ID

7461

Description

S1011 Prestudy Form (#8218) Standard or Extended Pelvic Lymphadenectomy in Treating Patients Undergoing Surgery for Invasive Bladder Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=93990004-B6E8-D71A-E040-BB89AD433C84

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=93990004-B6E8-D71A-E040-BB89AD433C84

Mots-clés

  1. 26/08/2012 26/08/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
Téléchargé le

9 janvier 2015

DOI

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Licence

Creative Commons BY-NC 3.0 Legacy

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    Bladder Cancer NCT01224665 Pre-Study - S1011 Prestudy Form (#8218) - 3152929v1.0

    Instructions: Submit this form within 7 days of registration. All dates are MONTH, DAY, YEAR. Explain any blank fields or blank dates in the Comments section. Place an X in appropriate boxes. Circle AMENDED items in red and write AMENDED across top of form. ELIGIBILITY VERIFICATION: Each of the fields below corresponds to a criterion in Section 5 and must be completed for patient to be eligible

    Header
    Description

    Header

    SWOG Patient ID
    Description

    Trial subject ID SWOG

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C1519429
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25699
    SWOG Study No.
    Description

    Protocol ID SWOG

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1519429
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25699
    Registration Step
    Description

    Registration Number

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1514821
    NCI Thesaurus ObjectClass
    C25646
    UMLS CUI-2
    C0237753
    NCI Thesaurus Property
    C16154
    NCI Thesaurus ValueDomain-2
    C16154
    Patient Initials (L, F M)
    Description

    Patient Initials

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    Institution/Affiliate
    Description

    Institution Name

    Type de données

    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
    Physician
    Description

    Investigator Name

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2826892
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ObjectClass
    C17089
    NCI Thesaurus ObjectClass-2
    C25644
    Participating Group Name
    Description

    Participating Group

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2347449
    NCI Thesaurus ObjectClass
    C25608
    NCI Thesaurus ObjectClass-2
    C17005
    NCI Thesaurus Property
    C25364
    Participating Group Study No.
    Description

    Study Number Participating Group

    Type de données

    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
    Participating Group Patient ID
    Description

    Trial subject ID Participating Group

    Type de données

    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
    Patient And Disease Description
    Description

    Patient And Disease Description

    Zubrod Performance Status Score (see section 10.5 of the protocol)
    Description

    ZubrodPerformanceStatusScore

    Type de données

    text

    Alias
    NCI Thesaurus Property
    C25367
    NCI Thesaurus ObjectClass
    C20641
    UMLS 2011AA ObjectClass
    C1518965
    NCI Thesaurus ValueDomain
    C25338
    UMLS 2011AA ValueDomain
    C0449820
    Height (cm)
    Description

    Patient Height

    Type de données

    float

    Unités de mesure
    • cm
    Alias
    NCI Thesaurus ValueDomain
    C25209
    UMLS CUI-1
    C0489786
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25347
    cm
    Weight (kg)
    Description

    Patient Weight

    Type de données

    float

    Unités de mesure
    • Kg
    Alias
    NCI Thesaurus ValueDomain
    C25209
    UMLS CUI-1
    C0005910
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25208
    Kg
    Date of Chest X-ray (MM DD YYYY Please enter date of chest x-ray to rule out visceral or nodal metastatic disease)
    Description

    ChestX-RayAssessmentDate

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus ObjectClass
    C25389
    UMLS 2011AA ObjectClass
    C0817096
    NCI Thesaurus ObjectClass-2
    C17261
    Date of CT or MRI (MM DD YYYY Please enter date of CT or MRI to rule out visceral or nodal metastatic disease)
    Description

    AbdominalPelvisScanPerformedDate

    Type de données

    date

    Alias
    NCI Thesaurus ObjectClass
    C12767
    UMLS 2011AA ObjectClass
    C0030797
    NCI Metathesaurus ObjectClass
    C0000726
    NCI Thesaurus ObjectClass-2
    C17999
    UMLS 2011AA ObjectClass-2
    C0441633
    NCI Thesaurus Property
    C38000
    UMLS 2011AA Property
    C0884358
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    Date Current Staging Assessment Completed (MM DD YYYY Please enter date of most recent TURBT, bimanual exam or cross sectional imaging for clinical staging of disease. For patients who have received neoadjuvant chemotherapy, please list the most recent prior to the initiation of therapy)
    Description

    CurrentStageCompleteAssessmentDate

    Type de données

    date

    Alias
    NCI Thesaurus ObjectClass
    C25471
    UMLS 2011AA ObjectClass
    C0521116
    NCI Thesaurus ObjectClass-2
    C16899
    UMLS 2011AA ObjectClass-2
    C1300072
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C25250
    UMLS 2011AA Property-2
    C0205197
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    Disease Description
    Description

    Disease Description

    Clinical T Stage
    Description

    BladderCarcinomaClinicalTStage

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C3262
    UMLS 2011AA ObjectClass
    C0027651
    NCI Thesaurus ObjectClass-2
    C12414
    UMLS 2011AA ObjectClass-2
    C0005682
    NCI Thesaurus Property
    C25398
    UMLS 2011AA Property
    C0205210
    NCI Thesaurus Property-2
    C25728
    UMLS 2011AA Property-2
    C0475455
    NCI Thesaurus ValueDomain
    C25398
    UMLS 2011AA ValueDomain
    C0205210
    NCI Thesaurus ValueDomain-2
    C4912
    UMLS 2011AA ValueDomain-2
    C0699885
    NCI Thesaurus ValueDomain-3
    C16899
    UMLS 2011AA ValueDomain-3
    C1300072
    NCI Thesaurus ValueDomain-4
    C25728
    UMLS 2011AA ValueDomain-4
    C0475455
    Bimanual Exam Result
    Description

