Management patterns and survival outcomes in biliary tract malignancies: a 3-year retrospective cohort from Karachi, Pakistan

Management patterns and survival outcomes in biliary tract malignancies: a 3-year retrospective cohort from Karachi, Pakistan | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Management patterns and survival outcomes in biliary tract malignancies: a 3-year retrospective cohort from Karachi, Pakistan Batool Aslam Memon, Maryum Nouman, Maryam Nasrummin Allah, Kiran Marvi, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8219764/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background: Biliary tract malignancies (BTMs), including gallbladder carcinoma (GBC) and cholangiocarcinoma (CCA), are aggressive cancers with poor prognosis. Data from South Asia remain limited. Objectives: To evaluate patient characteristics, diagnostic patterns, treatment modalities, and survival outcomes among BTM patients at a tertiary care center in Karachi, Pakistan. Methods: This retrospective cohort study included patients ≥16 years with histologically confirmed GBC or CCA between May 2022 and May 2025. Data on demographics, clinical presentation, laboratory values, imaging, stage, treatment, and survival were collected. Kaplan–Meier analysis and Cox regression identified survival outcomes and predictors. Results: A total of 141 patients were included (GBC, n=99; CCA, n=42). Median age was similar between groups (GBC 58.1 vs CCA 58.5 years; p=0.971), with female predominance (GBC 58.6%; CCA 64.3%; p=0.527). Gallstones were more frequent in GBC (46.5% vs 26.2%; p=0.025). Adenocarcinoma was the predominant histology, while rare histologies were more frequent in CCA (16.7% vs 4.0%; p=0.022). Lymph node and liver metastases were common; median time from symptom onset to diagnosis was 2.33 months. Curative surgery was more frequent in Stage I–III GBC (53.6%) than Stage IV (23.9%; p=0.032), whereas CCA surgery was less common and location-specific. Adjuvant capecitabine and palliative gemcitabine-based regimens were used; biliary drainage was more frequent in advanced disease. In GBC, multivariate Cox analysis identified advanced stage (HR 4.85; p=0.010) and treatment group (HR 2.21; p=0.003) as independent predictors of survival; combined surgery and chemotherapy reduced mortality by 73% compared to chemotherapy alone (HR 0.27; p=0.019). mRECIST response rates were comparable between GBC and CCA (ORR 18.7% vs 15.0%; DCR 34.7% vs 32.5%). Early-stage disease and aggressive treatment were associated with longer survival (median 28.6 vs 12.0 months, p=0.040; log-rank p<0.001). At last follow-up, more CCA patients were alive than GBC patients (76.2% vs 38.4%; p<0.001). Conclusion: Advanced disease stage is the strongest independent predictor of poor survival in BTMs. Multimodal treatment combining surgery and chemotherapy significantly improves outcomes, though overall response rates remain modest. Early detection, aggressive management, and improved access to care are critical to enhance survival in high-risk South Asian populations. Biliary tract neoplasms Gallbladder carcinoma Cholangiocarcinoma Survival analysis Retrospective cohort study Multimodal treatment Figures Figure 1 Figure 2 Figure 3 INTRODUCTION Biliary tract malignancies (BTMs) include carcinoma of the gallbladder (GBC) and cholangiocarcinoma. Gallbladder carcinoma was first documented by Austrian physician Maximilian Stoll in 1777 1 . Despite being relatively uncommon overall, GBC is the most common biliary tract malignancy, accounting