ID

11916

Descripción

On-Study Form Bladder Cancer NCT00014534 CALGB-90104 NCT00014534 NCI Cooperative Group On-Study Form-Revised (CALGB-90104) Combination Chemotherapy in Treating Patients With Bladder Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BE1B6E9C-942E-7181-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BE1B6E9C-942E-7181-E034-0003BA12F5E7

Palabras clave

Versiones (3)
  1. 26/8/12 26/8/12 -
  2. 9/1/15 9/1/15 - Martin Dugas
  3. 21/8/15 21/8/15 - Martin Dugas
Subido en

21 de agosto de 2015

DOI

Para solicitar uno, por favor iniciar sesión.

Licencia

Creative Commons BY-NC 3.0 Legacy
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On-Study Form Bladder Cancer NCT00014534 CALGB-90104

Inglés

No Instruction available.

1 formularios  
  1. StudyEvent: NCI Cooperative Group On-Study Form-Revised (CALGB-90104)
    1. No Instruction available.
Muscle Invasive Bladder Disease: Prior Treatment Affecting The Bladder
Descripción

Muscle Invasive Bladder Disease: Prior Treatment Affecting The Bladder

Prior Intravesical Therapy (Note: If no, skip to Prior Surgery below)
Descripción

PriorTherapyIntravesicalAdministeredInd-3

Tipo de datos

boolean

Alias
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C15368
NCI Thesaurus Property
C13415
UMLS 2011AA Property
C0442124
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Type of Prior Immunotherapy
Descripción

PriorImmunotherapyTreatmentType

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C15262
UMLS 2011AA ObjectClass
C0021083
NCI Thesaurus ObjectClass-2
C25629
UMLS 2011AA ObjectClass-2
C0332152
NCI Thesaurus Property
C15368
Number of Courses
Descripción

PriorImmunotherapyTreatmentCount

Tipo de datos

float

Alias
NCI Thesaurus ObjectClass
C15262
UMLS 2011AA ObjectClass
C0021083
NCI Thesaurus ObjectClass-2
C25629
UMLS 2011AA ObjectClass-2
C0332152
NCI Thesaurus Property
C15368
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
Specify agent
Descripción

PriorImmunotherapyOtherAgent

Tipo de datos

text

Agent Start Date
Descripción

Medication Start Date

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C1521826
NCI Thesaurus ValueDomain-2
C25431
UMLS CUI-2
C0808070
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus Property
C25275
Agent End Date
Descripción

Medication End Date

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C1521826
NCI Thesaurus ObjectClass
C1708
UMLS CUI-2
C0806020
NCI Thesaurus Property
C25275
Type of Prior Chemotherapy
Descripción

PriorChemotherapyType

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Number of Courses
Descripción

PriorChemotherapyTreatmentCount

Tipo de datos

float

Alias
NCI Thesaurus ObjectClass
C15632
UMLS 2011AA ObjectClass
C0392920
NCI Thesaurus Property
C15368
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
Specify agent
Descripción

PriorChemotherapyOtherName

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C15632
UMLS 2011AA ObjectClass
C0392920
NCI Thesaurus ObjectClass-2
C25629
UMLS 2011AA ObjectClass-2
C0332152
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus Property-2
C25364
UMLS 2011AA Property-2
C0600091
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ValueDomain-2
C17649
UMLS 2011AA ValueDomain-2
C0205394
Prior Surgery (for urothelial disease)
Descripción

PriorSurgeryPerformedInd-3

Tipo de datos

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
Prior Surgery Type
Descripción

PriorSurgeryType

Tipo de datos

text

Other, specify
Descripción

PriorSurgery,OtherType

Tipo de datos

text

TURBT, specify number
Descripción

PriorSurgery,TURBTCount

Tipo de datos

float

Prior surgery date
Descripción

PriorSurgeryDate

Tipo de datos

date

Any Other Prior Therapy
Descripción

PriorTherapyOtherAdministeredInd-3

Tipo de datos

boolean

Alias
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C15368
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Prior Therapy Name
Descripción

PriorTherapyName

Tipo de datos

text

Alias
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C15368
NCI Thesaurus ValueDomain
C42614
UMLS 2011AA ValueDomain
C0027365
Prior Therapy Date
Descripción