    BimanualExamResultType

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus Property
    C20200
    UMLS 2011AA Property
    C1274040
    NCI Thesaurus ObjectClass
    C25305
    UMLS 2011AA ObjectClass
    C0582103
    NCI Thesaurus ObjectClass-2
    C25433
    UMLS 2011AA ObjectClass-2
    C1511117
    Histologic Type (Please select all that apply based on TURBT or biopsy; pure squamous cell carcinoma or pure adenocarcinoma not eligible)
    Description

    BladderTumorHistologicCategory

    Type de données

    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
    Description

    Histologic Type, other

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS CUI-1
    C1299220
    NCI Thesaurus ObjectClass
    C3262
    NCI Thesaurus Property
    C25526
    NCI Thesaurus Property-2
    C25161
    Type of Variant Histology (if selected please specify)
    Description

    TumorHistologicVariationCategory

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25372
    UMLS 2011AA ValueDomain
    C0683312
    NCI Thesaurus ObjectClass
    C3262
    UMLS 2011AA ObjectClass
    C0027651
    NCI Thesaurus Property
    C25526
    UMLS 2011AA Property
    C0205462
    NCI Thesaurus Property-2
    C25713
    UMLS 2011AA Property-2
    C0205419
    Date of Planned Surgery (MM DD YYYY)
    Description

    PlannedSurgeryDate

    Type de données

    date

    Alias
    NCI Thesaurus Property
    C25164
    UMLS 2011AA Property
    C0011008
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C15329
    UMLS 2011AA ObjectClass
    C0543467
    NCI Thesaurus ObjectClass-2
    C25619
    UMLS 2011AA ObjectClass-2
    C1301732
    Laboratory Values
    Description

    Laboratory Values

    Peripheral Platelet Count (mcl)
    Description

    Platelets

    Type de données

    float

    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS CUI-1
    C0005821
    NCI Thesaurus Property
    C20200
    NCI Thesaurus Property-2
    C12520
    NCI Thesaurus ValueDomain
    C38046
    NCI Thesaurus ValueDomain-2
    C25712
    WBC (x 10^3/ mcL)
    Description

    Leukocytes (WBC)

    Type de données

    float

    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS CUI-1
    C0023508
    NCI Thesaurus Property
    C12529
    NCI Thesaurus Property-2
    C20200
    NCI Thesaurus ValueDomain
    C38046
    NCI Thesaurus ValueDomain-2
    C25712
    Hemoglobin (g/dL)
    Description

    Hemoglobin

    Type de données

    float

    Alias
    NCI Thesaurus Property
    C16676
    UMLS CUI-1
    C0019046
    NCI Thesaurus Property-2
    C20200
    NCI Thesaurus ObjectClass
    C25294
    NCI Thesaurus ValueDomain
    C25712
    Hematocrit (%)
    Description

    LaboratoryProcedureHematocritOutcomePercentageValue

    Type de données

    float

    Unités de mesure
    • %
    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    NCI Thesaurus Property
    C20200
    UMLS 2011AA Property
    C1274040
    NCI Thesaurus Property-2
    C64796
    UMLS 2011AA Property-2
    C0018935
    NCI Thesaurus ValueDomain
    C25613
    UMLS 2011AA ValueDomain
    C0439165
    NCI Thesaurus ValueDomain-2
    C25712
    UMLS 2011AA ValueDomain-2
    C1522609
    %
    Total Bilirubin (mg/dL)
    Description

    Bilirubin, Total

    Type de données

    float

    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS CUI-1
    C0201913
    NCI Thesaurus Property
    C20200
    NCI Thesaurus Property-2
    C38037
    NCI Thesaurus ValueDomain
    C38046
    NCI Thesaurus ValueDomain-2
    C25712
    Total Bilirubin ULN (mg/dL)
    Description

    Bilirubin, Total ULN

    Type de données

    float

    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS CUI-1
    C0201913
    NCI Thesaurus Property
    C20200
    UMLS CUI-2
    C1519815
    NCI Thesaurus Property-2
    C38037
    NCI Thesaurus ValueDomain
    C25712
    NCI Thesaurus ValueDomain-2
    C25706
    SGPT (ALT) (U/L)
    Description

    SGPT (ALT)

    Type de données

    float

    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS CUI-1
    C0201836
    NCI Thesaurus Property
    C20200
    NCI Thesaurus Property-2
    C25293
    NCI Thesaurus ValueDomain
    C38046
    NCI Thesaurus ValueDomain-2
    C25712
    SGPT (ALT) ULN (U/L)
    Description

    LaboratoryProcedureSerumGlutamicPyruvicTransaminaseResultUpperLimitofNormalValue

    Type de données

    float

    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    NCI Thesaurus Property
    C20200
    UMLS 2011AA Property
    C1274040
    NCI Thesaurus Property-2
    C25293
    UMLS 2011AA Property-2
    C0376147
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    NCI Thesaurus ValueDomain-2
    C25706
    UMLS 2011AA ValueDomain-2
    C1519815
    Collection Date (MM DD YYYY)
    Description

