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Starting in 2004, SEER adopted the Collaborative Stage (CS) system and SEER registries started to provide detail regarding the sub-stages of M1 disease: M1a (non-regional lymph nodes), M1b (bone), and M1c (other site, with or without bone disease).
Beginning with cases diagnosed in 2004, the NCDB started collecting Collaborative Stage data elements, in addition to physician-recorded AJCC clinical and pathological tumor node metastasis (TNM) elements and overall stage.
Patients were identified as having a SEER-based measure of BM if the AJCC metastatic component in the Collaborative Stage (CS) coding system indicated 'M1b' status, i.e. metastasis to bone at diagnosis.
Upon cohort identification, Team ACCESS collaborated with experienced coders at the NSCR to conduct an extensive chart review and stage all CRC cases using the Collaborative Stage (CS Data Collection Systemm, resulting in CS derived AJCC stage groups [ 6, 9].
Personnel from the NS Cancer Registry NSCRR) identified all CRC cases diagnosed in NS in the time period, and undertook a comprehensive chart review to stage this cohort using the Collaborative Stage (CS) Data Collection System [ 20].
Lymph node-level data were parsed from Collaborative Stage site-specific factors 3 and 4 of the SEER data for H&N tumor site, which included information regarding lymph node involvement for levels 1, 2, and 3 and levels 4, 5, and retropharyngeal lymph nodes, respectively.
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(A collaborative staging with the director Anne Bogart's SITI Company, at BAM last season, provided powerful theatre for Wolfe's music).
Collaborative staging was applied to all patients within the cohort [ 23] and was the source of nodal harvest information.
The pathology and treatment details of 683 (29.6%) were independently reviewed for accuracy as a part of a collaborative staging project.
Staging was determined using collaborative staging, or if it was unavailable, from the best available data from the registry, medical records, or interviews.
Reasons for this increase in staging may include physician education, introduction of less invasive staging procedures, and adoption of a collaborative staging system by SEER in 2004, which combines and standardizes information using computer algorithms to assign a stage.
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