Prior Therapy Date

Chest X-ray assessment date
Descripción

ChestX-RayAssessmentDate

Tipo de datos

date

Chest X-ray results
Descripción

ChestX-RayResult

Tipo de datos

text

Abdominal/pelvic CT assessment date
Descripción

Abdominal/PelvicCTAssessmentDate

Tipo de datos

text

CT results
Descripción

Abdominal/pelvicCTresult

Tipo de datos

text

ANC
Descripción

ANC

Tipo de datos

float

Unidades de medida
  • 1000/ul
Alias
NCI Thesaurus Property
C12533
NCI Thesaurus Property-2
C20200
NCI Thesaurus ObjectClass
C25294
NCI Thesaurus ValueDomain
C25712
UMLS CUI [1]
C0200633
1000/ul
Peripheral Platelet Count
Descripción

Peripheral Platelet Count

Tipo de datos

float

Unidades de medida
  • 1000/uL
Alias
NCI Thesaurus Property
C20200
NCI Thesaurus Property-2
C12520
NCI Thesaurus ObjectClass
C25294
NCI Thesaurus ValueDomain
C25712
UMLS CUI [1]
C0005821
1000/uL
Bilirubin, total
Descripción

Bilirubin, total

Tipo de datos

float

Unidades de medida
  • mg/dL
Alias
UMLS CUI [1]
C0201913
mg/dL
Bilirubin ULN
Descripción

Bilirubin ULN

Tipo de datos

float

Unidades de medida
  • mg/dL
Alias
NCI Thesaurus ObjectClass
C25294
NCI Thesaurus Property
C20200
NCI Thesaurus Property-2
C305
NCI Thesaurus ValueDomain
C25712
NCI Thesaurus ValueDomain-2
C25706
UMLS CUI [1,1]
C0005437
UMLS CUI [1,2]
C1519815
mg/dL
Creatinine
Descripción

Creatinine

Tipo de datos

float

Unidades de medida
  • mg/dL
Alias
NCI Thesaurus ObjectClass
C25225
NCI Thesaurus Property
C399
NCI Thesaurus Property-2
C25294
NCI Thesaurus ValueDomain
C25712
UMLS CUI [1]
C0201976
mg/dL
Creatinine Clearance
Descripción

Creatinine Clearance

Tipo de datos

float

Unidades de medida
  • mL/min
Alias
UMLS CUI [1]
C0373595
mL/min
Alkaline Phosphatase
Descripción

Alkaline Phosphatase

Tipo de datos

float

Unidades de medida
  • U/L
Alias
UMLS CUI [1]
C0201850
U/L
Alkaline Phosphatase ULN
Descripción

Alkaline Phosphatase ULN

Tipo de datos

float

Unidades de medida
  • U/L
Alias
NCI Thesaurus ObjectClass
C25294
NCI Thesaurus Property
C20200
NCI Thesaurus Property-2
C16276
NCI Thesaurus ValueDomain
C25712
NCI Thesaurus ValueDomain-2
C25706
UMLS CUI [1,1]
C0151420
UMLS CUI [1,2]
C1519815
U/L
AST (SGOT)
Descripción

AST (SGOT)

Tipo de datos

float

Unidades de medida
  • U/L
Alias
NCI Thesaurus ObjectClass
C13308
NCI Thesaurus Property
C25202
NCI Thesaurus ValueDomain
C38046
NCI Thesaurus Property-2
C37984
NCI Thesaurus ValueDomain-2
C25712
UMLS CUI [1]
C0201899
U/L
AST (SGOT) ULN
Descripción

AST (SGOT) ULN

Tipo de datos

float

Unidades de medida
  • U/L
Alias
NCI Thesaurus ObjectClass
C25294
NCI Thesaurus Property
C25202
NCI Thesaurus Property-2
C20200
NCI Thesaurus ValueDomain
C25712
NCI Thesaurus ValueDomain-2
C25706
UMLS CUI [1,1]
C0242192
UMLS CUI [1,2]
C1519815
U/L
Completed by
Descripción

Person Completing Form

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1550483
NCI Thesaurus ObjectClass
C25657
NCI Thesaurus Property
C25364
Date form completed
Descripción

Date Form Completed

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C1115437
NCI Thesaurus ObjectClass
C40988
NCI Thesaurus Property
C25250
NCI Thesaurus ValueDomain-2
C25367
Ccrr Module For Nci Cooperative Group On-study Form-revised (calgb-90104)
Descripción

Ccrr Module For Nci Cooperative Group On-study Form-revised (calgb-90104)

CALGB Form
Descripción

CALGB Form

Tipo de datos

text

Alias
UMLS CUI-1
C3262252
UMLS CUI-2
C1516238
CALGB Study No.
Descripción

Protocol ID CALGB

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1516238
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25442
CALGB Patient ID
Descripción

Trial subject ID CALGB

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1516238
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25442
Are data amended?
Descripción

Are data amended?

