ECOGProtocolNo.
Item
ECOG Protocol No.
text
ECOGPatientID
Item
ECOG Patient ID
text
RegistrationStep
Item
Registration Step
text
Patient'sName
Item
Patient?s Name
text
ParticipatingGroupProtocolNo.
Item
Participating Group Protocol No.
text
ParticipatingGroupPatientID
Item
Participating Group Patient ID
text
MainMemberInstitution/Affiliate
Item
Institution/Affiliate
text
AmendedDataInd
Item
Are data amended?
boolean
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
FormNo.
Item
Form No.
text
Item
Performance status
text
Code List
Performance status
CL Item
0 (Fully active, able to carry on all pre-disease performance without restriction (Karnofsky 90-100))
C0919414 (NCI Metathesaurus)
CL Item
1 (Restricted in physically strenuous activity but ambulatory (K 70-80))
CL Item
2 (Ambulatory and capable of all selfcare but unable to carry out any work activities (K 50-60))
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (Capable of only limited selfcare, confined to bed or chair more than 50% of waking hours (K 30-40))
CL Item
4 (completely disabled (K 10-20))
Item
Weight loss in previous 6 months (choose one)
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C3445 (NCI Thesaurus Property)
C0043096 (UMLS 2011AA Property)
Code List
Weight loss in previous 6 months (choose one)
CL Item
<5% Of Body Weight (less than 5% of body weight)
CL Item
5 To <10% Of Body Weight (5 - <10% of body weight)
CL Item
10 To <20% Of Body Weight (10 - <20% of body weight)
CL Item
> Or = 20% Of Body Weight (greater than or equal to 20% of body weight)
FirstPositiveBiopsyDate
Item
Date of initial diagnosis of primary tumor (first positive biopsy date)
date
PriorRecentRecurrenceDate
Item
Date of most recent prior recurrence (if patient has responded to prior treatment)
date
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25279 (NCI Thesaurus Property)
C0332162 (UMLS 2011AA Property)
Item
Primary site (choose one)
text
Code List
Primary site (choose one)
CL Item
Head Of Pancreas (Head of pancreas)
C0227579 (NCI Metathesaurus)
CL Item
Body Of Pancreas (Body of pancreas)
C0227582 (NCI Metathesaurus)
CL Item
Tail Of Pancreas (Tail of pancreas)
C0227590 (NCI Metathesaurus)
CL Item
Uncinate Process (Uncinate process)
CL Item
Diffuse (Diffuse)
C14175 (NCI Thesaurus)
C0205219 (UMLS 2011AA)
CL Item
Other, Specify (Other)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
PrimarySite,Other
Item
Primary Site, other specify
text
Item
Histologic grade (choose one)
text
Code List
Histologic grade (choose one)
CL Item
Tumor Is Well Differentiated According To Who Grading System (Well differentiated)
CL Item
Tumor Is Moderately Differentiated According To Who Grading System (Moderately differentiated)
CL Item
Tumor Is Poorly Differentiated According To Who Grading System (Poorly differentiated)
CL Item
Tumor Is Undifferentiated According To Who Grading System (Undifferentiated)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Histologic Type (choose one)
text
Code List
Histologic Type (choose one)
CL Item
Ductal Adenocarcinoma (Ductal adenocarcinoma)
CL Item
Neuroendocrine Carcinoma (Neuroendocrine carcinoma)
C3773 (NCI Thesaurus)
C0206695 (UMLS 2011AA)
CL Item
Mixed-type (ductal-endocrine Or Acinar-endocrine) (Mixed ductal - endocrine carcinoma)
CL Item
Undifferentiated (anaplastic) Carcinoma (Undifferentiated (anaplastic) carcinoma)
CL Item
Other, Specify (Other)
HistologicType,OtherName
Item
Other specify
text
Item
Is there histologic proof of residual or metastatic malignant disease?
