Collaborative Staging

Collaborative Staging (CS) is to be used for cases diagnosed on or after January 1, 2004 through December 31, 2017. It is not to be used for cases diagnosed prior to that date. Its introduction does not affect CoC requirements for physicians to assign AJCC staging or the requirement that the physician-assigned staging values be recorded in the registry.  CS Version 2 was implemented in 2010, and all cases previously entered under CS Version 1 were converted to CSv2.  

Collaborative Staging was designed for registrar use. For Collaborative Staging, registrars code discrete pieces of information once and the CS computer algorithm derives the values for AJCC T, N, M and Stage Group, Summary Stage 1977, and Summary Stage 2000. The derived stage codes are ideally suited for data analysis because of the consistency that can be obtained with objectively-recorded, identically-processed data items.

The timing rule for CS coding was designed to make use of the most complete information possible to yield the ”best stage” information for the tumor at the time of diagnosis-- "use all information gathered through completion of surgery(ies) in first course of treatment or all information available within four months of the date of diagnosis in the absence of disease progression, whichever is longer." Disease progression is defined as further direct extension or distant metastasis known to have developed after the diagnosis was established. Information about tumor extension, lymph node involvement, or distant metastasis obtained after disease progression is documented should be excluded from the CS coding.

The following CS data items are coded by the registrar.

The CS algorithm produces the output items listed below. The derived AJCC items are separate from the physician-coded items; and the derived Summary Stage items are separate from the manually-coded items collected by the CoC in the past. The derived items cannot be manually entered.

Unlike the AJCC and Summary Stage codes that are derived from it, CS is more of a site-specific data collection system. The CS algorithm uses tumor site and histology to determine which CS schema to apply. Depending on the schema, the coding instructions and code definitions will vary. Collaborative Staging codes are defined for every site and histology combination. The AJCC Cancer Staging Manual does not cover all sites, and some histologies are excluded from sites with an AJCC coding scheme. When the CS algorithm processes a site-histology combination that does not have an applicable AJCC code, it assigns the display string "NA" for "Not applicable." A blank display string for a derived item means the CS algorithm was not run for the case.

Coding CS Items

The complete instructions and site-histology defined codes are available in the Collaborative Stage Data Collection System Coding Instructions (CS Manual). Effective 01/01/2014, CS version 02.05 was implemented. Part I, Section 1 provides general instructions and the instructions and codes for generic (non site-specific) items. Part I, Section 2 contains lab tests, tumor markers, and site specific factor notes.  Part II contains the site-specific schemas and codes. The CS Manual and related information is available electronically on the AJCC Web site:  http://cancerstaging.org/cstage/Pages/default.aspx.  For an easily navigable web-based list of site-specific schema and coding instructions, go to http://cancerstaging.org/cstage/schema/Pages/version0205.aspx  Use the downloadable manual as well as the website to view the notes and appropriate codes for each schema.  

Begin assigning codes for the Collaborative Staging data items. Be sure to read the notes and follow the site/histology-specific instructions at the beginning of each item. Some schemas require additional staging or prognostic information for that particular site. CS Site-Specific Factors 1-25 are designed to collect that information.  

• Code the tumor size in the CS Tumor Size item.

• Code how far the tumor has spread directly in the CS Extension item.

• Code how the farthest tumor spread was determined in the CS Tumor Size/Ext Eval item.

• Code whether regional lymph nodes are involved in the CS Lymph Nodes item.

• Code how the farthest lymph node spread was determined in the CS Reg Node Eval item.

• Code the number of positive regional lymph nodes from the pathology report in the Regional Nodes Positive item.

• Code the number of regional lymph nodes examined by the pathologist in the Regional Nodes Examined item.

• Code the farthest distant metastasis (including distant lymph nodes) in the CS Mets at Dx item.

• Code how the distant metastasis was determined in the CS Mets Eval item.

• Code the presence or absence of bone, brain, liver, or lung metastases.

• Code all required CS Site-Specific Factors.

The derived stage information for AJCC 6th edition staging will be calculated when the case is saved, or prior to exiting the case. The derived stage information for AJCC 7th edition will only be calculated for cases diagnosed January 1, 2010, forward.  When the computer derives the final stage information, the program will check the histology code and other coded information to determine whether T, N, M and Stage Group will be generated for the case. If the histology code is not in that schema's inclusion list for that site, the T, N, M, and Stage Group will be reported as "Not Applicable." Summary Stage is generated for every case.