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. 2025 Jul 23;17(15):2445.
doi: 10.3390/cancers17152445.

Prognostic Factors and Survival Outcomes in Resected Biliary Tract Cancers: A Multicenter Retrospective Analysis

Michele Ghidini  1 , Fausto Petrelli  2 , Matteo Paccagnella  3 , Massimiliano Salati  4 , Francesca Bergamo  5 , Margherita Ratti  6 , Caterina Soldà  5 , Barbara Galassi  1 , Ornella Garrone  1 , Massimo Rovatti  7 , Arianna Zefelippo  8 , Lucio Caccamo  8 , Enrico Gringeri  9 , Alessandro Zerbi  10   11 , Guido Torzilli  10   12 , Silvia Bozzarelli  13 , Lorenza Rimassa  10   13 , Gianluca Tomasello  14
Affiliations

Prognostic Factors and Survival Outcomes in Resected Biliary Tract Cancers: A Multicenter Retrospective Analysis

Michele Ghidini et al. Cancers (Basel). .

Abstract

Background/Objectives: Biliary tract cancers (BTCs) are aggressive malignancies with a poor prognosis. Surgery remains the only curative option, yet recurrence rates are high, and the role of adjuvant chemotherapy remains debated. This study aims to evaluate the impact of adjuvant chemotherapy and prognostic factors on survival outcomes in resected BTCs. Methods: We conducted a retrospective multicenter study analyzing patients diagnosed with intrahepatic (iCCA) and extrahepatic cholangiocarcinoma (eCCA) or gallbladder cancer (GBC) who underwent curative-intent surgical resection between 1999 and 2023. Demographic, clinicopathological, and treatment data were collected from institutional databases. Survival outcomes were assessed using Kaplan-Meier analysis, and prognostic factors were identified through Cox proportional hazards regression. Results: A total of 155 patients were included, with a median follow-up of 84.6 months. The cohort comprised 38.7% iCCA, 31.6% eCCA, and 29.7% GBC. R0 resection was achieved in 77.4% of cases, while lymph node involvement was present in 39.4%. Median overall survival (OS) significantly varied by stage (p < 0.001), ranging from >60 months for stage I to ~12 months for stage IVA. Eastern Cooperative Oncology Group (ECOG) performance status (PS) emerged as the strongest independent prognostic factor for OS (p < 0.001). Adjuvant chemotherapy, administered to 49.0% of patients, did not significantly improve OS in the overall cohort (p = 0.899). However, subgroup analyses suggested potential benefits in iCCA and eCCA but not in GBC. High CA19-9 levels and vascular invasion were associated with poorer survival outcomes. Conclusions: This study highlights the prognostic significance of ECOG PS, resection margin status, lymph node involvement, and CA19-9 levels in resected BTCs. The lack of a clear survival benefit from adjuvant chemotherapy underscores the need for improved therapeutic strategies. Future research should focus on refining risk stratification models and identifying more effective adjuvant treatments to enhance long-term survival outcomes in patients with BTC.

Keywords: adjuvant chemotherapy; biliary tract cancers; extrahepatic cholangiocarcinoma; gallbladder cancer; intrahepatic cholangiocarcinoma.

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Conflict of interest statement

Michele Ghidini declares honoraria and lectures activities with Servier, Roche, Pfizer, Italfarmaco, Astrazeneca and travel expenses with Pfizer. Lorenza Rimassa declares consulting fees with AbbVie, AstraZeneca, Basilea, Bayer, BMS, Eisai, Elevar Therapeutics, Exelixis, Genenta, Hengrui, Incyte, Ipsen, Jazz Pharmaceuticals, MSD, Nerviano Medical Sciences, Roche, Servier, Taiho Oncology, Zymeworks; honoraria (lecture fees) with AstraZeneca, Bayer, BMS, Guerbet, Incyte, Ipsen, Roche, Servier; Travel expenses with AstraZeneca, Servier; research funding to her institution with AbbVie, AstraZeneca, BeiGene, Exelixis, Fibrogen, Incyte, Ipsen, Jazz Pharmaceuticals, MSD, Nerviano Medical Sciences, Roche, Servier, Taiho Oncology, TransThera Sciences, Zymeworks. Silvia Bozzarelli declares Institutional research funding from Jazz Pharmaceuticals and Arcus Biosciences, consulting fees from Servier and support for congress attendance from AstraZeneca. The other authors do not have any conflicts of interest to declare.

Figures

Figure 1
Figure 1
(A) Kaplan–Meier Curve for overall survival. (B) Kaplan–Meier curves for overall survival by tumor site (iCCA, eCCA, GBC).
Figure 2
Figure 2
(A) Kaplan–Meier Curve for relapse-free survival. (B) Kaplan–Meier curves for relapse-free survival by tumor site (iCCA, eCCA, GBC).
Figure 2
Figure 2
(A) Kaplan–Meier Curve for relapse-free survival. (B) Kaplan–Meier curves for relapse-free survival by tumor site (iCCA, eCCA, GBC).
See this image and copyright information in PMC

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