for eighty to nine-five percent of all biliary tract malignancies. It is the 5th most common gastrointestinal malignancy worldwide 2 . Geographically, GBC incidence varies significantly, with countries like Chile, Japan, and northern India reporting markedly higher rates 1 . Gallstones, porcelain GB, GB poly and congenital cysts and chronic S.typii infections are known risk factors 1 . Cholangiocarcinoma, on the other hand, refers to malignancies arising from the bile ducts, which can be classified as intrahepatic, perihilar (also called Klatskin tumors), or distal depending on their location. It accounts for a smaller proportion of biliary tract cancers but is associated with aggressive behavior and late-stage diagnosis 5 . The incidence of gallbladder cancer (GBC) varies significantly across different geographic regions and ethnic groups, ranging from 1 to 23 cases per 100,000 individuals 1 . Over the past two decades, both the incidence and prevalence of GC have reportedly increased in South-East Asia compared to Western countries 1,3 . Unfortunately, Pakistan lacks a formal tumor registry; however, sporadic hospital-based studies indicate that gallbladder cancer (GBC) is a common malignancy in the country, particularly among females. For instance, a study by Bhurgri et al. (up to 2002) in Karachi South reported that gallbladder cancer (GBC) was the second most common malignancy among females and ranked ninth overall among all cancers 1,4 . However, according to the GLOBOCAN 2022 estimates, gallbladder cancer now ranks 20th among females and 22nd overall worldwide in terms of incidence 21 . The prognosis for gallbladder and Cholangiocarcinoma remains poor, with a five-year survival rate of less than 5% 2 . Several factors contribute to this unfavorable outcome, including the absence of specific clinical symptoms, diagnosis at an advanced stage, and the tumor's tendency for early spread 1 . By the time of diagnosis, the cancer is often inoperable, leading most patients to receive only palliative care 2 . The aim of our study is to assess the frequency, clinical characteristics, diagnostic methods, treatment approaches, and analyze outcomes and survival patterns in patients with biliary tract malignancies treated at a tertiary care center over a three-year period. METHODS & MATERIALS Study Design, Data Sources & Collection: This is a cross-sectional, retrospective study of biopsy proven gallbladder carcinoma or cholangiocarcinoma patients presented during the last 3 years from 1st May 2022 till 1st May 2025 to the Department of Medical Oncology at Dow University Hospital, Karachi, Pakistan. Primary Data source was our hospital-based registry of the Medical Oncology Department initially collected manually on the Google excel doc. The diagnosis and staging were done in accordance with international guidelines. Author’s retrospectively collected data from unique hospital MR number regarding demographic characteristics for each individual (Age, gender, comorbidities, BMI, smoking, any other malignancy, family history), symptoms at presentation, LFTs and CA 19.9, association of gallstones, imaging studies, mode of diagnoses (radiological or histologic), stage at presentation, metastasis if any, treatment offered (surgical or chemotherapy or chemoradiotherapy), palliative procedure undertaken and overall survival was recorded. The senior registrars conduct monthly audits to ensure the quality of the registration data, and cross-checking is carried out to improve database consistency. Inclusion & Exclusion Criteria: Inclusion criteria include the following: histopathologic evidence of GB or Cholangiocarcinoma, age 16 years and above &complete medical record. Suspected GB or cholangiocarcinoma, a history of any other malignant tumor, biliary trauma, bilio-enteric fistula, and other hepatobiliary malignancies are among the exclusion criteria. Patients with insufficient medical records are also not included. Data Collection & Statistical Analysis: Patient data will be compiled in Microsoft Excel and analyzed using SPSS version 27.0. Descriptive statistics summarized demographic and clinical characteristics. Group comparisons for categorical variables were made using Chi-square or Fisher’s exact tests. Overall survival was estimated with Kaplan–Meier analysis, and differences between groups were assessed using the log-rank test. Cox proportional hazards regression was applied for univariate and multivariate analyses to identify independent predictors of survival. Treatment responses were compared using RECIST criteria. Statistical significance was set at p < 0.05. RESULTS A. Patient Demographics and Clinical Characteristics: A total of 141 patients with BTMs were included in the study, comprising 99 patients with gallbladder carcinoma (GBC) and 42 with cholangiocarcinoma (CCA). The baseline characteristics are summarized in Table 1. The median age was comparable between groups (GBC: 58.1 ± 11.8 years vs. CCA: 58.5 ± 11.5 years; p = 0.971). Female patients predominated in both cohorts (GBC: 58.6%; CCA: 64.3%; p = 0.527). Family history of cancer was infrequent and showed no significant difference between the groups (GBC: 10.1% vs. CCA: 11.9%; p = 0.751). Comorbidities differed significantly, with hypertension more prevalent in CCA patients (47.6%) compared to GBC (13.1%; p = 0.025). Conversely, gallstones were significantly more common in the GBC group (46.5% vs. 26.2%; p = 0.025), consistent with established etiological associations. Presenting symptoms varied by tumor type. Abdominal pain was more frequently reported in GBC patients (84.8%) than in those with CCA (52.4%), whereas obstructive jaundice was more common in CCA (47.6% vs. 20.2%). Other symptoms, including weight loss, anorexia, and constitutional complaints, were distributed similarly between groups. ECOG performance status was generally favorable in both groups, with ECOG 0–1 seen in 73.7% of CCA and 73.7% of GBC patients (p = 0.269). Laboratory parameters such as bilirubin levels were markedly elevated in CCA patients (median: 6.46 mg/dL) compared to GBC (0.56 mg/dL), likely reflecting a higher incidence of biliary obstruction. Tumor markers and liver enzymes showed high variability but were not statistically different between the two groups. TABLE 1 BASELINE DEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF PATIENTS WITH BILLIARY TRACT MALAGNANCIES Characteristics GB (n=99) CHOLANGIOCARCINOMA (n=42) p value Age, median (range), years 58.1 ± 11.8 58.5 ± 11.5 0.971 <40 8(8.1%) 3 (7.1% 40-59 43 (43.4%) 19 (45.2%) ≥60 48 (48.5%) 20 (47.6%) Gender 0.527 Male 41 (41.4%). 