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C38148
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
UMLS CUI [1]
C0680532
Patient Initials
Descripción

Patient Initials

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Participating group
Descripción

Participating Group

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2347449
NCI Thesaurus ObjectClass
C25608
NCI Thesaurus ObjectClass-2
C17005
NCI Thesaurus Property
C25364
Patient medical record number
Descripción

Medical Record Number

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1301894
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25261
NCI Thesaurus Property-2
C25198
Participating group protocol number
Descripción

Study Number Participating Group

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
Institution/Affiliate
Descripción

Institution Name

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C25454
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass-2
C21541
NCI Thesaurus Property
C25364
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ValueDomain-2
C21541
Participating Group Patient ID
Descripción

Trial subject ID Participating Group

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
Date of Initial Symptom
Descripción

ResponseSymptomaticDeteriorationDate

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C25755
UMLS 2011AA ObjectClass
C0871261
NCI Thesaurus Property
C25269
UMLS 2011AA Property
C0231220
NCI Thesaurus Property-2
C25751
UMLS 2011AA Property-2
C0868945
Has the patient had a prior history of superficial disease?
Descripción

PriorDiseaseSuperficialPresentInd-3

Tipo de datos

boolean

Alias
NCI Thesaurus ObjectClass
C25629
NCI Thesaurus ObjectClass-2
C2991
NCI Thesaurus Property
C25626
NCI Thesaurus Property-2
C25239
NCI Thesaurus ValueDomain
C38148
UMLS CUI [1,1]
C0262512
UMLS CUI [1,2]
C0205124
Number of Prior Occurrences of Papillary
Descripción

Number of Prior Occurrences of Papillary

Tipo de datos

integer

Number of Prior Occurrence of CIS
Descripción

PriorCISOccurrences

Tipo de datos

float

Date of Initial Pathologic Diagnosis of muscle invasive bladder cancer
Descripción

InitialDiagnosisDate,Pathologic

Tipo de datos

date

Date of Initial Pathologic Diagnosis of muscle invasive bladder cancer
Descripción

InitialDiagnosisDate,Pathologic

Tipo de datos

date

Date of Current pathologic diagnosis for muscle invasive bladder cancer
Descripción

PathologicDiagnosisDate

Tipo de datos

date

Date of Most recent prior recurrence for muscle invasive bladder cancer
Descripción

PriorRecentRecurrenceDate

Tipo de datos

date

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus Property
C25279
UMLS 2011AA Property
C0332162
Histologic Type (mark all that apply)
Descripción

BladderTumorHistologicCategory

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus ObjectClass-2
C12414
UMLS 2011AA ObjectClass-2
C0005682
NCI Thesaurus Property
C25526
UMLS 2011AA Property
C0205462
NCI Thesaurus Property-2
C25161
UMLS 2011AA Property-2
C0008902
NCI Thesaurus ValueDomain
C25372
UMLS 2011AA ValueDomain
C0683312
NCI Thesaurus ValueDomain-2
C25526
UMLS 2011AA ValueDomain-2
C0205462
Other, specify
Descripción

TumorHistologicCategorySpecify

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus Property
C25161
UMLS 2011AA Property
C0008902
Histologic Grade (check the highest grade)
Descripción

BladderTumorHistologicGrade

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C3262
NCI Thesaurus ObjectClass-2
C12414
NCI Thesaurus Property
C25526
NCI Thesaurus Property-2
C25365
NCI Thesaurus ValueDomain
C25526
NCI Thesaurus ValueDomain-2
C18000
UMLS CUI [1,1]
C0919553
UMLS CUI [1,2]
C0005695
Pathologic T Stage (Indicate highest stage at the current presentation of disease)
Descripción

