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8360

Description

Primary Gynecologic Cancer - On Study Form, GOG-0209, Form OSE Combination Chemotherapy in Treating Patients With Stage III, Stage IV, or Recurrent Endometrial Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0CC45F2A-6926-41E8-E044-0003BA3F9857

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0CC45F2A-6926-41E8-E044-0003BA3F9857

Mots-clés

Versions (2)
  1. 27/08/2012 27/08/2012 -
  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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    Endometrial Cancer NCT00063999 On-Study - Primary Gynecologic Cancer - On Study Form, GOG-0209, Form OSE - 2450967v1.0

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    No Instruction available.

    1 Formulaires  
    1. StudyEvent: Primary Gynecologic Cancer - On Study Form, GOG-0209, Form OSE
      1. No Instruction available.
    Header Module
    Description

    Header Module

    Date form originally completed (m d y)
    Description

    Form Completion Date

    Type de données

    date

    Alias
    NCI Thesaurus ObjectClass
    C19464
    UMLS CUI-1
    C1549507
    NCI Thesaurus Property
    C25250
    NCI Thesaurus Property-2
    C25604
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25367
    Date form amended (m d y)
    Description

    FormAmendedCompleteDate

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C19464
    UMLS 2011AA ObjectClass
    C0376315
    NCI Thesaurus Property
    C25250
    UMLS 2011AA Property
    C0205197
    NCI Thesaurus Property-2
    C25416
    UMLS 2011AA Property-2
    C1691222
    NCI Thesaurus ValueDomain-2
    C25367
    Person amending form, last name
    Description

    Person Amending Form

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C0680532
    NCI Thesaurus ObjectClass
    C25190
    UMLS CUI-2
    C1547383
    NCI Thesaurus Property
    C25364
    Patient Initials (First, Middle, Last)
    Description

    Patient Initials

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    Patient Study ID
    Description

    Patient Study ID

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25462
    NCI Thesaurus Property-2
    C25364
    Person Completing Form, Last Name
    Description

    Person Completing Form Last Name

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C25190
    UMLS CUI-1
    C1550483
    NCI Thesaurus ObjectClass-2
    C25657
    UMLS CUI-2
    C1301584
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25551
    NCI Thesaurus ValueDomain
    C25191
    Disease Description - Prior History
    Description

    Disease Description - Prior History

    Date of definitive histologic diagnosis of primary tumor (m d y Note: Word ?tumor? obstructed by graphic)
    Description

    PrimaryTumorDiagnosisDate

    Type de données

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C3262
    UMLS 2011AA ObjectClass
    C0027651
    NCI Thesaurus ObjectClass-2
    C25251
    UMLS 2011AA ObjectClass-2
    C0205225
    NCI Thesaurus Property
    C15220
    UMLS 2011AA Property
    C0011900
    Stage (at diagnosis FIGO)
    Description

    GynecologicTumorGroupingStage

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C3262
    UMLS 2011AA ObjectClass
    C0027651
    NCI Thesaurus ObjectClass-2
    C28016
    UMLS 2011AA ObjectClass-2
    C0205480
    NCI Thesaurus ValueDomain
    C16899
    UMLS 2011AA ValueDomain
    C1300072
    NCI Thesaurus Property
    C25523
    UMLS 2011AA Property
    C1522242
    Lymph Node Type
    Description

    GynecologicLymphNodeAnatomicSite

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C12745
    UMLS 2011AA ObjectClass
    C0024204
    NCI Thesaurus ObjectClass-2
    C28016
    UMLS 2011AA ObjectClass-2
    C0205480
    NCI Thesaurus Property
    C25341
    UMLS 2011AA Property
    C0450429
    NCI Thesaurus Property-2
    C25421
    UMLS 2011AA Property-2
    C0002808
    NCI Thesaurus ValueDomain
    C13717
    UMLS 2011AA ValueDomain
    C1515974
    Other specify
    Description

    LymphNodeAnatomicSiteSpecify

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus Property
    C25341
    UMLS 2011AA Property
    C0450429
    NCI Thesaurus ObjectClass
    C12745
    UMLS 2011AA ObjectClass
    C0024204
    NCI Thesaurus Property-2
    C25421
    UMLS 2011AA Property-2
    C0002808
    Lymph Node Involvement (*Indicate node involvement 0=not evaluated; 1=positive; 2=negative; 3=equivocal; 9=unknown)
    Description

    LymphNodeInvolvementType

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C12745
    UMLS 2011AA ObjectClass
    C0024204
    NCI Thesaurus Property
    C25547
    Number of Positive Lymph Nodes
    Description