15 (35.7%) Female 58 (58.6%) 27 (64.3%) Family History 0.751 Positive 10 (10.1%) 5 (11.9%) Negative 89 (89.9%) 37 (88.1%) Comorbidities 0.025 Liver diseases (HBV, HCV, NBNC) 5 (5.1%) 3 (7.1%) Hypertension (HTN) 13 (13.1%) 20 (47.6%) Diabetes (DM) 21 (21.2%) 7 (16.7%) Ischemic Heart Disease (IHD) 4 (4.0%) 0 (0.0%) NKCM 56 (56.56%) 12 (28.57%) Addictions History 0.502 YES 23 (23.2%) 12 (28.6%) NO 76 (76.8%) 30 (71.4%) Gall Stones 0.025 Present 46 (46.5%) 11 (26.2%) Absent 53 (53.5%) 31 (73.8%) Presenting Symptoms Obstructive Jaundice 20 (20.2%) 20 (47.6%) Abdominal Pain 84 (84.8%) 22 (52.4%) Weight loss 33 (33.3%) 20 (47.6%) Nausea / Vomiting / Anorexia 19 (19.2%) 13 (31.0%) Epigastric / Dyspeptic symptoms 11 (11.1%) 10 (23.8%) Constitutional symptoms (weakness, fatigue, constipation, breathlessness, general malaise) 15 (15.2%) 9 (21.4%) Other / Non-specific (back pain, hematuria, dysphagia, SOB) 10 (10.1%) 6 (14.3%) ECOG Status 0.269 0 21 (21.2%) 15 (35.7%) 1 52 (52.5%) 20 (47.6%) 2 20 (20.2%) 6 (14.3%) 3 6 (6.1%) 1 (2.4%) Baseline Labs CA-19-9 700 (356, 7459.5) 1.0 (0.6, 221) CEA 2.89 (2.40, 4.05) 2.38 (1.48, 2.86) AFP 5.0 (2.13, 5.0) 3.8 (3.1, 194.3) Bilirubin (mg/dL) median, (IQR) 0.56 (0.48, 2.36) 6.46 (3.45, 17.03) 0.602 ALT IU/L (μmol/L), median (Q1, Q3) 21 (13, 67) 59 (38, 139) 0.852 ALP (μmol/L), median (Q1, Q3) 671 (345, 1526) 338 (323.5, 504.5) 0.468 AST IU/L (μmol/L), median (Q1, Q3) 29 (28, 56) 118 (73, 120.5) 0.877 GGT IU/L (μmol/L), median (Q1, Q3) 96 (66.5, 383) 388 (239.5, 580.5) 0.206 B. Year-wise Distribution of Cases: Year-wise trend shows that gallbladder carcinoma (GB) cases were highest in 2023 (n = 34, 34.3%), followed by 2025 (n = 30, 30.3%) and 2024 (n = 27, 27.3%) (shown in Fig. 1). In contrast, cholangiocarcinoma cases showed a gradual increase over time, with the highest number recorded in 2025 (n = 16, 38.1%), and equal counts in 2023 and 2024 (n = 9, 21.4% each). In 2022, both GB and cholangiocarcinoma had 8 cases each. Although the data for 2025 were available only up to May 2025, the observed counts already indicate a higher incidence of both GB and cholangiocarcinoma, suggesting a continuing upward trend. C. Tumor Characteristics: Tumor characteristics are presented in Table 2. GBC tumors tended to be larger at presentation than CCA tumors. Tumors ≥5 cm were more prevalent in GBC (60.6%) compared to CCA (19.0%; p < 0.001), with a significantly higher mean tumor size among GBC patients across all categories. Staging at presentation revealed a higher proportion of advanced disease (Stage IV) among GBC patients (74.7%) than CCA patients (50.0%; p = 0.037). Histologically, adenocarcinoma was the most common subtype in both groups (GBC: 70.7%; CCA: 64.3%), followed by squamous and mucinous carcinoma. Notably, rare histologies (e.g., ampullary carcinoma, non-keratinizing subtypes) were more frequent in the CCA cohort (16.7% vs. 4.0%; p = 0.022). Poorly differentiated tumors were more common in CCA (50.0%) compared to GBC (40.4%), though this was not statistically significant (p = 0.078). Lymph node involvement and metastases were common in both groups, with liver being the most frequent site of metastasis (GBC: 46.5%; CCA: 54.8%). Time from symptom onset to diagnosis averaged 2.33 ± 2.83 months. TABLE 2: MALIGNANCY AND TUMOR CHARACTERISTICS OF PATIENTS WITH BILIARY TRACT CANCERS MALIGNANCY DETAILS FREQUENCY (n=)/ MEAN ± SD P VALUE Tumor size (cm) <3 cm GB Cancer 22 (2.42 ± 0.57 cm) 5 cm GB Cancer 60 (8.19 ± 2.57 cm) Cholangiocarcinoma 8 (5.85 ± 0.74 cm) Type of Malignancy Gallbladder carcinoma (8140/3 | C23.9) 92 (65.2%) Cholangiocarcinoma 42 (34.1%) · Intrahepatic (8160/3 | C22.1) 11 (7.8%) · Hilar (8162/3 | C24.0) 5 (3.5%) · Perihilar (Klatskin tumor) (8162/3 | C24.0) 7 (5.0%) · Klatskin (8162/3 | C24.0) 3 (2.1%) · Distal extrahepatic (8160/3 | C24.0) 14 (9.9%) · Ampullary carcinoma (8144/3 | C24.1) 6 (4.3%) · Non-keratinizing cholangiocarcinoma (8072/3 | C24.0) 2 (1.4%) Large Cell Neuroendocrine Carcinoma (8013/3 | C23.9) 1 (0.7%) Tumor Stage at Presentation (AJCC TNM) 0.037 Stage I GB Cancer 3 (3.0%) Cholangiocarcinoma 0 (0.0%) Stage II GB Cancer 4 (4.0%) Cholangiocarcinoma 8 (19.0%) Stage III GB Cancer 21 (21.2%) Cholangiocarcinoma 13 (31.0%) Stage IV GB Cancer 74 (74.7%) Cholangiocarcinoma 26 (50.0%) Histopathological Type Adenocarcinoma GB Cancer 70 (70.7%) 0.022 Cholangiocarcinoma 27 (64.3%) Squamous cell carcinoma GB Cancer 7 (7.1%) Cholangiocarcinoma 2 (4.8%) Mucinous carcinoma GB Cancer 3 (3.0%) Cholangiocarcinoma 2 (4.8%) Neuroendocrine carcinoma GB Cancer 1 (1.0%) Cholangiocarcinoma 0 (0.0%) Other / Rare types GB Cancer 4 (4.0%) Cholangiocarcinoma 7 (16.7%) Histological Grade 0.078 Well-differentiated GB Cancer 18 (18.2%) Cholangiocarcinoma 2 (4.8%) Moderately differentiated GB Cancer 40 (40.4%) Cholangiocarcinoma 16 (38.1%) Poorly differentiated GB Cancer 40 (40.4%) Cholangiocarcinoma 21 (50.0%) Immunohistochemical Markers 0.376 GB CK7 17 (17.2%) CK19 15 (15.2%) CK20 8 (8.1%) AE1/AE3 3 (3.0%) CDX2 3 (3.0%) P63 2 (2.0%) Ki-67 1 (1.0%) Synaptophysin 1 (1.0%) CK5/6 1 (1.0%) Cholangiocarcinoma CK7 2 (4.8%) CK19 5 (11.9%) CK20 2 (4.8%) AE1/AE3 3 (7.1%) CDX2 1 (2.4%) Lymph Node Involvement 0.379 Yes GB Cancer 83 (83.8%) Cholangiocarcinoma 32 (76.2%) No GB Cancer 16 (16.2%) Cholangiocarcinoma 10 (23.8%) Metastasis at Diagnosis 0.756 GB Liver 46 (46.5%) Lung 3 (3.0%) Abdomen (peritoneal, omental, etc.) 6 (6.1%) Adrenal 3 (3.0%) duodenum 3 (3.0%) pancreas 1 (1.0%) Cecum 2 (2.0%) cervix 1 (1.0%) Adnexal 1 (1.0%) Portal vein 1 (1.0%) No Metastasis 25 (27.3%) Cholangiocarcinoma Liver 23 (54.8%) Lung 1 (2.4%) Bone 2 (4.8%) No Metastasis 16 (38.1%) Time from Symptom Onset to Diagnosis 2.33 ± 2.83 D. Treatment Modalities: A total of 141 patients with biliary tract cancers were included, comprising 49 with Stage I–III and 92 with Stage IV disease (Table 3). Among these, gallbladder (GB) cancer patients accounted for 28 in Stage I–III and 74 in Stage IV, while cholangiocarcinoma patients included 21 in both Stage I–III and Stage IV groups. Among GB cancer patients, surgical intervention was significantly more frequent in early-stage disease, with 53.6% (15/28) undergoing curative resection compared to 23.9% (16/67) in Stage IV (p = 0.032). The most common procedure in Stage I–III GB cases was extended cholecystectomy with lymphadenectomy (35.7%), followed by cholecystectomy (10.7%) and hepatic resection with hepaticojejunostomy (10.7%). A single patient (3.6%) underwent laparoscopic cholecystectomy with lymph node harvest, completion cholecystectomy with extrahepatic biliary tree excision, lymphadenectomy, and billio-enteric anastomosis. In comparison, among Stage IV GB patients, extended cholecystectomy with lymphadenectomy was performed in only 7.0%, cholecystectomy in 11.3%, and Whipple’s procedure in 1.4%, while 76.1% did not undergo any surgical intervention. For cholangiocarcinoma, surgical management was also more frequent in early stages, with 76.2% (16/21) of Stage I–III patients undergoing resection versus 28.6% (6/21) in Stage IV (p = 0.005). The most common operations included extended hepatic resections and Whipple’s procedures, performed in 9.5% of early-stage and 19.1% of advanced-stage cases. Two patients (2.8%) underwent laparoscopic excision of a liver lesion. No surgical procedure was recorded in 23.8% of Stage I–III and 71.4% of Stage IV cholangiocarcinoma patients, demonstrating a substantial decline in curative surgery with disease advancement. Notably, in patients classified as Stage IV, surgery was