins
Pending SSFs - Recommended for Clinical Care
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Slide17“Complete List” of Clinically Relevant SSFs
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Slide18“Complete List” of Clinically Relevant SSFs
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Slide19Manual to Include Complete Site-Specific Field Definitions, Instructions & Codes
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Do Not Use
Old Manuals for New Site Specific Field Definitions, Instructions, or Codes
2018 - New Manual for ALL New Site Specific Fields – Date TBA
Will Include All Required for Staging Fields
May Include Some Recommended for Clinical Care Fields
Definitions, Instructions, and Codes Included
Slide20Using Required SSFs to Assign Stage Group
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Slide21What if the Required SSF Info is Missing?
Cake will be fine without using baking power – right?
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I am in a hurry– Can I bake the cake @ 500
o
for 15 min?
No Substitutions
Recipe Includes Ingredients AND Instructions
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Slide22Analytic Cases with No Attempt to Code SSFs
Default Value ‘999’ or NOS = No Value
Use All Resources in Registrar Toolbox
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Slide23Site-Specific Prognostic Factors Training
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Slide24FCDS Prognostic Factors Webcast – 9/21/17
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Slide25Resources
Genetic Testing and Molecular Biomarkers
is the leading peer-reviewed journal covering all aspects of human genetic testing including molecular biomarkers. The Journal provides a forum for the development of new technology; the application of testing to decision making in an increasingly varied set of clinical situations; ethical, legal, social, and economic aspects of genetic testing; and issues concerning effective genetic counseling. This is the definitive resource for researchers, clinicians, and scientists who develop, perform, and interpret genetic tests and their results.Genetic Testing and Molecular Biomarkers coverage includes:Diagnosis across the life spanRisk assessmentCarrier detection in individuals, couples, and populationsNovel methods and new instrumentation for genetic testingResults of molecular, biochemical, and cytogenetic testingGenetic counseling
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Slide26Questions
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