    SpecimenCollectedDate

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C19157
    UMLS 2011AA ObjectClass
    C0370003
    NCI Thesaurus Property
    C25452
    NCI Thesaurus Property-2
    C25275
    UMLS 2011AA Property
    C2745955
    Collection Date (MM DD YYYY)
    Description

    SpecimenCollectedDate

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C19157
    UMLS 2011AA ObjectClass
    C0370003
    NCI Thesaurus Property
    C25452
    NCI Thesaurus Property-2
    C25275
    UMLS 2011AA Property
    C2745955
    Collection Date (MM DD YYYY)
    Description

    SpecimenCollectedDate

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C19157
    UMLS 2011AA ObjectClass
    C0370003
    NCI Thesaurus Property
    C25452
    NCI Thesaurus Property-2
    C25275
    UMLS 2011AA Property
    C2745955
    Collection Date (MM DD YYYY)
    Description

    SpecimenCollectedDate

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C19157
    UMLS 2011AA ObjectClass
    C0370003
    NCI Thesaurus Property
    C25452
    NCI Thesaurus Property-2
    C25275
    UMLS 2011AA Property
    C2745955
    Collection Date (MM DD YYYY)
    Description

    SpecimenCollectedDate

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C19157
    UMLS 2011AA ObjectClass
    C0370003
    NCI Thesaurus Property
    C25452
    NCI Thesaurus Property-2
    C25275
    UMLS 2011AA Property
    C2745955
    Collection Date (MM DD YYYY)
    Description

    SpecimenCollectedDate

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C19157
    UMLS 2011AA ObjectClass
    C0370003
    NCI Thesaurus Property
    C25452
    NCI Thesaurus Property-2
    C25275
    UMLS 2011AA Property
    C2745955
    Collection Date (MM DD YYYY)
    Description

    SpecimenCollectedDate

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C19157
    UMLS 2011AA ObjectClass
    C0370003
    NCI Thesaurus Property
    C25452
    NCI Thesaurus Property-2
    C25275
    UMLS 2011AA Property
    C2745955
    Collection Date (MM DD YYYY)
    Description

    SpecimenCollectedDate

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C19157
    UMLS 2011AA ObjectClass
    C0370003
    NCI Thesaurus Property
    C25452
    NCI Thesaurus Property-2
    C25275
    UMLS 2011AA Property
    C2745955
    SGOT (AST) (U/L)
    Description

    SGOT (AST)

    Type de données

    float

    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS CUI-1
    C0201899
    NCI Thesaurus Property
    C25202
    NCI Thesaurus Property-2
    C20200
    NCI Thesaurus ValueDomain
    C38046
    NCI Thesaurus ValueDomain-2
    C25712
    SGOT (AST) ULN (U/L)
    Description

    LaboratoryProcedureSerumGlutamicOxaloaceticTransferaseResultUnspecifiedUpperLimitofNormalValue

    Type de données

    float

    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    NCI Thesaurus Property
    C25202
    UMLS 2011AA Property
    C0242192
    NCI Thesaurus Property-2
    C20200
    UMLS 2011AA Property-2
    C1274040
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    NCI Thesaurus ValueDomain-2
    C25706
    UMLS 2011AA ValueDomain-2
    C1519815
    Alkaline Phosphatase (U/L)
    Description

    Alkaline Phosphatase

    Type de données

    float

    Alias
    NCI Thesaurus Property
    C20200
    UMLS CUI-1
    C0201850
    NCI Thesaurus ObjectClass
    C25294
    NCI Thesaurus ValueDomain
    C25712
    NCI Thesaurus Property-2
    C16276
    Alkaline Phosphatase ULN (U/L)
    Description

    Alkaline Phosphatase ULN

    Type de données

    float

    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS CUI-1
    C0151420
    NCI Thesaurus Property
    C20200
    NCI Thesaurus Property-2
    C16276
    NCI Thesaurus ValueDomain
    C25712
    NCI Thesaurus ValueDomain-2
    C25706
    Laboratory Values1
    Description

    Laboratory Values1

    Serum Creatinine (mg/dL)
    Description

    Creatinine, Serum

    Type de données

    float

    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS CUI-1
    C0201976
    NCI Thesaurus Property
    C20200
    NCI Thesaurus Property-2
    C399
    NCI Thesaurus ValueDomain
    C38046
    NCI Thesaurus ValueDomain-2
    C25712
    Serum Creatinine ULN (mg/dL)
    Description

    Creatinine, serum ULN

    Type de données

    float

    Unités de mesure
    • mg/dL
    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS CUI-1
    C0201976
    NCI Thesaurus Property
    C20200
    UMLS CUI-2
    C1519815
    NCI Thesaurus Property-2
    C399
    NCI Thesaurus ValueDomain
    C25712
    NCI Thesaurus ValueDomain-2
    C25706
    mg/dL
    Collection Date (MM DD YYYY)
    Description

    SpecimenCollectedDate

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C19157
    UMLS 2011AA ObjectClass
    C0370003
    NCI Thesaurus Property
    C25452
    NCI Thesaurus Property-2
    C25275
    UMLS 2011AA Property
    C2745955
    Prior Treatment Related To This Cancer
    Description

