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Clinical calculator summary

ASCO 2022 stage II colon high-risk feature checklist

A non-weighted source checklist for postoperative assessment of resected pT3-pT4, pN0, M0 colon cancer.

Evidence-based context for fast calculator use

Purpose:
Identify the ASCO-listed pathologic and presentation features that frame postoperative adjuvant-therapy discussion.
Population:
Resected stage II colon cancer at the initial postoperative adjuvant assessment.
Factors:
T4 category, Examined-node count, LVI and PNI, Grade with dMMR exception, Obstruction and tumor perforation, BD3 tumor budding
Reference:
Baxter et al. J Clin Oncol. 2022;40:892-910. DOI 10.1200/JCO.21.02538.
HomeASCO 2022 Stage II Colon High-Risk Feature Assessment
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ASCO 2022 Stage II Colon High-Risk Feature Assessment

Enter a nonnegative whole-number count; fewer than 12 is a listed high-risk feature.

MMR/MSI modifies interpretation of poor differentiation; it is not an additive score item.

Clinical Context & Background

This page implements the high-risk feature checklist in the 2022 ASCO guideline update for postoperative assessment of resected stage II colon cancer. It is a source decision table, not a weighted recurrence score or individualized recurrence probability.
The applicable population is pT3, pT4a, or pT4b; pN0; M0 colon cancer after initial resection. Rectal, appendiceal, anal, and small-bowel cancers and node-positive, metastatic, recurrent, unresected, unstaged, or post-neoadjuvant disease are outside scope. No field is preselected; unresolved required pathology never produces a low-risk result.
The listed features are T4 disease, fewer than 12 examined lymph nodes, lymphovascular invasion, perineural invasion, poorly or undifferentiated grade, obstruction, tumor perforation, and BD3 tumor budding. Poor differentiation alone is not counted for dMMR/MSI-H tumors. MMR/MSI is a treatment-context modifier and does not erase other qualifying features.
Primary Source EvidenceBaxter NN et al. Adjuvant Therapy for Stage II Colon Cancer: ASCO Guideline Update. J Clin Oncol. 2022;40:892-910. PMID 34936379. DOI 10.1200/JCO.21.02538.
Formula Logic
ASCO 2022 high-risk feature checklist for resected stage II colon cancer: pT4a/pT4b; fewer than 12 examined nodes; lymphovascular invasion; perineural invasion; poorly or undifferentiated grade except when dMMR/MSI-H is the only adverse feature; obstruction; tumor perforation; or BD3 tumor budding (at least 10 buds per 0.785 mm2). This is not a weighted score or recurrence probability.

Reference Data

Resolved source stateASCO 2022 interpretation
pT3 with no listed high-risk featureAdjuvant chemotherapy is not routinely recommended
pT3 with another listed high-risk featureAdjuvant chemotherapy may be offered through shared decision-making
pT4a or pT4bAdjuvant chemotherapy should be offered for discussion
Required pathology or MMR/MSI unresolvedIncomplete assessment; do not classify as no listed feature

Clinical Workflow

Use, Interpret, And Continue The Patient Pathway

Expand for workflow guidance, limitations, examples, and related next steps.

When To Use

  • After initial resection of pT3-pT4, pN0, M0 colon cancer.
  • After pathology, examined-node count, MMR/MSI, and tumor-budding assessment are available.

How To Interpret

  • T4 is the strongest listed feature and has a distinct recommendation strength.
  • Other listed features support shared decision-making; the checklist is not a recurrence probability or weighted score.
  • For dMMR/MSI-H, poor differentiation alone is excluded, while other listed features remain relevant.

What To Do Next

  • Document the exact source features and any unresolved pathology.
  • Discuss benefits, harms, tumor biology, comorbidity, and patient preferences in multidisciplinary context.

Limitations

  • Not applicable outside resected stage II colon cancer.
  • Does not select a regimen, duration, or estimate individualized chemotherapy benefit.
  • ctDNA, CEA, margins, mucinous histology, age, and comorbidity are not calculated by this checklist.

Validated Population

Patients with resected stage II colon cancer considered for postoperative adjuvant therapy in the population addressed by the ASCO 2022 guideline.

Node-count boundary

Eleven examined nodes is a listed high-risk feature; twelve examined nodes is not.

Calculation verification history

Verified

  1. : Production browser revalidation

    • Three source-backed cases passed through the visible production controls for the pT3 no-listed-feature branch, the exact 11/12-node transition, and the pT4a high-risk branch.
    • The production result and expanded decision trace matched the ASCO 2022 source checklist in every case.
    • No unexpected N/A, stale or non-actionable control, literal undefined/null value, or browser-console error was observed.
    Download latest production check (Excel)

    Case-level evidence is retained in validation/browser-revalidation/colorectal-cancer-recurrence-risk-2026-08-03.json.

  2. : Production browser validation

    • Ten source-backed cases were exercised on the public production route through visible browser controls; 10/10 case records passed their expected-versus-observed assertions across 11 visible submissions.
    • Overall browser status: failed-console. medium: Production emitted minified React error #418 during route loads/reloads used by this run.
    • Case-level inputs, expected and observed results, reset/repeat behavior, failure reproductions, and console evidence are retained in the production-browser evidence record.

    Case-level production evidence is retained in validation/browser-production/colorectal-cancer-recurrence-risk.json.

  3. : Full validation test

    • 1,592/1,592 independent source-state, boundary, applicability, incomplete-assessment, invalid-input, UI, trace, registry, report, history, and isolation checks passed.
    • This verifies implementation against the cited ASCO 2022 guideline; it is not independent clinical validation, regulatory approval, a recurrence probability, or medical advice.

  4. : Source, calculation, and input-contract correction

    • Locked the assessment to the ASCO 2022 guideline for resected pT3-pT4, pN0, M0 colon cancer and removed the unsupported weighted risk-factor score.
    • Restored the complete feature table and dMMR/MSI-H poor-differentiation exception, and separated T4, obstruction, tumor perforation, LVI, PNI, and BD3 tumor budding.
    • Added strict staging and pathology scope gates, the exact 11/12-node boundary, explicit incomplete-assessment pathways, and completely unselected initial/reset states.

    Included in the current validation report.

Verification confirms the calculator implementation against the cited model; it is not independent clinical validation, regulatory approval, or medical advice.

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Frequently Asked Questions

When should ASCO 2022 Stage II Colon High-Risk Feature Assessment be used?

Use it for patients with the specific gastrointestinal, stromal, colorectal, or peritoneal disease context described by the model when all required inputs and the intended clinical setting are confirmed.

Can ASCO 2022 Stage II Colon High-Risk Feature Assessment determine treatment by itself?

No. Interpret the result with the cited evidence, complete clinical assessment, current guidelines, and patient-specific goals.

Evidence-based oncology decision support. Verify with clinical guidelines.