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ID

8459

Beschrijving

Z1031 Preoperative Endocrine Prognostic Index Form (PEPI) Exemestane, Letrozole, or Anastrozole in Treating Postmenopausal Women Who Are Undergoing Surgery for Stage II or Stage III Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=739D9DB4-532C-7818-E040-BB89AD4371E4

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=739D9DB4-532C-7818-E040-BB89AD4371E4

Trefwoorden

Versies (2)
  1. 19-09-12 19-09-12 -
  2. 09-01-15 09-01-15 - Martin Dugas
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9 januari 2015

DOI

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Creative Commons BY-NC 3.0 Legacy
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    Endometrial Cancer NCT00265759 On-Study - Z1031 Preoperative Endocrine Prognostic Index Form (PEPI) - 2940238v1.0

    Engels

    This form is to be completed using information from the "PEPI Worksheet." The worksheet will be completed by the ACOSOG Central Laboratory and returned after surgery. Please contact the lab with questions: (314) 454-7615

    1 Formulieren  
    Unnamed 1
    Beschrijving

    Unnamed 1

    Visit
    Beschrijving

    AmericanCollegeofSurgeonsOncologyGroupVisitPeriodAmericanCollegeofSurgeonsOncologyGroupVisitPeriodType

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus Property
    C25616
    UMLS 2011AA Property
    C1948053
    NCI Thesaurus ObjectClass
    C19712
    UMLS 2011AA ObjectClass
    C1515944
    NCI Thesaurus ObjectClass-2
    C25716
    UMLS 2011AA ObjectClass-2
    C0545082
    Patient ID (Pt. ID issued during registration or previously issued patient ID)
    Beschrijving

    Patient Study ID

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25462
    NCI Thesaurus Property-2
    C25364
    Institution No.
    Beschrijving

    Institution Number

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass
    C21541
    UMLS CUI-2
    C0805701
    NCI Thesaurus Property
    C25364
    Patient Initials (F M L)
    Beschrijving

    Patient Initials

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    Institution Name
    Beschrijving

    Institution Name

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass
    C21541
    NCI Thesaurus ValueDomain-2
    C21541
    NCI Thesaurus Property
    C25364
    Preoperative Endocrine Prognostic Index/treatment Information
    Beschrijving

    Preoperative Endocrine Prognostic Index/treatment Information

    Did patient complete protocol AI therapy
    Beschrijving

    AromataseInhibitorReceivedInd-2

    Datatype

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus Property
    C25639
    UMLS 2011AA Property
    C1514756
    NCI Thesaurus ObjectClass
    C1740
    UMLS 2011AA ObjectClass
    C0593802
    Date results received from Central Lab (mm dd yyyy)
    Beschrijving

    SpecimenCentralLaboratoryResultReceivedDate

    Datatype

    date

    Alias
    NCI Thesaurus ObjectClass
    C19157
    UMLS 2011AA ObjectClass
    C0370003
    NCI Thesaurus Property
    C25639
    UMLS 2011AA Property
    C1514756
    NCI Thesaurus Property-2
    C37984
    UMLS 2011AA Property-2
    C0022877
    NCI Thesaurus Property-3
    C25445
    UMLS 2011AA Property-3
    C0205099
    MGED Property
    X-MO-770
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    Ki67 Score (%)
    Beschrijving

    LaboratoryProcedureTumorMarkerKi-67AntigenResultValue

    Datatype

    float

    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    NCI Thesaurus Property
    C20200
    UMLS 2011AA Property
    C1274040
    NCI Thesaurus Property-2
    C17220
    UMLS 2011AA Property-2
    C0041365
    NCI Thesaurus Property-3
    C17675
    UMLS 2011AA Property-3
    C0208804
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    Allred score
    Beschrijving

    EstrogenReceptorPercentageIntensityStainDescriptionScore

    Datatype

    float

    Alias
    NCI Thesaurus ObjectClass
    C17069
    UMLS 2011AA ObjectClass
    C0034804
    NCI Thesaurus Property
    C25613
    UMLS 2011AA Property
    C0439165
    NCI Thesaurus Property-2
    C25539
    UMLS 2011AA Property-2
    C0522510
    NCI Thesaurus Property-3
    C25365
    UMLS 2011AA Property-3
    C0678257
    NCI Metathesaurus Property
    C0038128
    NCI Thesaurus ValueDomain
    C25338
    UMLS 2011AA ValueDomain
    C0449820
    PEPI Score
    Beschrijving

    PersonPreoperativeEndocrinePrognosticIndexValue

    Datatype

    float

    Alias
    NCI Thesaurus ObjectClass
    C25190
    UMLS 2011AA ObjectClass
    C0027361
    NCI Thesaurus Property
    C54732
    UMLS 2011AA Property
    C0445204
    NCI Thesaurus Property-2
    C41064
    UMLS 2011AA Property-2
    C0521425
    NCI Thesaurus Property-3
    C25390
    UMLS 2011AA Property-3
    C0918012
    NCI Thesaurus Property-4
    C25263
    UMLS 2011AA Property-4
    C0220901
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    Treatment Plan (Per protocol: Chemotherapy is not recommended for patients with PEPI score = 0 and pathological stage T1N0 or T0N0 pathologic complete response)
    Beschrijving

    BreastProtocolPlannedTreatmentType

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C25320
    UMLS 2011AA ObjectClass
    C1507394
    NCI Thesaurus ObjectClass-2
    C12971
    UMLS 2011AA ObjectClass-2
    C0006141
    NCI Thesaurus Property
    C15368
    NCI Thesaurus Property-2
    C25619
    UMLS 2011AA Property
    C1301732
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    Footer Module
    Beschrijving