    Prior Treatment Related To This Cancer

    Prior Neoadjuvant Chemotherapy
    Description

    NeoadjuvantTherapyPriorChemotherapyAdministeredInd-3

    Type de données

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C15665
    UMLS 2011AA ObjectClass
    C0600558
    NCI Thesaurus Property
    C15632
    UMLS 2011AA Property
    C0392920
    NCI Thesaurus Property-2
    C25629
    UMLS 2011AA Property-2
    C0332152
    NCI Thesaurus Property-3
    C25382
    UMLS 2011AA Property-3
    C1521801
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    Specify reason treatment not initiated
    Description

    Reason treatment never started, specify

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25594
    UMLS CUI-1
    C3539764
    NCI Thesaurus Property-2
    C25431
    UMLS CUI-2
    C1521902
    NCI Thesaurus Property-3
    C25365
    NCI Thesaurus ValueDomain
    C25685
    Neoadjuvant Treatment Related To This Bladder Cancer
    Description

    Neoadjuvant Treatment Related To This Bladder Cancer

    Chemotherapy Regimen (select all that apply)
    Description

    ChemotherapyRegimenType

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C15632
    UMLS 2011AA ObjectClass
    C0392920
    NCI Thesaurus Property
    C15697
    UMLS 2011AA Property
    C0040808
    Specify agent (other)
    Description

    PriorChemotherapyRegimenText

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS 2011AA ValueDomain
    C1527021
    NCI Thesaurus ObjectClass
    C15632
    UMLS 2011AA ObjectClass
    C0392920
    NCI Thesaurus ObjectClass-2
    C25629
    UMLS 2011AA ObjectClass-2
    C0332152
    NCI Thesaurus Property
    C15697
    UMLS 2011AA Property
    C0040808
    Number of Cycles
    Description

    AgentCourseCount

    Type de données

    float

    Alias
    NCI Thesaurus ValueDomain
    C25463
    UMLS 2011AA ValueDomain
    C0750480
    NCI Thesaurus Property
    C25379
    UMLS 2011AA Property
    C0750729
    NCI Thesaurus ObjectClass
    C1708
    UMLS 2011AA ObjectClass
    C0450442
    Treatment Start Date (MM DD YYYY)
    Description

    Treatment Start Date

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C3173309
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25431
    NCI Thesaurus Property-2
    C25275
    Date of Last Treatment (MM DD YYYY)
    Description

    LastTreatmentDate

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus ObjectClass-2
    C25551
    UMLS 2011AA ObjectClass
    C1517741
    NCI Thesaurus Property
    C25275
    UMLS 2011AA Property
    C2745955
    Comments
    Description

    Comments

    Comments
    Description

    Research Comments

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS CUI-1
    C0947611
    NCI Thesaurus ObjectClass
    C15319
    NCI Thesaurus Property
    C25393

    Similar models

    Instructions: Submit this form within 7 days of registration. All dates are MONTH, DAY, YEAR. Explain any blank fields or blank dates in the Comments section. Place an X in appropriate boxes. Circle AMENDED items in red and write AMENDED across top of form. ELIGIBILITY VERIFICATION: Each of the fields below corresponds to a criterion in Section 5 and must be completed for patient to be eligible

