---
title: "Updated Review: Using the National Cancer Database (NCDB) for Outcomes Research"
id: "pubmed-41848188"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-41848188"
content_type: "clinical_feed_article"
specialty: "Oncology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/41848188/"
doi: "10.1097/XCS.0000000000001924"
published_at: "2026-08-14T16:40:26.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Updated Review: Using the National Cancer Database (NCDB) for Outcomes Research
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-41848188
- **Specialty:** [Oncology](https://medichelpline.com/clinical-feed/oncology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/41848188/)
- **DOI:** [10.1097/XCS.0000000000001924](https://doi.org/10.1097%2FXCS.0000000000001924)
- **Published At:** 2026-08-14T16:40:26.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The **National Cancer Database (NCDB)** captures an estimated 73.7% of newly diagnosed cancers in the United States and underlies thousands of outcomes studies that inform oncologic practice. - The NCDB currently aggregates data from 1,413 Commission on Cancer–accredited hospitals and contains more than 55 million records. - Since 2020 the **Rapid Cancer Reporting System** supports near-real-time, monthly submissions, improving analytic timeliness. - Embargo periods for data release were shortened: survival data from 5 to 3 years and other variables to 2 years, increasing the currency of available data. - Follow-up data are now limited to 15 years beginning January 1, 2022; investigators must account for this truncation in longitudinal analyses. - Major variable-level changes: continuous tumor size in millimeters (since 2016); tumor grade separated into clinical, pathologic, and posttherapy fields (since 2018); phased radiation treatment reporting (since 2018). - Staging updates include implementation of the **AJCC eighth edition staging** in January 2018 and ongoing rollout of the ninth edition; staging transitions affect cohort definitions and comparability across time. - New data elements added for policy and emerging clinical relevance include Medicaid expansion status (2020), COVID-19 variables (2020–2021) with a reported 12.4% case reduction in 2020, smoking status (2023), and planned programmed death-ligand 1 (PD-L1) reporting for non–small cell lung cancer beginning in 2025. - The authors conducted a narrative review of annual NCDB data dictionary revisions, American College of Surgeons bulletins, and internal program updates in collaboration with NCDB leadership to characterize structural, variable, and policy changes over the past decade. - Conclusions emphasize that the NCDB has become more granular and policy-relevant but that investigators must explicitly address staging transitions, variable maturation, follow-up limits, and registry-specific biases to ensure valid interpretation of NCDB-based research.
## Clinical Analysis & Structured Key Points
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Epub 2026 Aug 14. # Updated Review: Using the National Cancer Database for Outcomes-Based Research [Oluwaseun F Ayoade](https://pubmed.ncbi.nlm.nih.gov/?term=Ayoade+OF&cauthor_id=41848188)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#full-view-affiliation-1 "From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT \(Ayoade, Caturegli, Boffa\)."), [Giorgio Caturegli](https://pubmed.ncbi.nlm.nih.gov/?term=Caturegli+G&cauthor_id=41848188)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#full-view-affiliation-1 "From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT \(Ayoade, Caturegli, Boffa\)."), [Bryan Palis](https://pubmed.ncbi.nlm.nih.gov/?term=Palis+B&cauthor_id=41848188)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#full-view-affiliation-2 "Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL \(Palis, McCabe\).")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#full-view-affiliation-3 "Cancer Program, American College of Surgeons, Chicago, IL \(Palis, McCabe, Weigel, Canavan, Boughey, Boffa\)."), [Ryan McCabe](https://pubmed.ncbi.nlm.nih.gov/?term=McCabe+R&cauthor_id=41848188)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#full-view-affiliation-2 "Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL \(Palis, McCabe\).")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#full-view-affiliation-3 "Cancer Program, American College of Surgeons, Chicago, IL \(Palis, McCabe, Weigel, Canavan, Boughey, Boffa\)."), [Ronald J Weigel](https://pubmed.ncbi.nlm.nih.gov/?term=Weigel+RJ&cauthor_id=41848188)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#full-view-affiliation-3 "Cancer Program, American College of Surgeons, Chicago, IL \(Palis, McCabe, Weigel, Canavan, Boughey, Boffa\).")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#full-view-affiliation-4 "Department of Surgery, Carver College of Medicine, University of Iowa, Iowa City, IA \(Weigel\)."), [Maureen E Canavan](https://pubmed.ncbi.nlm.nih.gov/?term=Canavan+ME&cauthor_id=41848188)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#full-view-affiliation-3 "Cancer Program, American College of Surgeons, Chicago, IL \(Palis, McCabe, Weigel, Canavan, Boughey, Boffa\).")