Cancer_Modifier. Metastasis

Cancer Modifier

Metastasis

Rationale

The Metastasis Concept Class as part of Cancer Modifier Vocabulary is developed to capture facts of distant metastatic spread.

The Class is designed to be utilized as an obvious trigger of ** Metastatic Disease Episode **and in some cases as a trigger of **Progression Episode, **from Disease Extent and Disease Dynamic Episode domain classes respectively.

• The first time a Metastasis occurs the Metastatic Disease Episode could be initiated

• Every new distinct concept_id from the class could trigger the Progression Episodeas the majority of widely used clinical protocols interpret new cancerous lesions as Progression.

  • The exception for Progression Episode triggering may be considered for Parent - Children Metastasis concepts according**_ to the Investigator’s request.
  • Additionally, combination of Metastasis concept_id and value_concept_id may trigger the episodes change

• The concepts are designed as comprehensive and self-sufficient facts, thus there is NO need to use value_as_concept_id.

  • If tracking of the Metastasis dynamics is desired then the facts should be stored as postcoordinated pairs (event and value). In this case, we suggest storing the distinct value_as_concept_id for the same Metastasis concept (measurement_concept_id) to reflect the time course of the metastasis in its origin site. For value examples see the table below:

value_concept_id	value_concept_name	value_concept_class_id	value_vocabulary_id
4181412	Present	Meas Value	SNOMED
4132135	Absent	Meas Value	SNOMED
4128639	Decrease	Meas Value	SNOMED
4123515	Increase	Meas Value	SNOMED
… etc

Source structure

The Class encompasses about half a thousand concepts primarily designed to capture the fact of distant metastatic spread. The majority of concepts are standard. The concept class was developed de novo as a part of the Oncology OMOP CDM initiative.

Concept Standertness	Number of concepts
Standard	529
Non-Standard*	50

*The existence of Non-Standard concepts is attributed to nature of development process of ontology

Relationships

Hierarchy

The concepts in the Class are structurized in internal hierarchical relationships to ease the phenotyping and querying.

See the example of a branch

Metastasis to ethmoid bone Is a -> Metastasis to bone of skull Is a -> Metastasis to bone Is a -> Metastasis

Finding site signature

The concepts are also linked to special anatomical sites according to the metastasis location. These links are built to be used to non trivial querying depending on special research scenarios as they provide access to the major Standard OMOP terminology - SNOMED.