    Name
    Type
    Description | Question | Decode (Coded Value)
    Type de données
    Alias
    Item Group
    Header
    Trial subject ID SWOG
    Item
    SWOG Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1519429 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25699 (NCI Thesaurus Property-2)
    Protocol ID SWOG
    Item
    SWOG Study No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1519429 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25699 (NCI Thesaurus Property-2)
    Registration Number
    Item
    Registration Step
    text
    C25337 (NCI Thesaurus ValueDomain)
    C1514821 (UMLS CUI-1)
    C25646 (NCI Thesaurus ObjectClass)
    C0237753 (UMLS CUI-2)
    C16154 (NCI Thesaurus Property)
    C16154 (NCI Thesaurus ValueDomain-2)
    Patient Initials
    Item
    Patient Initials (L, F M)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    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)
    Investigator Name
    Item
    Physician
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2826892 (UMLS CUI-1)
    C25364 (NCI Thesaurus Property)
    C17089 (NCI Thesaurus ObjectClass)
    C25644 (NCI Thesaurus ObjectClass-2)
    Participating Group
    Item
    Participating Group Name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2347449 (UMLS CUI-1)
    C25608 (NCI Thesaurus ObjectClass)
    C17005 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    Study Number Participating Group
    Item
    Participating Group Study No.
    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)
    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)
    Item Group
    Patient And Disease Description
    Item
    Zubrod Performance Status Score (see section 10.5 of the protocol)
    text
    C25367 (NCI Thesaurus Property)
    C20641 (NCI Thesaurus ObjectClass)
    C1518965 (UMLS 2011AA ObjectClass)
    C25338 (NCI Thesaurus ValueDomain)
    C0449820 (UMLS 2011AA ValueDomain)
    Code List
    Zubrod Performance Status Score (see section 10.5 of the protocol)
    CL Item
    Normal Activity (0)
    CL Item
    Symptoms, But Nearly Fully Ambulatory (1)
    CL Item
    Some Bed Time, But Needs To Be In Bed <50% Of Normal Daytime (2)
    CL Item
    Needs To Be In Bed > 50% Of Normal Daytime (3)
    CL Item
    Unable To Get Out Of Bed (4)
    Patient Height
    Item
    Height (cm)
    float
    C25209 (NCI Thesaurus ValueDomain)
    C0489786 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25347 (NCI Thesaurus Property)
    Patient Weight
    Item
    Weight (kg)
    float
    C25209 (NCI Thesaurus ValueDomain)
    C0005910 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25208 (NCI Thesaurus Property)
    ChestX-RayAssessmentDate
    Item
    Date of Chest X-ray (MM DD YYYY Please enter date of chest x-ray to rule out visceral or nodal metastatic disease)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C25389 (NCI Thesaurus ObjectClass)
    C0817096 (UMLS 2011AA ObjectClass)
    C17261 (NCI Thesaurus ObjectClass-2)
    AbdominalPelvisScanPerformedDate
    Item
    Date of CT or MRI (MM DD YYYY Please enter date of CT or MRI to rule out visceral or nodal metastatic disease)
    date
    C12767 (NCI Thesaurus ObjectClass)
    C0030797 (UMLS 2011AA ObjectClass)
    C0000726 (NCI Metathesaurus ObjectClass)
    C17999 (NCI Thesaurus ObjectClass-2)
    C0441633 (UMLS 2011AA ObjectClass-2)
    C38000 (NCI Thesaurus Property)
    C0884358 (UMLS 2011AA Property)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    CurrentStageCompleteAssessmentDate
    Item
    Date Current Staging Assessment Completed (MM DD YYYY Please enter date of most recent TURBT, bimanual exam or cross sectional imaging for clinical staging of disease. For patients who have received neoadjuvant chemotherapy, please list the most recent prior to the initiation of therapy)
    date
    C25471 (NCI Thesaurus ObjectClass)
    C0521116 (UMLS 2011AA ObjectClass)
    C16899 (NCI Thesaurus ObjectClass-2)
    C1300072 (UMLS 2011AA ObjectClass-2)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C25250 (NCI Thesaurus Property-2)
    C0205197 (UMLS 2011AA Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    Item Group
    Disease Description
    Item
    Clinical T Stage
    text
    C3262 (NCI Thesaurus ObjectClass)
    C0027651 (UMLS 2011AA ObjectClass)
    C12414 (NCI Thesaurus ObjectClass-2)
    C0005682 (UMLS 2011AA ObjectClass-2)
    C25398 (NCI Thesaurus Property)
    C0205210 (UMLS 2011AA Property)
    C25728 (NCI Thesaurus Property-2)
    C0475455 (UMLS 2011AA Property-2)
    C25398 (NCI Thesaurus ValueDomain)
    C0205210 (UMLS 2011AA ValueDomain)
    C4912 (NCI Thesaurus ValueDomain-2)
    C0699885 (UMLS 2011AA ValueDomain-2)
    C16899 (NCI Thesaurus ValueDomain-3)
    C1300072 (UMLS 2011AA ValueDomain-3)
    C25728 (NCI Thesaurus ValueDomain-4)
    C0475455 (UMLS 2011AA ValueDomain-4)