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25180 (NCI Thesaurus ValueDomain-2)
C1522602 (UMLS 2011AA ValueDomain-2)
Code List
Is there histologic proof of residual or metastatic malignant disease?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Primarytumor/Pancreas
Item
Pancreas
boolean
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25180 (NCI Thesaurus ValueDomain-2)
C1522602 (UMLS 2011AA ValueDomain-2)
RegionalLymphNode(s)Ind
Item
Regional lymph nodes
boolean
DistantLymphNode(s)Ind
Item
Distant lymph nodes
boolean
Adjacentviscera/vessels
Item
Adjacent viscera/vessels
boolean
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25180 (NCI Thesaurus ValueDomain-2)
C1522602 (UMLS 2011AA ValueDomain-2)
LiverSiteInd
Item
Liver
boolean
PeritoneumInd
Item
Peritoneum
boolean
LungSiteInd
Item
Lung
boolean
BoneSiteInd
Item
Bone
boolean
OtherSiteInd
Item
Other
boolean
OtherSiteName
Item
Other specify
text
Item
Advanced Disease Status at Registration
text
Code List
Advanced Disease Status at Registration
CL Item
Initial Diagnosis (Initial diagnosis)
CL Item
Recurrence (Recurrence)
CEA
Item
CEA (ng/dl)
text
LaboratoryProcedureCarcinoembryonicAntigenOutcomeUpperLimitNormalValue
Item
CEA ULN
float
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C25159 (NCI Thesaurus Property)
C0007082 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
C1519815 (UMLS 2011AA ValueDomain-2)
CarcinoembryonicAntigenSpecimenCollectionDate
Item
Date CEA obtained (M D Y)
text
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25159 (NCI Thesaurus ObjectClass)
C0007082 (UMLS 2011AA ObjectClass)
C25453 (NCI Thesaurus Property)
C1516698 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass-2)
C0370003 (UMLS 2011AA ObjectClass-2)
CA19-9
Item
CA19-9 (U/ml)
text
DateCA19-9obtained
Item
Date CA19-9 obtained (M D Y)
text
WBCcount(x1000),LLN
Item
WBC count (x1000), LLN
text
Lab,Hematology,WBC
Item
WBC count (x1000), Value
float
Lab,Hematology,SampleCollectionDate
Item
Date Obtained (M D Y)
date
Lab,Hematology,GranulocyteCount
Item
Granulocyte count (AGC/ANC), Value
float
Plateletscount(x1000),LLN
Item
Platelets count (x1000), LLN
float
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25555 (NCI Thesaurus ValueDomain-2)
C1518030 (UMLS 2011AA ValueDomain-2)
Lab,Hematology,Platelets
Item
Platelets count (x1000), Value
float
Hemoglobin(g/dl),LLN
Item
Hemoglobin (g/dl), LLN
text
Lab,Hematology,Hemoglobin
Item
Hemoglobin (g/dl), Value
float
Albumin(g/dl),LLN
Item
Albumin (g/dl), LLN
float
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25555 (NCI Thesaurus ValueDomain-2)
C1518030 (UMLS 2011AA ValueDomain-2)
Lab,Chemistry,Albumin
Item
Albumin (g/dl), Value
float
Creatinine(mg/dl),ULN
Item
Creatinine (mg/dl), ULN
text
Lab,Renal,Creatinine
Item
Creatinine (mg/dl), Value
float
SGOT(AST)ULN
Item
SGOT (AST) (U/L), ULN
float
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
C1519815 (UMLS 2011AA ValueDomain-2)
Lab,Hepatic,SGOT
Item
SGOT (AST) (U/L), Value
float
Bilirubin(mg/dl),ULN
Item
Bilirubin (mg/dl), ULN
float
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
C1519815 (UMLS 2011AA ValueDomain-2)
Lab,Hepatic,Bilirubin
Item
Bilirubin (mg/dl), Value
float
PriorRTInd
Item
Prior radiation therapy? (Choose one:)
boolean
PriorRTBeginDate
Item
Prior RT begin date (M D Y)
date
PriorRTEndDate
Item
Prior RT end date (M D Y)
date
RTSite
Item
RT site:
text
DiseaseInvolvementSite,Other
Item
Site(s) of Involvement, Other specify
text
Specifyagents
Item
Specify agents
text
PriorSurgeryInd
Item
Prior surgery
boolean
Item
Specify prior thrombotic event
text
Code List
Specify prior thrombotic event
CL Item
Thrombosis (thrombosis)
C26891 (NCI Thesaurus)
C0040053 (UMLS 2011AA)
CL Item
Both Thrombosis And Embolus (both thrombosis and embolus)
CL Item
Embolus (embolus)
C0013932 (NCI Metathesaurus)
Doesthepatienthaveapriorhistoryofdeepveinthrombosisorpulmonaryembolus?
Item
Does the patient have a prior history of deep vein thrombosis or pulmonary embolus?
boolean
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
Priorthrombosis?
Item
Prior thrombosis?
boolean
Item
Time frame of thrombosis
text
Code List
Time frame of thrombosis
CL Item
> 1 Year Prior To Diagnosis Of Primary Cancer (> 1 year prior to diagnosis of primary cancer)
CL Item
Within 1 Year Of Diagnosis Of Primary Cancer (within 1 year of diagnosis of primary cancer)
Priorembolus?
Item
Prior embolus?
boolean
Item
Time frame of embolus
text
Code List
Time frame of embolus
CL Item
> 1 Year Prior To Diagnosis Of Primary Cancer (> 1 year prior to diagnosis of primary cancer)
CL Item
Within 1 Year Of Diagnosis Of Primary Cancer (within 1 year of diagnosis of primary cancer)
PriorSurgeryDate
Item
date of prior surgery
date
InitialDiagnosisDate,LocallyAdvanced
Item
Date of initial diagnosis of unresectable locally advanced disease
date
InitialDiagnosisDate,Metastatic
Item
Date of initial diagnosis of metastatic disease
date
DiseaseAssessment,MeasurableInd
Item
Is measurable disease present?
boolean
DiseaseAssessment,Non-measurableInd
Item
Is non-measurable disease present?
boolean
PriorAdjuvantChemotherapyEndDate
Item
Prior adjuvant chemotherapy end date
date
PriorAdjuvantChemotherapyBeginDate
Item
Prior adjuvant chemotherapy begin date
date
Comments
Item
Comments
text
InvestigatorSignature
Item
Investigator Signature
text
C25678 (NCI Thesaurus Property)
C1519316 (UMLS 2011AA Property)
C17089 (NCI Thesaurus ObjectClass)
C0035173 (UMLS 2011AA ObjectClass)
InvestigatorSignatureDate
Item
Date
date