    Footer Module

    Completed by
    Beschrijving

    Person Completing Form

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C1550483
    NCI Thesaurus ObjectClass
    C25657
    NCI Thesaurus Property
    C25364
    Date Form Completed (mm dd yyyy)
    Beschrijving

    Date Form Completed

    Datatype

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C1115437
    NCI Thesaurus ObjectClass
    C40988
    NCI Thesaurus Property
    C25250
    NCI Thesaurus ValueDomain-2
    C25367
    Terug naar het begin van de pagina

    Similar models

    This form is to be completed using information from the "PEPI Worksheet." The worksheet will be completed by the ACOSOG Central Laboratory and returned after surgery. Please contact the lab with questions: (314) 454-7615

    1 Formulieren
    Name
    Type
    Description | Question | Decode (Coded Value)
    Datatype
    Alias
    Item Group
    Unnamed 1
    Item
    Visit
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C25616 (NCI Thesaurus Property)
    C1948053 (UMLS 2011AA Property)
    C19712 (NCI Thesaurus ObjectClass)
    C1515944 (UMLS 2011AA ObjectClass)
    C25716 (NCI Thesaurus ObjectClass-2)
    C0545082 (UMLS 2011AA ObjectClass-2)
    CL.1
    Code List
    Visit
    CL Item
    30 Days Post Surgery (30 Days post surgery)
    Patient Study ID
    Item
    Patient ID (Pt. ID issued during registration or previously issued patient ID)
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25462 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Institution Number
    Item
    Institution No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass)
    C0805701 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    Patient Initials
    Item
    Patient Initials (F M L)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    Institution Name
    Item
    Institution Name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass)
    C21541 (NCI Thesaurus ValueDomain-2)
    C25364 (NCI Thesaurus Property)
    Item Group
    Preoperative Endocrine Prognostic Index/treatment Information
    AromataseInhibitorReceivedInd-2
    Item
    Did patient complete protocol AI therapy
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C25639 (NCI Thesaurus Property)
    C1514756 (UMLS 2011AA Property)
    C1740 (NCI Thesaurus ObjectClass)
    C0593802 (UMLS 2011AA ObjectClass)
    SpecimenCentralLaboratoryResultReceivedDate
    Item
    Date results received from Central Lab (mm dd yyyy)
    date
    C19157 (NCI Thesaurus ObjectClass)
    C0370003 (UMLS 2011AA ObjectClass)
    C25639 (NCI Thesaurus Property)
    C1514756 (UMLS 2011AA Property)
    C37984 (NCI Thesaurus Property-2)
    C0022877 (UMLS 2011AA Property-2)
    C25445 (NCI Thesaurus Property-3)
    C0205099 (UMLS 2011AA Property-3)
    X-MO-770 (MGED Property)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    LaboratoryProcedureTumorMarkerKi-67AntigenResultValue
    Item
    Ki67 Score (%)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    C20200 (NCI Thesaurus Property)
    C1274040 (UMLS 2011AA Property)
    C17220 (NCI Thesaurus Property-2)
    C0041365 (UMLS 2011AA Property-2)
    C17675 (NCI Thesaurus Property-3)
    C0208804 (UMLS 2011AA Property-3)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    EstrogenReceptorPercentageIntensityStainDescriptionScore
    Item
    Allred score
    float
    C17069 (NCI Thesaurus ObjectClass)
    C0034804 (UMLS 2011AA ObjectClass)
    C25613 (NCI Thesaurus Property)
    C0439165 (UMLS 2011AA Property)
    C25539 (NCI Thesaurus Property-2)
    C0522510 (UMLS 2011AA Property-2)
    C25365 (NCI Thesaurus Property-3)
    C0678257 (UMLS 2011AA Property-3)
    C0038128 (NCI Metathesaurus Property)
    C25338 (NCI Thesaurus ValueDomain)
    C0449820 (UMLS 2011AA ValueDomain)
    PersonPreoperativeEndocrinePrognosticIndexValue
    Item
    PEPI Score
    float
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C54732 (NCI Thesaurus Property)
    C0445204 (UMLS 2011AA Property)
    C41064 (NCI Thesaurus Property-2)
    C0521425 (UMLS 2011AA Property-2)
    C25390 (NCI Thesaurus Property-3)
    C0918012 (UMLS 2011AA Property-3)
    C25263 (NCI Thesaurus Property-4)
    C0220901 (UMLS 2011AA Property-4)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    Item
    Treatment Plan (Per protocol: Chemotherapy is not recommended for patients with PEPI score = 0 and pathological stage T1N0 or T0N0 pathologic complete response)
    text
    C25320 (NCI Thesaurus ObjectClass)
    C1507394 (UMLS 2011AA ObjectClass)
    C12971 (NCI Thesaurus ObjectClass-2)
    C0006141 (UMLS 2011AA ObjectClass-2)
    C15368 (NCI Thesaurus Property)
    C25619 (NCI Thesaurus Property-2)
    C1301732 (UMLS 2011AA Property)
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    CL.4
    Code List
    Treatment Plan (Per protocol: Chemotherapy is not recommended for patients with PEPI score = 0 and pathological stage T1N0 or T0N0 pathologic complete response)
    CL Item
    Adjuvant Chemotherapy (Adjuvant chemotherapy)
    C15360 (NCI Thesaurus)
    C0085533 (UMLS 2011AA)
    CL Item
    No Chemotherapy (No chemotherapy)
    Item Group
    Footer Module
    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 (mm dd yyyy)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C1115437 (UMLS CUI-1)
    C40988 (NCI Thesaurus ObjectClass)
    C25250 (NCI Thesaurus Property)
    C25367 (NCI Thesaurus ValueDomain-2)
    Terug naar het begin van de pagina 

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