    Code List
    Clinical T Stage
    CL Item
    Tumor Invades Muscularis Propria (cT2)
    CL Item
    Tumor Invades Perivesical Tissue (cT3)
    CL Item
    Tumor Invades Prostatic Stroma, Uterus, Vagina (cT4a)
    Item
    Bimanual Exam Result
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C20200 (NCI Thesaurus Property)
    C1274040 (UMLS 2011AA Property)
    C25305 (NCI Thesaurus ObjectClass)
    C0582103 (UMLS 2011AA ObjectClass)
    C25433 (NCI Thesaurus ObjectClass-2)
    C1511117 (UMLS 2011AA ObjectClass-2)
    Code List
    Bimanual Exam Result
    CL Item
    Normal (Normal)
    C14165 (NCI Thesaurus)
    C0205307 (UMLS 2011AA)
    CL Item
    Induration Only (Induration only)
    CL Item
    3 Dimensional Mass (3 dimensional mass)
    CL Item
    Fixed (Fixed)
    Item
    Histologic Type (Please select all that apply based on TURBT or biopsy; pure squamous cell carcinoma or pure adenocarcinoma not eligible)
    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)
    Code List
    Histologic Type (Please select all that apply based on TURBT or biopsy; pure squamous cell carcinoma or pure adenocarcinoma not eligible)
    CL Item
    Urothelial Carcinoma (Urothelial cell carcinoma)
    C4030 (NCI Thesaurus)
    C0007138 (UMLS 2011AA)
    CL Item
    Squamous Cell Carcinoma (Squamous cell carcinoma)
    C2929 (NCI Thesaurus)
    C0007137 (UMLS 2011AA)
    CL Item
    Adenocarcinoma (Adenocarcinoma)
    C2852 (NCI Thesaurus)
    C0001418 (UMLS 2011AA)
    CL Item
    Micropapillary Transitional Cell Carcinoma (Micropapillary carcinoma)
    C65182 (NCI Thesaurus)
    C1266012 (UMLS 2011AA)
    CL Item
    Other Specify (Other, specify)
    Histologic Type, other
    Item
    Other specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1299220 (UMLS CUI-1)
    C3262 (NCI Thesaurus ObjectClass)
    C25526 (NCI Thesaurus Property)
    C25161 (NCI Thesaurus Property-2)
    Item
    Type of Variant Histology (if selected please specify)
    text
    C25372 (NCI Thesaurus ValueDomain)
    C0683312 (UMLS 2011AA ValueDomain)
    C3262 (NCI Thesaurus ObjectClass)
    C0027651 (UMLS 2011AA ObjectClass)
    C25526 (NCI Thesaurus Property)
    C0205462 (UMLS 2011AA Property)
    C25713 (NCI Thesaurus Property-2)
    C0205419 (UMLS 2011AA Property-2)
    Code List
    Type of Variant Histology (if selected please specify)
    CL Item
    Urothelial Carcinoma (< 50% Urothelial cell carcinoma)
    C4030 (NCI Thesaurus)
    C0007138 (UMLS 2011AA)
    C4030 (NCI Thesaurus-3)
    C0007138 (UMLS 2011AA-4)
    CL Item
    Urothelial Carcinoma (>= 50% Urothelial cell carcinoma)
    C4030 (NCI Thesaurus)
    C0007138 (UMLS 2011AA)
    C4030 (NCI Thesaurus-3)
    C0007138 (UMLS 2011AA-4)
    CL Item
    Squamous Cell Carcinoma (< 50% Squamous cell carcinoma)
    C2929 (NCI Thesaurus)
    C0007137 (UMLS 2011AA)
    C2929 (NCI Thesaurus-3)
    C0007137 (UMLS 2011AA-4)
    CL Item
    Squamous Cell Carcinoma (>= 50% Squamous cell carcinoma)
    C2929 (NCI Thesaurus)
    C0007137 (UMLS 2011AA)
    C2929 (NCI Thesaurus-3)
    C0007137 (UMLS 2011AA-4)
    CL Item
    Adenocarcinoma (< 50% Adenocarcinoma)
    C2852 (NCI Thesaurus)
    C0001418 (UMLS 2011AA)
    C2852 (NCI Thesaurus-3)
    C0001418 (UMLS 2011AA-4)
    CL Item
    Adenocarcinoma (>= 50% Adenocarcinoma)
    C2852 (NCI Thesaurus)
    C0001418 (UMLS 2011AA)
    C2852 (NCI Thesaurus-3)
    C0001418 (UMLS 2011AA-4)
    CL Item
    Micropapillary Transitional Cell Carcinoma (< 50% Micropapillary carcinoma)
    C65182 (NCI Thesaurus)
    C1266012 (UMLS 2011AA)
    C65182 (NCI Thesaurus-3)
    C1266012 (UMLS 2011AA-4)
    CL Item
    Micropapillary Transitional Cell Carcinoma (>= 50% Micropapillary carcinoma)
    C65182 (NCI Thesaurus)
    C1266012 (UMLS 2011AA)
    C65182 (NCI Thesaurus-3)
    C1266012 (UMLS 2011AA-4)
    PlannedSurgeryDate
    Item
    Date of Planned Surgery (MM DD YYYY)
    date
    C25164 (NCI Thesaurus Property)
    C0011008 (UMLS 2011AA Property)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C15329 (NCI Thesaurus ObjectClass)
    C0543467 (UMLS 2011AA ObjectClass)
    C25619 (NCI Thesaurus ObjectClass-2)
    C1301732 (UMLS 2011AA ObjectClass-2)
    Item Group
    Laboratory Values
    Platelets
    Item
    Peripheral Platelet Count (mcl)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0005821 (UMLS CUI-1)
    C20200 (NCI Thesaurus Property)
    C12520 (NCI Thesaurus Property-2)
    C38046 (NCI Thesaurus ValueDomain)
    C25712 (NCI Thesaurus ValueDomain-2)
    Leukocytes (WBC)
    Item
    WBC (x 10^3/ mcL)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0023508 (UMLS CUI-1)
    C12529 (NCI Thesaurus Property)
    C20200 (NCI Thesaurus Property-2)
    C38046 (NCI Thesaurus ValueDomain)
    C25712 (NCI Thesaurus ValueDomain-2)
    Hemoglobin
    Item
    Hemoglobin (g/dL)
    float
    C16676 (NCI Thesaurus Property)
    C0019046 (UMLS CUI-1)
