Surgery and Orthopedics Poster Session
The first project of Tumors Registry began in February 1989. In January 1990 we started a pilot program in the Gregorio Marañón Hospital and San Carlos Universitary Hospital. At the same time we developed a software model. This software was demostrated in November 1990 at M.D.Anderson Cancer Center. Department of Patients Studies. Vincent F. Guinee. MD. PhD.
At the begining of 1991 we began to register the data of tumors of these two large hospitals in software model form. Since 1993 five large hospital collected data In our system.
Materials and Methods
We are using information from Pathology Department, Medical Record Department and Outpatient Department. In each Hospital we have some variations of these sources because of their characteristics The collection data is made in the same format in all hospitals. The data is kept on a filing card and computer base, generating a data base to be used in computer programs very easily. With this software and this data base, the hospital is capable to doing quality control and follow-ups. The hospital registries, periodically send data base to Central Registry where we do studies, external quality control, statistics and reports.
The Central Registry has maintained the data manual, supervised data entry and quality control, created and maintained computer software, and provided overall coordination. The Central Registry has assumed a role of spoksmen in International liason especially with the International Cancer Patient Data Exchange System (UICC).
Until December, 31, 1997. We have registered 21.946 tumors from five large hospitals.
In this first part of report we analyze the data base called "treatment". This data base has the following structure:
Previous diagnosis and/or treatment elsewhere. Most valid basis of diagnosis of cancer in other institution.Treatment in other institution. Anatomical site. Topography (ICD-O). Histological type. Morphology (ICD-O). Multiple primaries. Clinical extent of disease before treatment. Initial treatment at reporting institution.Most valid basis of diagnosis of cancer at reporting institution.
TABLE I: Tumors recorded by quarter.
A analysis of more important item shows very important information. We analize only the following items: Anatomical site. Topography (ICD-O). Histological type. Morphology (ICD-O). Clinical extent of disease before treatment. Initial treatment at reporting institution. Most valid basis of diagnosis of cancer at reporting institution.
Primary cancer site.
We have put in the appropriate code according to the ICD-O (1976), topography section.
TABLE II. Most frequently topography.
TABLE III. Basic list. ICD.O. Topography.
We have put in the appropriate morphology code for a reportable malignant neoplasm according to the ICD-O (1976), morphology section. Allowable histology codes for malignant neoplasm are limited to those for which the fifth digit "behavoir code" is equal or greater that 2. In five histological categories, we registered a 59% of tumors. Others categories have only little quantities.
TABLE IV. Most frequently histology.
TABLE V. Basic list. ICD.O. Morphology.
Extent of Disease Before Treatment.
In this item we register the extent of disease at the moment of diagnostic at reporting institution. We have been using only the categories 2,4,and 6 of the item 16 of the system manual of UICC. This decision was take by consensus of the members of Cancer Exchange Data System (CEDS).
The category in situ is reported by behaviour code /2 of ICD-O, morphology section. At the present we can not register TNM Classification.
TABLE VI. Extent of Disease. Excluded Luekemias and Lymphomas.
Initial Course of Therapy at the Reporting Institution.
We have considered that the initial course of therapy include all cancer directed treatments administered. This consideration includes the sequence treatment.
TABLE VII: Initial Course of Therapy .
In this part of report we analyze the data base called "patients". This data base has the following structure: National Identification Number. First name and surname. Sex. Date of Birth. Site of Birth. Address. We analized only sex and age.
Sex and Age.
TABLE VIII. Sex and Age.
The medium age is 64,5 year, with a mode of 61,5 years. The 73% of the patients are more of 55 years old.
In the last part of report we analyze the data base called "follow-up". This data base has the following structure: Date of Dead. Cause of Dead. International Classification of Cause of Dead. Autopsy. Vital Satus.
In each hospital our systems is conected with the Outpatient Department and with Medical Record Department. We have directly conexion with data base of these department and in this form we have capable to do a first follow-up. Each year, and mounth by mounth, by listed all the tumors without follow-up and send a letter for
three times and finally if we does not have answer, we telephone.
At same time we registered the Cause of Death according to the Ninth Revision of the International Classification of Disease (ICD).
TABLE IX: Cause of Death.
TABLE X: Dead for Primary Site.
The esophagus cancer is the more letal tumor. Is more frecuent that other and dead rate is very high.
TABLE XI. Disease Status of Patient at Annual Contact.
Discussion and Conclusion
These data suggest that hospital cancer register statistics can be used to assess cancer patients care for hospital cohorts of patients. The 10 cancer anatomic site most commonly reported were breast (12,3%), lung (11%), colon (7,1%), bladder (7%) and stomach (5,8%). But the most important cause of death were esophagus (73%) and lung (65%). The survival value is 63 months, (95% confidence interval; 60/67), using the Kaplan-Meyer test.
In medical practice, the data of tumor register serves many purposes. It helps clinicians analizy outcomes, evaluate results therapy, and assess the results of early cancer detection. Highligths of these reports is inform physician actively involved in the care of cancer patients of the latest findings.
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|Gonzalez-Navarro, A; Gonzalez-Hernandez, MJ; (1998). Report of Cancer Exchange System. Year of 1997. Central Registry.. Presented at INABIS '98 - 5th Internet World Congress on Biomedical Sciences at McMaster University, Canada, Dec 7-16th. Available at URL http://www.mcmaster.ca/inabis98/surgeryortho/gonzalez-navarro0709/index.html|
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