TStage,Pathologic

Tipo de datos

text

Pathologic N Stage (Distant Metastasis)
Descripción

BladderTumorPathologicNStage

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus ObjectClass-2
C12414
UMLS 2011AA ObjectClass-2
C0005682
NCI Thesaurus Property
C25610
UMLS 2011AA Property
C1521733
NCI Thesaurus Property-2
C25580
UMLS 2011AA Property-2
C0456532
NCI Thesaurus ValueDomain
C16899
UMLS 2011AA ValueDomain
C1300072
Pathologic M Stage
Descripción

BladderTumorPathologicMStage

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus ObjectClass-2
C12414
UMLS 2011AA ObjectClass-2
C0005682
NCI Thesaurus Property
C25610
UMLS 2011AA Property
C1521733
NCI Thesaurus Property-2
C25727
UMLS 2011AA Property-2
C0456533
NCI Thesaurus ValueDomain
C16899
UMLS 2011AA ValueDomain
C1300072
Lymph Node Type (unnamed)
Descripción

LymphNodesType

Tipo de datos

text

Other, specify
Descripción

LymphNodesOtherType

Tipo de datos

text

Lymph Node Involvement (unnamed)
Descripción

LymphNodeInvolvement

Tipo de datos

text

Number of Lymph Nodes Examined
Descripción

LymphNodeExaminedCount

Tipo de datos

float

Alias
NCI Thesaurus Property
C25500
UMLS 2011AA Property
C0332128
NCI Thesaurus ObjectClass
C12745
UMLS 2011AA ObjectClass
C0024204
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
Number of Positive Lymph Nodes
Descripción

LymphNodePositiveCount

Tipo de datos

integer

Alias
NCI Thesaurus Property
C25246
NCI Thesaurus ObjectClass
C12745
NCI Thesaurus ValueDomain
C25463
UMLS CUI [1,1]
C0237753
UMLS CUI [1,2]
C0746319
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No Instruction available.