    C20200 (NCI Thesaurus Property-2)
    C25294 (NCI Thesaurus ObjectClass)
    C25712 (NCI Thesaurus ValueDomain)
    LaboratoryProcedureHematocritOutcomePercentageValue
    Item
    Hematocrit (%)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    C20200 (NCI Thesaurus Property)
    C1274040 (UMLS 2011AA Property)
    C64796 (NCI Thesaurus Property-2)
    C0018935 (UMLS 2011AA Property-2)
    C25613 (NCI Thesaurus ValueDomain)
    C0439165 (UMLS 2011AA ValueDomain)
    C25712 (NCI Thesaurus ValueDomain-2)
    C1522609 (UMLS 2011AA ValueDomain-2)
    Bilirubin, Total
    Item
    Total Bilirubin (mg/dL)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0201913 (UMLS CUI-1)
    C20200 (NCI Thesaurus Property)
    C38037 (NCI Thesaurus Property-2)
    C38046 (NCI Thesaurus ValueDomain)
    C25712 (NCI Thesaurus ValueDomain-2)
    Bilirubin, Total ULN
    Item
    Total Bilirubin ULN (mg/dL)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0201913 (UMLS CUI-1)
    C20200 (NCI Thesaurus Property)
    C1519815 (UMLS CUI-2)
    C38037 (NCI Thesaurus Property-2)
    C25712 (NCI Thesaurus ValueDomain)
    C25706 (NCI Thesaurus ValueDomain-2)
    SGPT (ALT)
    Item
    SGPT (ALT) (U/L)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0201836 (UMLS CUI-1)
    C20200 (NCI Thesaurus Property)
    C25293 (NCI Thesaurus Property-2)
    C38046 (NCI Thesaurus ValueDomain)
    C25712 (NCI Thesaurus ValueDomain-2)
    LaboratoryProcedureSerumGlutamicPyruvicTransaminaseResultUpperLimitofNormalValue
    Item
    SGPT (ALT) ULN (U/L)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    C20200 (NCI Thesaurus Property)
    C1274040 (UMLS 2011AA Property)
    C25293 (NCI Thesaurus Property-2)
    C0376147 (UMLS 2011AA Property-2)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    C25706 (NCI Thesaurus ValueDomain-2)
    C1519815 (UMLS 2011AA ValueDomain-2)
    SpecimenCollectedDate
    Item
    Collection Date (MM DD YYYY)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C19157 (NCI Thesaurus ObjectClass)
    C0370003 (UMLS 2011AA ObjectClass)
    C25452 (NCI Thesaurus Property)
    C25275 (NCI Thesaurus Property-2)
    C2745955 (UMLS 2011AA Property)
    SpecimenCollectedDate
    Item
    Collection Date (MM DD YYYY)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C19157 (NCI Thesaurus ObjectClass)
    C0370003 (UMLS 2011AA ObjectClass)
    C25452 (NCI Thesaurus Property)
    C25275 (NCI Thesaurus Property-2)
    C2745955 (UMLS 2011AA Property)
    SpecimenCollectedDate
    Item
    Collection Date (MM DD YYYY)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C19157 (NCI Thesaurus ObjectClass)
    C0370003 (UMLS 2011AA ObjectClass)
    C25452 (NCI Thesaurus Property)
    C25275 (NCI Thesaurus Property-2)
    C2745955 (UMLS 2011AA Property)
    SpecimenCollectedDate
    Item
    Collection Date (MM DD YYYY)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C19157 (NCI Thesaurus ObjectClass)
    C0370003 (UMLS 2011AA ObjectClass)
    C25452 (NCI Thesaurus Property)
    C25275 (NCI Thesaurus Property-2)
    C2745955 (UMLS 2011AA Property)
    SpecimenCollectedDate
    Item
    Collection Date (MM DD YYYY)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C19157 (NCI Thesaurus ObjectClass)
    C0370003 (UMLS 2011AA ObjectClass)
    C25452 (NCI Thesaurus Property)
    C25275 (NCI Thesaurus Property-2)
    C2745955 (UMLS 2011AA Property)
    SpecimenCollectedDate
    Item
    Collection Date (MM DD YYYY)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C19157 (NCI Thesaurus ObjectClass)
    C0370003 (UMLS 2011AA ObjectClass)
    C25452 (NCI Thesaurus Property)
    C25275 (NCI Thesaurus Property-2)
    C2745955 (UMLS 2011AA Property)
    SpecimenCollectedDate
    Item
    Collection Date (MM DD YYYY)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C19157 (NCI Thesaurus ObjectClass)
    C0370003 (UMLS 2011AA ObjectClass)
    C25452 (NCI Thesaurus Property)
    C25275 (NCI Thesaurus Property-2)
    C2745955 (UMLS 2011AA Property)
    SpecimenCollectedDate
    Item
    Collection Date (MM DD YYYY)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C19157 (NCI Thesaurus ObjectClass)
    C0370003 (UMLS 2011AA ObjectClass)
    C25452 (NCI Thesaurus Property)
    C25275 (NCI Thesaurus Property-2)
    C2745955 (UMLS 2011AA Property)
    SGOT (AST)
    Item
    SGOT (AST) (U/L)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0201899 (UMLS CUI-1)
    C25202 (NCI Thesaurus Property)
    C20200 (NCI Thesaurus Property-2)
    C38046 (NCI Thesaurus ValueDomain)
    C25712 (NCI Thesaurus ValueDomain-2)
    LaboratoryProcedureSerumGlutamicOxaloaceticTransferaseResultUnspecifiedUpperLimitofNormalValue
    Item
    SGOT (AST) ULN (U/L)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    C25202 (NCI Thesaurus Property)
    C0242192 (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)
    Alkaline Phosphatase