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#full-view-affiliation-5 "Yale Cancer Outcomes, Public Policy and Effectiveness Research \(COPPER\) Center Yale University School of Medicine, New Haven, CT \(Canavan, Boffa\)."), [Judy C Boughey](https://pubmed.ncbi.nlm.nih.gov/?term=Boughey+JC&cauthor_id=41848188)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#full-view-affiliation-3 "Cancer Program, American College of Surgeons, Chicago, IL \(Palis, McCabe, Weigel, Canavan, Boughey, Boffa\).")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#full-view-affiliation-6 "Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN \(Boughey\)."), [Daniel J Boffa](https://pubmed.ncbi.nlm.nih.gov/?term=Boffa+DJ&cauthor_id=41848188)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#full-view-affiliation-1 "From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT \(Ayoade, Caturegli, Boffa\).")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#full-view-affiliation-3 "Cancer Program, American College of Surgeons, Chicago, IL \(Palis, McCabe, Weigel, Canavan, Boughey, Boffa\).")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#full-view-affiliation-5 "Yale Cancer Outcomes, Public Policy and Effectiveness Research \(COPPER\) Center Yale University School of Medicine, New Haven, CT \(Canavan, Boffa\).") Affiliations Expand ### Affiliations * 1 From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (Ayoade, Caturegli, Boffa). * 2 Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL (Palis, McCabe). * 3 Cancer Program, American College of Surgeons, Chicago, IL (Palis, McCabe, Weigel, Canavan, Boughey, Boffa). * 4 Department of Surgery, Carver College of Medicine, University of Iowa, Iowa City, IA (Weigel). * 5 Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center Yale University School of Medicine, New Haven, CT (Canavan, Boffa). * 6 Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN (Boughey). * PMID: **41848188** * DOI: [ 10.1097/XCS.0000000000001924 ](https://doi.org/10.1097/xcs.0000000000001924) Item in Clipboard Review # Updated Review: Using the National Cancer Database for Outcomes-Based Research Oluwaseun F Ayoade et al. J Am Coll Surg. 2026. Show details Display options Display options Format Abstract PubMed PMID J Am Coll Surg Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Am+Coll+Surg%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Am+Coll+Surg%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/41848188/) . 2026 Sep 1;243(3):696-707. doi: 10.1097/XCS.0000000000001924. Epub 2026 Aug 14. ### Authors [Oluwaseun F Ayoade](https://pubmed.ncbi.nlm.nih.gov/?term=Ayoade+OF&cauthor_id=41848188)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#short-view-affiliation-1 "From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT \(Ayoade, Caturegli, Boffa\)."), [Giorgio Caturegli](https://pubmed.ncbi.nlm.nih.gov/?term=Caturegli+G&cauthor_id=41848188)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#short-view-affiliation-1 "From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT \(Ayoade, Caturegli, Boffa\)."), [Bryan Palis](https://pubmed.ncbi.nlm.nih.gov/?term=Palis+B&cauthor_id=41848188)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#short-view-affiliation-2 "Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL \(Palis, McCabe\).")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#short-view-affiliation-3 "Cancer Program, American College of Surgeons, Chicago, IL \(Palis, McCabe, Weigel, Canavan, Boughey, Boffa\)."), [Ryan McCabe](https://pubmed.ncbi.nlm.nih.gov/?term=McCabe+R&cauthor_id=41848188)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#short-view-affiliation-2 "Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL \(Palis, McCabe\).")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#short-view-affiliation-3 "Cancer Program, American College of Surgeons, Chicago, IL \(Palis, McCabe, Weigel, Canavan, Boughey, Boffa\)."), [Ronald J Weigel](https://pubmed.ncbi.nlm.nih.gov/?term=Weigel+RJ&cauthor_id=41848188)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#short-view-affiliation-3 "Cancer Program, American College of Surgeons, Chicago, IL \(Palis, McCabe, Weigel, Canavan, Boughey, Boffa\).")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#short-view-affiliation-4 "Department of Surgery, Carver College of Medicine, University of Iowa, Iowa City, IA \(Weigel\)."), [Maureen E Canavan](https://pubmed.ncbi.nlm.nih.gov/?term=Canavan+ME&cauthor_id=41848188)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#short-view-affiliation-3 "Cancer Program, American College of Surgeons, Chicago, IL \(Palis, McCabe, Weigel, Canavan, Boughey, Boffa\).")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#short-view-affiliation-5 "Yale Cancer Outcomes, Public Policy and Effectiveness Research \(COPPER\) Center Yale University School of Medicine, New Haven, CT \(Canavan, Boffa\)."), [Judy C Boughey](https://pubmed.ncbi.nlm.nih.gov/?term=Boughey+JC&cauthor_id=41848188)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#short-view-affiliation-3 "Cancer Program, American College of Surgeons, Chicago, IL \(Palis, McCabe, Weigel, Canavan, Boughey, Boffa\).")