Neoadjuvant Therapy - Treatment Effect
Organization | Field Name | ID | Required |
|---|---|---|---|
KCR | Neoadjuvant Therapy – Treatment Effect (NeoadjuvTherapyTreatmentEffect) | 31183 | Yes |
SEER | Neoadjuvant Therapy - Treatment Effect | Yes |
See SEER Appendix C for site specific code responses for Neoadjuvant Therapy-Treatment Effect*
Code | Description |
|---|---|
0 | Neoadjuvant therapy not given/no known presurgical therapy |
1 | No residual invasive carcinoma present in the breast after presurgical therapy Residual in situ carcinoma only Stated as Complete response (CR) |
3 | Probable or definite response to presurgical therapy in the invasive carcinoma Stated as Partial response (PR) Stated as minimal or near complete response |
4 | No definite response to presurgical therapy in the invasive carcinoma Stated as No response (NR) Stated as poor response |
6 | Neoadjuvant therapy completed and surgical resection performed, response not documented or unknown Cannot be determined |
7 | Neoadjuvant therapy completed and planned surgical resection not performed |
9 | Unknown if neoadjuvant therapy performed Unknown if planned surgical procedure performed after completion of neoadjuvant therapy Death Certificate only (DCO) |
Description
This data item records the pathologist’s statement of neoadjuvant treatment effect on the primary tumor from the surgical pathology report. Whenever treatment effect definitions are recommended by or available in CAP Cancer Protocols, this data item follows the CAP definitions indicating absent or present effect. When specific CAP definitions are not available, registrars should use treatment effect general use categories.
Rationale
This data item provides information related to the quality of care and describes the pathological outcomes after neoadjuvant therapy. This data item provides prognostically relevant information by quantifying the extent of therapy-induced tumor regression. Therefore, this item can provide a better risk stratification for patients who received neoadjuvant therapy. In addition, this data item can contribute to assessments of cancer care quality.
Neoadjuvant Therapy--Treatment Effect data item [NAACCR # 1634] is related to the Neoadjuvant Therapy data item [NAACCR # 1632]. This data item records the findings from the post neoadjuvant therapy surgical pathology report ONLY when surgery is performed after neoadjuvant therapy. This set of codes applies to the Breast schema.
Note: For Breast only, there are separate criteria for evaluating the primary tumor and lymph nodes. For purposes of this data item, record the information on the primary tumor only. If lymph node information is available, record this in the treatment text field.
For purposes of this data item, neoadjuvant therapy is defined as systemic treatment (chemotherapy, endocrine/hormone therapy, targeted therapy, immunotherapy, or biological therapy) and/or radiation therapy given to shrink a tumor before surgical resection.
Surgical resection: For purposes of this data item, surgical resection is defined as the most definitive surgical procedure that removes some or all of the primary tumor or site, with or without lymph nodes and/or distant metastasis. For many sites, this would be Surgical Codes 30-80; however, there are some sites where surgical codes less than 30 could be used (for example, code 22 for Breast (excisional biopsy or lumpectomy)).
Note: This data item is not the same as AJCC’s Post Therapy Path (yp) Pathological Response, which is based on the managing/treating physician’s evaluation from the surgical pathology report and clinical evaluation after neoadjuvant therapy. This data item addresses response based on the surgical pathology report including the Treatment Effect section of the CAP Cancer Protocol if applicable.
Coding Instructions
Use the Neoadjuvant Therapy--Treatment Effect data item [NAACCR # 1634] to record the findings from the post neoadjuvant therapy surgical pathology report ONLY including the Treatment Effect section of the CAP Cancer Protocol if applicable.
Assign code 0
a. When the patient did not receive neoadjuvant therapy prior to surgical resection
b. When the treatment administered is not neoadjuvant therapy (pre-surgical treatment) because surgical resection was not planned
Example: Patient with unresectable breast cancer (no surgical resection planned), chemotherapy and radiation administered.
c. When it is clear that the patient did not have neoadjuvant therapy based on the sequence of diagnosis and treatment
Example: Patient diagnosed with breast cancer via needle core biopsy, had surgical resection followed by chemotherapy and radiation.
d. For autopsy only cases
Note: Neoadjuvant Therapy data item [NAACCR # 1632] coded to 0 or 3.
Assign code 1 when
a. A complete (total) pathological response (CR) is documented in the surgical pathology report
Note: CR is defined as the absence of all known primary tumor
b. Residual in situ cancer only
Note: Neoadjuvant Therapy data item [NAACCR # 1632] coded to 1 or 2.
Assign code 3 when
a. A probable or definite response is documented in the surgical pathology report
Note: Partial response (PR) is defined as a decrease in the size/extent of the tumor and there is evidence of tumor regression.
b. Documented as minimal or near complete response
Note: Neoadjuvant Therapy data item [NAACCR # 1632] coded to 1 or 2.
Assign code 4 when
a. No definite response (NR) or poor response is documented in the surgical pathology report
Note: No or poor response is defined as evidence of no or minimal change in the size/extent of the tumor or evidence of extensive residual invasive cancer identified.
Note: Neoadjuvant Therapy data item [NAACCR # 1632] coded to 1 or 2.
Assign code 6 when
a. Neoadjuvant therapy was completed and there is no documented treatment response in the surgical pathology report
b. Neoadjuvant therapy was completed and the treatment effect in the breast is stated only as “Present”
Note: Neoadjuvant Therapy data item [NAACCR # 1632] coded to 1 or 2.
Assign code 7 when
a. The planned post neoadjuvant surgical resection was not completed for reasons including
i. Complete clinical response and planned surgical resection cancelled
ii. Treatment failure (stable or progressive disease) and planned surgical resection cancelled
iii. Complications and planned surgical resection cancelled
iv. Patient refusal of planned surgical resection
v. Planned surgical resection started but not completed (surgical resection aborted)
Note 1: Neoadjuvant Therapy data item [NAACCR # 1632] coded to 1 or 2.
Note 2: Code the reason for the surgery not done in Reason for No Surgery [NAACCR # 1340].
Assign code 9 when
a. It is unknown whether neoadjuvant therapy was administered
i. Planned, but unknown if given
ii. Death certificate only (DCO)
b. The only information available is the managing/treating physician’s evaluation
Note 1: Neoadjuvant Therapy data item [NAACCR # 1632] coded to 9.
Note 2: Neoadjuvant Therapy--Clinical Response data item [NAACCR # 1633] coded to 9.
Note 3: Code 9 (unknown) should be used rarely.
Note 4: Use code 0 when it is clear that the patient did not have neoadjuvant therapy based on the sequence of diagnosis and treatment.