    Item
    Alkaline Phosphatase (U/L)
    float
    C20200 (NCI Thesaurus Property)
    C0201850 (UMLS CUI-1)
    C25294 (NCI Thesaurus ObjectClass)
    C25712 (NCI Thesaurus ValueDomain)
    C16276 (NCI Thesaurus Property-2)
    Alkaline Phosphatase ULN
    Item
    Alkaline Phosphatase ULN (U/L)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0151420 (UMLS CUI-1)
    C20200 (NCI Thesaurus Property)
    C16276 (NCI Thesaurus Property-2)
    C25712 (NCI Thesaurus ValueDomain)
    C25706 (NCI Thesaurus ValueDomain-2)
    Item Group
    Laboratory Values1
    Creatinine, Serum
    Item
    Serum Creatinine (mg/dL)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0201976 (UMLS CUI-1)
    C20200 (NCI Thesaurus Property)
    C399 (NCI Thesaurus Property-2)
    C38046 (NCI Thesaurus ValueDomain)
    C25712 (NCI Thesaurus ValueDomain-2)
    Creatinine, serum ULN
    Item
    Serum Creatinine ULN (mg/dL)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0201976 (UMLS CUI-1)
    C20200 (NCI Thesaurus Property)
    C1519815 (UMLS CUI-2)
    C399 (NCI Thesaurus Property-2)
    C25712 (NCI Thesaurus ValueDomain)
    C25706 (NCI Thesaurus ValueDomain-2)
    SpecimenCollectedDate
    Item
    Collection Date (MM DD YYYY)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C19157 (NCI Thesaurus ObjectClass)
    C0370003 (UMLS 2011AA ObjectClass)
    C25452 (NCI Thesaurus Property)
    C25275 (NCI Thesaurus Property-2)
    C2745955 (UMLS 2011AA Property)
    Item Group
    Prior Treatment Related To This Cancer
    NeoadjuvantTherapyPriorChemotherapyAdministeredInd-3
    Item
    Prior Neoadjuvant Chemotherapy
    boolean
    C15665 (NCI Thesaurus ObjectClass)
    C0600558 (UMLS 2011AA ObjectClass)
    C15632 (NCI Thesaurus Property)
    C0392920 (UMLS 2011AA Property)
    C25629 (NCI Thesaurus Property-2)
    C0332152 (UMLS 2011AA Property-2)
    C25382 (NCI Thesaurus Property-3)
    C1521801 (UMLS 2011AA Property-3)
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    Reason treatment never started, specify
    Item
    Specify reason treatment not initiated
    text
    C15368 (NCI Thesaurus ObjectClass)
    C25594 (NCI Thesaurus Property)
    C3539764 (UMLS CUI-1)
    C25431 (NCI Thesaurus Property-2)
    C1521902 (UMLS CUI-2)
    C25365 (NCI Thesaurus Property-3)
    C25685 (NCI Thesaurus ValueDomain)
    Item Group
    Neoadjuvant Treatment Related To This Bladder Cancer
    Item
    Chemotherapy Regimen (select all that apply)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C15632 (NCI Thesaurus ObjectClass)
    C0392920 (UMLS 2011AA ObjectClass)
    C15697 (NCI Thesaurus Property)
    C0040808 (UMLS 2011AA Property)
    Code List
    Chemotherapy Regimen (select all that apply)
    CL Item
    Doxorubicin Vinblastine Methotrexate Cisplatin (MVAC)
    C456 (NCI Thesaurus)
    C0013089 (UMLS 2011AA)
    C376 (NCI Thesaurus-3)
    C0008838 (UMLS 2011AA-4)
    C642 (NCI Thesaurus-5)
    C0025677 (UMLS 2011AA-6)
    C930 (NCI Thesaurus-7)
    C0042670 (UMLS 2011AA-8)
    CL Item
    Gemcitabine (Gemcitabine)
    C66876 (NCI Thesaurus)
    C0045093 (UMLS 2011AA)
    CL Item
    Cisplatin (Cisplatin)
    C376 (NCI Thesaurus)
    C0008838 (UMLS 2011AA)
    CL Item
    Carboplatin (Carboplatin)
    C1282 (NCI Thesaurus)
    C0079083 (UMLS 2011AA)
    CL Item
    Paclitaxel (Paclitaxel)
    C1411 (NCI Thesaurus)
    C0144576 (UMLS 2011AA)
    PriorChemotherapyRegimenText
    Item
    Specify agent (other)
    text
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    C15632 (NCI Thesaurus ObjectClass)
    C0392920 (UMLS 2011AA ObjectClass)
    C25629 (NCI Thesaurus ObjectClass-2)
    C0332152 (UMLS 2011AA ObjectClass-2)
    C15697 (NCI Thesaurus Property)
    C0040808 (UMLS 2011AA Property)
    AgentCourseCount
    Item
    Number of Cycles
    float
    C25463 (NCI Thesaurus ValueDomain)
    C0750480 (UMLS 2011AA ValueDomain)
    C25379 (NCI Thesaurus Property)
    C0750729 (UMLS 2011AA Property)
    C1708 (NCI Thesaurus ObjectClass)
    C0450442 (UMLS 2011AA ObjectClass)
    Treatment Start Date
    Item
    Treatment Start Date (MM DD YYYY)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C3173309 (UMLS CUI-1)
    C15368 (NCI Thesaurus ObjectClass)
    C25431 (NCI Thesaurus Property)
    C25275 (NCI Thesaurus Property-2)
    LastTreatmentDate
    Item
    Date of Last Treatment (MM DD YYYY)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C15368 (NCI Thesaurus ObjectClass)
    C25551 (NCI Thesaurus ObjectClass-2)
    C1517741 (UMLS 2011AA ObjectClass)
    C25275 (NCI Thesaurus Property)
    C2745955 (UMLS 2011AA Property)
    Item Group
    Comments
    Research Comments
    Item
    Comments
    text
    C25704 (NCI Thesaurus ValueDomain)
    C0947611 (UMLS CUI-1)
    C15319 (NCI Thesaurus ObjectClass)
    C25393 (NCI Thesaurus Property)

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