    LymphNodePositiveCount

    Type de données

    float

    Alias
    NCI Thesaurus Property
    C25246
    UMLS 2011AA Property
    C1446409
    NCI Thesaurus ObjectClass
    C12745
    UMLS 2011AA ObjectClass
    C0024204
    NCI Thesaurus ValueDomain
    C25463
    UMLS 2011AA ValueDomain
    C0750480
    Depth of Tumor Penetration into Myometrial Tissue
    Description

    MyometrialInvasionDepth

    Type de données

    text

    Does the patient have vascular-lymphatic involvement at study entry?
    Description

    TumorVascularLymphaticInvolvementInd-3

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C3262
    UMLS 2011AA ObjectClass
    C0027651
    NCI Thesaurus Property
    C13311
    UMLS 2011AA Property
    C1801960
    NCI Thesaurus Property-2
    C25548
    UMLS 2011AA Property-2
    C1314939
    NCI Thesaurus Property-3
    C25267
    UMLS 2011AA Property-3
    C1522604
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    Size of Residual Disease (cm Note: maximum size after resection is complete: 0=microscopic)
    Description

    ResidualDisease

    Type de données

    float

    Alias
    NCI Thesaurus ValueDomain
    C25209
    UMLS 2011AA ValueDomain
    C0242485
    Prior Treatment For Gynecologic Cancer
    Description

    Prior Treatment For Gynecologic Cancer

    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
    Retour au début de la page

    Similar models

    No Instruction available.