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#short-view-affiliation-6 "Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN \(Boughey\)."), [Daniel J Boffa](https://pubmed.ncbi.nlm.nih.gov/?term=Boffa+DJ&cauthor_id=41848188)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#short-view-affiliation-1 "From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT \(Ayoade, Caturegli, Boffa\).")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#short-view-affiliation-3 "Cancer Program, American College of Surgeons, Chicago, IL \(Palis, McCabe, Weigel, Canavan, Boughey, Boffa\).")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/41848188/#short-view-affiliation-5 "Yale Cancer Outcomes, Public Policy and Effectiveness Research \(COPPER\) Center Yale University School of Medicine, New Haven, CT \(Canavan, Boffa\).") ### Affiliations * 1 From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (Ayoade, Caturegli, Boffa). * 2 Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL (Palis, McCabe). * 3 Cancer Program, American College of Surgeons, Chicago, IL (Palis, McCabe, Weigel, Canavan, Boughey, Boffa). * 4 Department of Surgery, Carver College of Medicine, University of Iowa, Iowa City, IA (Weigel). * 5 Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center Yale University School of Medicine, New Haven, CT (Canavan, Boffa). * 6 Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN (Boughey). * PMID: **41848188** * DOI: [ 10.1097/XCS.0000000000001924 ](https://doi.org/10.1097/xcs.0000000000001924) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** The National Cancer Database (NCDB) captures 73.7% of newly diagnosed cancers in the USs and underpins thousands of outcomes studies informing oncologic practice. To remain relevant amid rapid therapeutic and policy changes, the NCDB has undergone substantial structural and variable-level revisions. We characterized major updates during the past decade and their implications for research. **Study design:** We performed a narrative review of annual NCDB data dictionary revisions, American College of Surgeons bulletins, and internal program updates in collaboration with NCDB leadership. Structural modifications, variable additions, and policy changes affecting data capture, follow-up, staging, and accessibility were systematically summarized. **Results:** The NCDB now includes data from 1,413 Commission on Cancer-accredited hospitals and more than 55 million records. Since 2020, the Rapid Cancer Reporting System enables near-real-time monthly submissions. Embargo periods were reduced from 5 to 3 years for survival data and 2 years for other variables, increasing analytic timeliness. Follow-up was limited to 15 years beginning January 1, 2022. Variable refinements include continuous tumor size in millimeters (since 2016), separation of tumor grade into clinical, pathologic, and posttherapy fields (since 2018), phased radiation treatment reporting (since 2018), and American Joint Committee on Cancer eighth edition staging implementation in January 2018 with nineth edition rollout ongoing. New data elements include Medicaid expansion status (2020), COVID-19 variables (2020 to 2021; 12.4% reduction in cases in 2020), smoking status (2023), and planned programmed death-ligand 1 reporting for non-small cell lung cancer beginning in 2025. **Conclusions:** The NCDB has evolved toward more granular, contemporary, and policy-relevant data capture while maintaining broad national coverage. Investigators must account for staging transitions, variable maturation, follow-up limits, and registry-specific biases to ensure valid interpretation of NCDB-based research. Copyright © 2026 by the American College of Surgeons. Published by Wolters Kluwer Health, LLC. All rights reserved. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas. ](https://pubmed.ncbi.nlm.nih.gov/36321557/) Crider K, Williams J, Qi YP, Gutman J, Yeung L, Mai C, Finkelstain J, Mehta S, Pons-Duran C, Menéndez C, Moraleda C, Rogers L, Daniels K, Green P.Crider K, et al.Cochrane Database Syst Rev. 2022 Feb 1;2(2022):CD014217. doi: 10.1002/14651858.CD014217.Cochrane Database Syst Rev. 2022.Update in: [Cochrane Database Syst Rev. 2026 Feb 18;2:CD014217. doi: 10.1002/14651858.CD014217.pub2.](https://pubmed.ncbi.nlm.nih.gov/41705996/)PMID: 36321557Free PMC article.Updated. * [ The National Cancer Data Base report on patterns of childhood cancers in the United States. ](https://pubmed.ncbi.nlm.nih.gov/9404710/) Grovas A, Fremgen A, Rauck A, Ruymann FB, Hutchinson CL, Winchester DP, Menck HR.Grovas A, et al.Cancer. 1997 Dec 15;80(12):2321-32. doi: 10.1002/(sici)1097-0142(19971215)80:12 3.0.co;2-w.Cancer. 1997.PMID: 9404710 * [ Is the Number of National Database Research Studies in Musculoskeletal Sarcoma Increasing, and Are These Studies Reliable? ](https://pubmed.ncbi.nlm.nih.gov/35767810/) Lawrenz JM, J
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