1 formularios
  1. StudyEvent: NCI Cooperative Group On-Study Form-Revised (CALGB-90104)
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Muscle Invasive Bladder Disease: Prior Treatment Affecting The Bladder
PriorTherapyIntravesicalAdministeredInd-3
Item
Prior Intravesical Therapy (Note: If no, skip to Prior Surgery below)
boolean
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C13415 (NCI Thesaurus Property)
C0442124 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
Item
Type of Prior Immunotherapy
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C15262 (NCI Thesaurus ObjectClass)
C0021083 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C15368 (NCI Thesaurus Property)
CL.2
Code List
Type of Prior Immunotherapy
CL Item
BCG (BCG)
C1328 (NCI Thesaurus)
CL Item
Interferon (Interferon)
C20493 (NCI Thesaurus)
C0733470 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
PriorImmunotherapyTreatmentCount
Item
Number of Courses
float
C15262 (NCI Thesaurus ObjectClass)
C0021083 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C15368 (NCI Thesaurus Property)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
PriorImmunotherapyOtherAgent
Item
Specify agent
text
Medication Start Date
Item
Agent Start Date
date
C25164 (NCI Thesaurus ValueDomain)
C1521826 (UMLS CUI-1)
C25431 (NCI Thesaurus ValueDomain-2)
C0808070 (UMLS CUI-2)
C1708 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)
Medication End Date
Item
Agent End Date
date
C25164 (NCI Thesaurus ValueDomain)
C1521826 (UMLS CUI-1)
C1708 (NCI Thesaurus ObjectClass)
C0806020 (UMLS CUI-2)
C25275 (NCI Thesaurus Property)
Item
Type of Prior Chemotherapy
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.3
Code List
Type of Prior Chemotherapy
CL Item
Mmc (MMC)
CL Item
Thiotepa (Thiotepa)
C875 (NCI Thesaurus)
C0039871 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
PriorChemotherapyTreatmentCount
Item
Number of Courses
float
C15632 (NCI Thesaurus ObjectClass)
C0392920 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus Property)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
PriorChemotherapyOtherName
Item
Specify agent
text
C15632 (NCI Thesaurus ObjectClass)
C0392920 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property-2)
C0600091 (UMLS 2011AA Property-2)
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus ValueDomain-2)
C0205394 (UMLS 2011AA ValueDomain-2)
PriorSurgeryPerformedInd-3
Item
Prior Surgery (for urothelial disease)
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
Item
Prior Surgery Type
text
CL.5
Code List
Prior Surgery Type
CL Item
Patient Previosly Had A Partial Cystectomy (Partial cystectomy)
CL Item
Patient Previosly Had A Radical Cystectomy (radical cystectomy)
CL Item
Patient Previosly Had A Turbt (TURBT)
CL Item
Patient Previously Had Other Surgery, Specify (Other, specify)
PriorSurgery,OtherType
Item
Other, specify
text
PriorSurgery,TURBTCount
Item
TURBT, specify number
float
PriorSurgeryDate
Item
Prior surgery date
date
PriorTherapyOtherAdministeredInd-3
Item
Any Other Prior Therapy
boolean
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
PriorTherapyName
Item
Prior Therapy Name
text
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
Item Group
Prior Therapy Date
ChestX-RayAssessmentDate
Item
Chest X-ray assessment date
date
Item
Chest X-ray results
text
CL.7
Code List
Chest X-ray results
CL Item
Negative (negative)
C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)
CL Item
Positive (positive)
C25246 (NCI Thesaurus)
C1446409 (UMLS 2011AA)
CL Item
Equivocal (equivocal)
C86071 (NCI Thesaurus)
C0332241 (UMLS 2011AA)
Abdominal/PelvicCTAssessmentDate
Item
Abdominal/pelvic CT assessment date
text
Item
CT results
text
CL.8
Code List
CT results
CL Item
Not Done (not done)
CL281691 (NCI Metathesaurus)
CL Item
Normal (normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
CL Item
Equivocal (equivocal)
C86071 (NCI Thesaurus)
C0332241 (UMLS 2011AA)
CL Item
Abnormal-disease Related (abnormal-disease related)
CL Item
Abnormal-not Disease Related (abnormal-not disease related)
CL Item
Unknown (unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Neutrophil count
Item
ANC
float
C12533 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C0200633 (UMLS CUI [1])
Platelets
Item
Peripheral Platelet Count
float
C20200 (NCI Thesaurus Property)
C12520 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C0005821 (UMLS CUI [1])
Bilirubin, total
Item
Bilirubin, total
float
C0201913 (UMLS CUI [1])
Bilirubin ULN
Item
