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National Cancer Data Base - Data Dictionary PUF 2016

AJCC Clinical M

PUF Data Item Name: 
NAACCR Item #: 
Allowable values: 
Alphanumeric, Uppercase
Identifies the clinically-determined absence or presence of distant metastasis (cM) as defined by the American Joint Committee on Cancer (AJCC).
Registry Coding Instructions: 

Refer to the applicable AJCC Cancer Staging Manual for coding rules in force for the particular edition.

Analytic Note: 

For cases diagnosed on or prior to December 31, 2003, this item was expected to be completed by an attending physician, though registry staff were frequently involved in the determination of the information coded in this item though the review of full range of clinical and patient notes available to registry staff. For cases diagnosed January 1, 2004, through December 31, 2007, the CoC required registries to copy the staging elements from a standardized document found in the patient record, as recorded by the managing physician. PUF users may notice an increase in the proportion of cases with cM reported as X as a consequence of the CoC restriction on the allowable range of registry coding of information beyond that documented by the managing physician.

The rules changed again with cases diagnosed in 2008. Beginning with 2008 diagnoses, registrars were required to record clinical stage. If it was not available from a physician, it was to be coded from information available in the medical record.

Cases are coded using the AJCC Cancer Staging Manual edition in use during the year in which the case was diagnosed. Consult the appropriate edition of this manual for organ or site specific codes and their definitions. See AJCC TNM Edition Number (NAACCR Item #1060). Prior to implementation of the 5th edition of the manual, some "slippage" in version occurred, and edition numbers are not included in the PUF for those older cases.

Codes on this list comprise all codes valid for any AJCC manual through the 7th edition and for any chapter. Please consult the applicable manual and chapter for codes that are valid for specific site, histology and AJCC edition combinations. Starting with the 2015 PUF (released in Fall 2017), clinical M has been backward converted to include c prefixes.

There is no standard mechanism to recode AJCC items from one edition to another. Careful review of the individual definitions in the respective AJCC manuals is necessary before combining or comparing data across two or more AJCC editions.

Code Definition
Blank Not available in patient record.
cX cMX
c0 cM0
c0I+ cM0(i+)
c1 cM1
c1A cM1a
c1B cM1b
c1C cM1c
c1D cM1d
88 Not appliable (not defined)