    1 Formulaires
    1. StudyEvent: Primary Gynecologic Cancer - On Study Form, GOG-0209, Form OSE
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Type de données
    Alias
    Item Group
    Header Module
    Form Completion Date
    Item
    Date form originally completed (m d y)
    date
    C19464 (NCI Thesaurus ObjectClass)
    C1549507 (UMLS CUI-1)
    C25250 (NCI Thesaurus Property)
    C25604 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    FormAmendedCompleteDate
    Item
    Date form amended (m d y)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C19464 (NCI Thesaurus ObjectClass)
    C0376315 (UMLS 2011AA ObjectClass)
    C25250 (NCI Thesaurus Property)
    C0205197 (UMLS 2011AA Property)
    C25416 (NCI Thesaurus Property-2)
    C1691222 (UMLS 2011AA Property-2)
    C25367 (NCI Thesaurus ValueDomain-2)
    Person Amending Form
    Item
    Person amending form, last name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C0680532 (UMLS CUI-1)
    C25190 (NCI Thesaurus ObjectClass)
    C1547383 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    Patient Initials
    Item
    Patient Initials (First, Middle, Last)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    Patient Study ID
    Item
    Patient Study ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25462 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Person Completing Form Last Name
    Item
    Person Completing Form, Last Name
    text
    C25190 (NCI Thesaurus ObjectClass)
    C1550483 (UMLS CUI-1)
    C25657 (NCI Thesaurus ObjectClass-2)
    C1301584 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25551 (NCI Thesaurus Property-2)
    C25191 (NCI Thesaurus ValueDomain)
    Item Group
    Disease Description - Prior History
    PrimaryTumorDiagnosisDate
    Item
    Date of definitive histologic diagnosis of primary tumor (m d y Note: Word ?tumor? obstructed by graphic)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C3262 (NCI Thesaurus ObjectClass)
    C0027651 (UMLS 2011AA ObjectClass)
    C25251 (NCI Thesaurus ObjectClass-2)
    C0205225 (UMLS 2011AA ObjectClass-2)
    C15220 (NCI Thesaurus Property)
    C0011900 (UMLS 2011AA Property)
    Item
    Stage (at diagnosis FIGO)
    text
    C3262 (NCI Thesaurus ObjectClass)
    C0027651 (UMLS 2011AA ObjectClass)
    C28016 (NCI Thesaurus ObjectClass-2)
    C0205480 (UMLS 2011AA ObjectClass-2)
    C16899 (NCI Thesaurus ValueDomain)
    C1300072 (UMLS 2011AA ValueDomain)
    C25523 (NCI Thesaurus Property)
    C1522242 (UMLS 2011AA Property)
    CL.1
    Code List
    Stage (at diagnosis FIGO)
    CL Item
    Refer To Figo Staging For Specific Gynecologic Cancer (IA)
    CL Item
    Refer To Figo Staging For Specific Gynecologic Cancer (IB)
    CL Item
    Refer To Figo Staging For Specific Gynecologic Cancer (IC)
    CL Item
    Refer To Figo Staging For Specific Gynecologic Cancer (II)
    CL Item
    Refer To Figo Staging For Specific Gynecologic Cancer (IIA)
    CL Item
    Refer To Figo Staging For Specific Gynecologic Cancer (IIB)
    CL Item
    Refer To Figo Staging For Specific Gynecologic Cancer (III)
    CL Item
    Refer To Figo Staging For Specific Gynecologic Cancer (IIIA)
    CL Item
    Refer To Figo Staging For Specific Gynecologic Cancer (IIIB)
    CL Item
    Refer To Figo Staging For Specific Gynecologic Cancer (IIIC)
    CL Item
    Refer To Figo Staging For Specific Gynecologic Cancer (IV)
    CL Item
    Refer To Figo Staging For Specific Gynecologic Cancer (IVA)
    CL Item
    Refer To Figo Staging For Specific Gynecologic Cancer (IVB)
    Item
    Lymph Node Type
    text
    C12745 (NCI Thesaurus ObjectClass)
    C0024204 (UMLS 2011AA ObjectClass)
    C28016 (NCI Thesaurus ObjectClass-2)
    C0205480 (UMLS 2011AA ObjectClass-2)
    C25341 (NCI Thesaurus Property)
    C0450429 (UMLS 2011AA Property)
    C25421 (NCI Thesaurus Property-2)
    C0002808 (UMLS 2011AA Property-2)
    C13717 (NCI Thesaurus ValueDomain)
    C1515974 (UMLS 2011AA ValueDomain)
    CL.2
    Code List
    Lymph Node Type
    CL Item
    Pelvic (pelvic)
    C25399 (NCI Thesaurus)
    C0030797 (UMLS 2011AA)
    CL Item
    Para-aortic (para-aortic)
    CL Item
    Other Specify (other)
    LymphNodeAnatomicSiteSpecify
    Item
    Other specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C25341 (NCI Thesaurus Property)
    C0450429 (UMLS 2011AA Property)
    C12745 (NCI Thesaurus ObjectClass)
    C0024204 (UMLS 2011AA ObjectClass)
    C25421 (NCI Thesaurus Property-2)
    C0002808 (UMLS 2011AA Property-2)
    Item
    Lymph Node Involvement (*Indicate node involvement 0=not evaluated; 1=positive; 2=negative; 3=equivocal; 9=unknown)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C12745 (NCI Thesaurus ObjectClass)
    C0024204 (UMLS 2011AA ObjectClass)
    C25547 (NCI Thesaurus Property)
    CL.3
    Code List
    Lymph Node Involvement (*Indicate node involvement 0=not evaluated; 1=positive; 2=negative; 3=equivocal; 9=unknown)
    CL Item
    Not Evaluated (not evaluated)
    CL Item
    Equivocal (equivocal)
    C86071 (NCI Thesaurus)
    C0332241 (UMLS 2011AA)
    CL Item
    Negative (negative)
    C25247 (NCI Thesaurus)
    C0205160 (UMLS 2011AA)
    CL Item
    Positive (positive)
    C25246 (NCI Thesaurus)
    C1446409 (UMLS 2011AA)
    CL Item
    Unknown (unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    LymphNodePositiveCount
    Item
    Number of Positive Lymph Nodes
    float
    C25246 (NCI Thesaurus Property)
    C1446409 (UMLS 2011AA Property)
    C12745 (NCI Thesaurus ObjectClass)
    C0024204 (UMLS 2011AA ObjectClass)
    C25463 (NCI Thesaurus ValueDomain)
    C0750480 (UMLS 2011AA ValueDomain)
    Item
    Depth of Tumor Penetration into Myometrial Tissue
    text
    CL.4
    Code List
    Depth of Tumor Penetration into Myometrial Tissue
    CL Item
    None (None)
    C41132 (NCI Thesaurus)
    C0549184 (UMLS 2011AA)
    CL Item
    <50% Thickness (<50% thickness)
    CL Item
    > Or = 50% Thickness (> or = 50% thickness)
    Item
    Does the patient have vascular-lymphatic involvement at study entry?
    text
    C3262 (NCI Thesaurus ObjectClass)
    C0027651 (UMLS 2011AA ObjectClass)
    C13311 (NCI Thesaurus Property)
    C1801960 (UMLS 2011AA Property)
    C25548 (NCI Thesaurus Property-2)
    C1314939 (UMLS 2011AA Property-2)
    C25267 (NCI Thesaurus Property-3)
    C1522604 (UMLS 2011AA Property-3)
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    CL.5
    Code List
    Does the patient have vascular-lymphatic involvement at study entry?
    CL Item
    No (NO)
    CL Item
    Yes (YES)
    CL Item
    Unknown (UNKNOWN)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    ResidualDisease
    Item
    Size of Residual Disease (cm Note: maximum size after resection is complete: 0=microscopic)
    float
    C25209 (NCI Thesaurus ValueDomain)
    C0242485 (UMLS 2011AA ValueDomain)
    Item Group
    Prior Treatment For Gynecologic Cancer
    Research Comments
    Item
    Comments
    text
    C25704 (NCI Thesaurus ValueDomain)
    C0947611 (UMLS CUI-1)
    C15319 (NCI Thesaurus ObjectClass)
    C25393 (NCI Thesaurus Property)
    Retour au début de la page 

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