Bilirubin ULN
float
C25294 (NCI Thesaurus ObjectClass)
C20200 (NCI Thesaurus Property)
C305 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
C0005437 (UMLS CUI [1,1])
C1519815 (UMLS CUI [1,2])
Creatinine, Serum
Item
Creatinine
float
C25225 (NCI Thesaurus ObjectClass)
C399 (NCI Thesaurus Property)
C25294 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C0201976 (UMLS CUI [1])
Creatinine Clearance
Item
Creatinine Clearance
float
C0373595 (UMLS CUI [1])
Alkaline Phosphatase
Item
Alkaline Phosphatase
float
C0201850 (UMLS CUI [1])
Alkaline Phosphatase ULN
Item
Alkaline Phosphatase ULN
float
C25294 (NCI Thesaurus ObjectClass)
C20200 (NCI Thesaurus Property)
C16276 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
C0151420 (UMLS CUI [1,1])
C1519815 (UMLS CUI [1,2])
AST
Item
AST (SGOT)
float
C13308 (NCI Thesaurus ObjectClass)
C25202 (NCI Thesaurus Property)
C38046 (NCI Thesaurus ValueDomain)
C37984 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain-2)
C0201899 (UMLS CUI [1])
AST ULN
Item
AST (SGOT) ULN
float
C25294 (NCI Thesaurus ObjectClass)
C25202 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
C0242192 (UMLS CUI [1,1])
C1519815 (UMLS CUI [1,2])
Person Completing Form
Item
Completed by
text
C25191 (NCI Thesaurus ValueDomain)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
Date Form Completed
Item
Date form completed
date
C25164 (NCI Thesaurus ValueDomain)
C1115437 (UMLS CUI-1)
C40988 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
Item Group
Ccrr Module For Nci Cooperative Group On-study Form-revised (calgb-90104)
CALGB Form
Item
CALGB Form
text
C3262252 (UMLS CUI-1)
C1516238 (UMLS CUI-2)
Protocol ID CALGB
Item
CALGB Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus Property-2)
Trial subject ID CALGB
Item
CALGB Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus Property-2)
Item
Are data amended?
text
C38148 (NCI Thesaurus ValueDomain)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
C0680532 (UMLS CUI [1])
CL.9
Code List
Are data amended?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C49488 (NCI Thesaurus-3)
C1705108 (UMLS CUI-1)
Patient Initials
Item
Patient Initials
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Participating Group
Item
Participating group
text
C25191 (NCI Thesaurus ValueDomain)
C2347449 (UMLS CUI-1)
C25608 (NCI Thesaurus ObjectClass)
C17005 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
Medical Record Number
Item
Patient medical record number
text
C25337 (NCI Thesaurus ValueDomain)
C1301894 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25261 (NCI Thesaurus Property)
C25198 (NCI Thesaurus Property-2)
Study Number Participating Group
Item
Participating group protocol number
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Institution Name
Item
Institution/Affiliate
text
C25454 (NCI Thesaurus ObjectClass)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
Trial subject ID Participating Group
Item
Participating Group Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
ResponseSymptomaticDeteriorationDate
Item
Date of Initial Symptom
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25755 (NCI Thesaurus ObjectClass)
C0871261 (UMLS 2011AA ObjectClass)
C25269 (NCI Thesaurus Property)
C0231220 (UMLS 2011AA Property)
C25751 (NCI Thesaurus Property-2)
C0868945 (UMLS 2011AA Property-2)
Prior history of superficial disease
Item
Has the patient had a prior history of superficial disease?
boolean
C25629 (NCI Thesaurus ObjectClass)
C2991 (NCI Thesaurus ObjectClass-2)
C25626 (NCI Thesaurus Property)
C25239 (NCI Thesaurus Property-2)
C38148 (NCI Thesaurus ValueDomain)
C0262512 (UMLS CUI [1,1])
C0205124 (UMLS CUI [1,2])
PriorPapillaryOccurrences
Item
Number of Prior Occurrences of Papillary
integer
PriorCISOccurrences
Item
Number of Prior Occurrence of CIS
float
InitialDiagnosisDate,Pathologic
Item
Date of Initial Pathologic Diagnosis of muscle invasive bladder cancer
date
InitialDiagnosisDate,Pathologic
Item
Date of Initial Pathologic Diagnosis of muscle invasive bladder cancer
date
PathologicDiagnosisDate
Item
Date of Current pathologic diagnosis for muscle invasive bladder cancer
date
PriorRecentRecurrenceDate
Item
Date of Most recent prior recurrence for muscle invasive bladder cancer
date
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25279 (NCI Thesaurus Property)
C0332162 (UMLS 2011AA Property)
Item
Histologic Type (mark all that apply)
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12414 (NCI Thesaurus ObjectClass-2)
C0005682 (UMLS 2011AA ObjectClass-2)
C25526 (NCI Thesaurus Property)
C0205462 (UMLS 2011AA Property)
C25161 (NCI Thesaurus Property-2)
C0008902 (UMLS 2011AA Property-2)
C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
C25526 (NCI Thesaurus ValueDomain-2)
C0205462 (UMLS 2011AA ValueDomain-2)
CL.11
Code List
Histologic Type (mark all that apply)
CL Item
Transitional Cell Carcinoma (Transitional cell carcinoma)
C2930 (NCI Thesaurus)
C0007138 (UMLS 2011AA)
CL Item
Other Specify (Other, specify)
TumorHistologicCategorySpecify
Item
Other, specify
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25161 (NCI Thesaurus Property)
C0008902 (UMLS 2011AA Property)
Item
Histologic Grade (check the highest grade)
text
C3262 (NCI Thesaurus ObjectClass)
C12414 (NCI Thesaurus ObjectClass-2)
C25526 (NCI Thesaurus Property)
C25365 (NCI Thesaurus Property-2)
C25526 (NCI Thesaurus ValueDomain)
C18000 (NCI Thesaurus ValueDomain-2)
C0919553 (UMLS CUI [1,1])
C0005695 (UMLS CUI [1,2])
CL.12
Code List
Histologic Grade (check the highest grade)
CL Item
Well Differentiated (G1)
C0205615 (UMLS CUI-1)
CL Item
Moderately Differentiated (G2)
C0205616 (UMLS CUI-1)
CL Item
Poorly Differentiated (G3)
C0205617 (UMLS CUI-1)
CL Item
Tumor Grade Cannot Be Assessed (GX)
C0475268 (UMLS CUI-1)
Item
Pathologic T Stage (Indicate highest stage at the current presentation of disease)
text
CL.13
Code List
Pathologic T Stage (Indicate highest stage at the current presentation of disease)
CL Item
No Evidence Of Primary Tumor (T0)
CL Item
Tumor Invades Subepithelial Connective Tissue (T1)
CL Item
Tumor Invades Superficial Muscles (inner Half) (T2a)
CL Item
Tumor Invades Deep Muscles (outer Half) (T2b)
CL Item
Tumor Invades Perivesical Tissue Microscopically (T3a)
CL Item
Tumor Invades Perivesical Tissue Macroscopically (extravesical Mass) (T3b)
CL Item
Inflammatory Carcinoma (T4)
C0334385 (NCI Metathesaurus)
Item
Pathologic N Stage (Distant Metastasis)
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12414 (NCI Thesaurus ObjectClass-2)
C0005682 (UMLS 2011AA ObjectClass-2)
C25610 (NCI Thesaurus Property)
C1521733 (UMLS 2011AA Property)
C25580 (NCI Thesaurus Property-2)
C0456532 (UMLS 2011AA Property-2)
C16899 (NCI Thesaurus ValueDomain)
C1300072 (UMLS 2011AA ValueDomain)
CL.14
Code List
Pathologic N Stage (Distant Metastasis)
CL Item
No Regional Lymph Node Metastasis (N0)
CL Item
Metastasis In A Single Lymph Node, 2 Cm Or Less In Greatest Dimension (N1)
CL Item
Metastasis In A Single Lymph Node, More Than 2 Cm But Not More Than 5 Cm In Greatest Dimension; Or Multiple Lymph Nodes, None More Than 5 Cm In Greatest Dimension (N2)
CL Item
Metastasis In A Lymph Node More Than 5 Cm In Greatest Dimension (N3)
CL Item
Regional Lymph Nodes Cannot Be Assessed (Nx)
Item
Pathologic M Stage
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12414 (NCI Thesaurus ObjectClass-2)
C0005682 (UMLS 2011AA ObjectClass-2)
C25610 (NCI Thesaurus Property)
C1521733 (UMLS 2011AA Property)
C25727 (NCI Thesaurus Property-2)
C0456533 (UMLS 2011AA Property-2)
C16899 (NCI Thesaurus ValueDomain)
C1300072 (UMLS 2011AA ValueDomain)
CL.15
Code List
Pathologic M Stage
CL Item
M0, According To Ajcc Staging Definitions (M0)
Item
Lymph Node Type (unnamed)
text
CL.16
Code List
Lymph Node Type (unnamed)
CL Item
Internal Iliac (Internal Iliac)
CL Item
External Iliac (External Iliac)
CL Item
Common Iliac (Common Iliac)
CL Item
Hypogastric (Hypogastric)
CL Item
Para-aortic (Para-aortic)
CL Item
Other, Specify (Other, specify)
LymphNodesOtherType
Item
Other, specify
text
Item
Lymph Node Involvement (unnamed)
text
CL.17
Code List
Lymph Node Involvement (unnamed)
CL Item
Lymph Nodes Were Not Evaluated For Involvement (not evaluated)
CL Item
Lymph Nodes Were Evaluated For Involvement, And They Were Positive (positive)
CL Item
Lymph Nodes Were Evaluated For Involvement, And They Were Negative (negative)
CL Item
Lymph Nodes Were Evaluated For Involvement, And They Were Equivocal (equivocal)
CL Item
Unknown Whether The Lymph Nodes Were Evaluated For Involvement (unknown)
LymphNodeExaminedCount
Item
Number of Lymph Nodes Examined
float
C25500 (NCI Thesaurus Property)
C0332128 (UMLS 2011AA Property)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
Number of Positive Lymph Nodes
Item
Number of Positive Lymph Nodes
integer
C25246 (NCI Thesaurus Property)
C12745 (NCI Thesaurus ObjectClass)
C25463 (NCI Thesaurus ValueDomain)
C0237753 (UMLS CUI [1,1])
C0746319 (UMLS CUI [1,2])
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