performed prior to the recognition of disease progression, and the diagnosis of advanced disease was made incidentally on postoperative histopathological examination rather than as part of a planned resection for known metastasis. Among Stage I–III GB patients, adjuvant chemotherapy was predominantly capecitabine (64.3%), while gemcitabine + cisplatin was administered to 3.6% and gemcitabine alone to 0%. In contrast, Stage I–III cholangiocarcinoma patients received capecitabine in 47.6% and gemcitabine + cisplatin in 9.5%; no patients received gemcitabine alone. Neoadjuvant chemotherapy was infrequently used: 3 Stage I–III cholangiocarcinoma patients received gemcitabine + cisplatin, while no Stage I–III GB patients received neoadjuvant therapy. These findings highlight that curative-intent chemotherapy was largely restricted to early-stage disease. Palliative chemotherapy was predominantly administered to Stage IV patients. In GB cancer, gemcitabine + cisplatin was used in 11.3%, gemcitabine alone in 8.5%, gemcitabine + cisplatin + pembrolizumab in 4.2%, and less frequently capecitabine, FOLFOX, gemcitabine + nab-paclitaxel, or carboplatin + etoposide. For cholangiocarcinoma, Stage IV patients received gemcitabine + cisplatin in 28.6%, gemcitabine + cisplatin + pembrolizumab in 19.0%, FOLFOX in 14.3%, Cape OX in 9.5%, and individual patients received gemcitabine alone, gemcitabine + nab-paclitaxel, or gemcitabine + oxaliplatin. Radiotherapy was infrequently used, with only one Stage IV GB patient receiving SBRT and 14.3% of Stage IV cholangiocarcinoma patients receiving SBRT (p = 0.072). Endoscopic or percutaneous biliary drainage was more frequently performed in Stage IV GB cancer patients, with ERCP plus stenting utilized in 32.4% compared to 10.7% of Stage I–III patients (p = 0.057). Percutaneous transhepatic biliary drainage (PTBD) was rare, performed in 0% of Stage I–III and 1.4% of Stage IV GB patients, while percutaneous cholangiography (PTC) was done in 7.1% of Stage I–III and 1.4% of Stage IV GB patients. In cholangiocarcinoma, ERCP with stenting was used in 42.9% of Stage I–III and 33.3% of Stage IV patients, with PTBD performed in 4.8% of Stage I–III and 9.5% of Stage IV cases; PTC was not performed in either group. These interventions likely reflect the increased need for biliary decompression in advanced disease to manage obstructive symptoms and improve quality of life. Supportive care measures were significantly more utilized in advanced disease: 42.3% of Stage IV GB and 52.4% of Stage IV cholangiocarcinoma patients received supportive care compared to 14.3% and 9.5% in Stage I–III, respectively (p = 0.029 for GB, p = 0.003 for cholangiocarcinoma). TABLE 3: TREATMENT MODALITIES RECEIVED BY PATIENTS WITH BILIARY TRACT CANCERS Treatment Modality STAGE I-III (n=49) STAGE IV (n=92) P VALUE SURGICAL INTERVENTION Curative resection (R0/R1) GB Cholecystectomy 3 (10.7%) 8 (11.3%) 0.032 Extended Cholecystectomy with Lymphadenectomy 10 (35.7%) 5 (7.0%) Hepatic Resection + Hepaticojejunostomy 3 (10.7%) 0 (0.0%) Whipple’s Procedure 0 (0.0%) 1 (1.4%) Laparoscopic cholecystectomy with lymph node harvest (LNH), Completion cholecystectomy + extrahepatic biliary tree excision + lymphadenectomy + bilioenteric anastomosis 1 (3.6%) 0 (0.0%) Laparoscopic excision of liver lesion 0 (0.0%) 2 (2.8%) NO Surgery 13 (46.4%) 54 (76.1%) Cholangiocarcinoma Cholecystectomy 4 (19.0%) 0 (0.0%) 0.005 Extended Left Hepatic Resection, Caudate Lobe Resection, Excision of Extrahepatic Bile Ducts, Right Hepatic Artery & Portal Vein Resection and Reconstruction, Roux-en-Y Hepaticojejunostomy 2 (9.6%) 0 (0.0%) Extrahepatic Biliary Tree Excision, Duodenal Repair, Roux-en-Y Hepaticojejunostomy 4 (19.1%) 0 (0.0%) Hepatectomy, Excision of Extrahepatic Biliary Tree, Hepaticojejunostomy 4 (19.1%) 2 (9.5%) Whipple’s Procedure (Pancreaticoduodenectomy) 2 (9.5% 4 (19.1%) No Surgery 5 (23.8%) 15 (71.4%) ADJUVANT CHEMOTHERAPY GB Capecitabine 18 (64.3%) 3 (4.2%) <0.001 Gemcitabine 0 (0.0%) 2 (2.8%) Gemcitabine + Cisplatin 1 (3.6%) 4 (5.6%) Cholangiocarcinoma Capecitabine 10 (47.6%) 5 (23.8%) 0.371 Gemcitabine 0 (0.0%) 0 (0.0%) Gemcitabine + Cisplatin 2 (9.5%) 3 (14.3%) NEOADJUVANT CHEMOTHERAPY GB Gemcitabine + Cisplatin 0 (0%) 1 (1.4%) 0.528 Gemcitabine + Cisplatin + Pembrolizumab 0 (0.0%) 5 (7.0%) Cholangiocarcinoma Gemcitabine + Cisplatin 3 (14.3%) 0 (0%) 0.072 Gemcitabine + Cisplatin + Pembrolizumab 0 (0.0%) 0 (0.0%) PALLIATIVE CHEMOTHERAPY GB Gemcitabine + Cisplatin 3 (10.7%) 8 (11.3%) 0.521 FOLFOX 0 (0.0%) 1 (1.4%) Gemcitabine 0 (0.0%) 6 (8.5%) Gemcitabine + Cisplatin + Pembrolizumab 0 (0.0%) 3 (4.2%) Capecitabine 0 (0.0%) 1 (1.4%) Gemcitabine + Nab-Paclitaxel 2 (7.1%) 0 (0.0%) Carboplatin + Etoposide 0 (0.0%) 1 (1.4%) Cholangiocarcinoma Gemcitabine + Cisplatin 2 (9.5%) 6 (28.6%) 0.349 Gemcitabine + Cisplatin + Pembrolizumab 1 (4.8%) 4 (19.0%) FOLFOX 0 (0.0%) 3 (14.3%) Cape OX 0 (0.0%) 2 (9.5%) Gemcitabine + Nab-Paclitaxel 0 (0.0%) 1 (4.8%) Gemcitabine 2 (9.5%) 0 (0.0%) Gemcitabine + Oxaliplatin 0 (0.0%) 1 (4.8%) RADIOTHERAPY GB Conventional RT 1 (3.6%) 0 (0.0%) 0.230 SBRT 0 (0.0%) 1 (1.4%) Cholangiocarcinoma Conventional RT 0 (0.0%) 0 (0.0%) 0.072 SBRT 0 (0.0%) 3 (14.3%) ENDOSCOPIC / PERCUTANEOUS DRAINAGE GB ERCP + Stenting 3 (10.7%) 23 (32.4%) 0.057 PTBD 0 (0.0%) 1 (1.4%) PTC (Percutaneous Cholangiography) 2 (7.1%) 1 (1.4%) Pigtail Catheter 1 (3.6%) 0 (0.0%) Cholangiocarcinoma ERCP + Stenting 9 (42.9%) 7 (33.3%) PTBD 1 (4.8%) 2 (9.5%) PTC (Percutaneous Cholangiography) 0 (0.0%) 0 (0.0%) SUPPORTIVE GB YES 4 (14.3%) 30 (42.3%) 0.029 NO 24 (85.7%) 41 (57.7%) Cholangiocarcinoma YES 2 (9.5%) 11 (52.4%) 0.003 NO 19 (90.5%) 10 (47.6%) SBRT (Stereotactic Body Radiotherapy), ERCP (Endoscopic Retrograde Cholangiopancreatography), PTBD (Percutaneous Transhepatic Biliary Drainage), PTC (Percutaneous Transhepatic Cholangiography). E. Univariate And Multivariate Cox Regression Analysis of Survival Predictors In this cohort of patients with gallbladder cancer (GBC), univariate Cox regression analyses (Table. 4) revealed that traditional demographic and clinical factors such as age, gender, family history, smoking status, presence of gallstones and tumor size did not significantly influence overall survival (all p > 0.05). CA 19-9 was analyzed as a continuous variable, showing a non-significant effect on survival with HR = 1.002 (95% CI: 0.999–1.005), p = 0.130, indicating minimal impact on hazard per unit increase. In contrast, poorer Eastern Cooperative Oncology Group (ECOG) performance status was significantly associated with increased mortality risk (HR = 1.69; 95% CI: 1.02–2.80; p = 0.042), indicating that functional status is a key determinant of prognosis. Disease stage emerged as a robust predictor of survival, with advanced-stage disease conferring a more than fivefold increase in the hazard of death (Univariate HR = 5.48; 95% CI: 1.51–19.90; p = 0.003). This finding underscores the aggressive nature of late-stage GBC and the critical importance of early diagnosis. Treatment modality also significantly affected survival outcomes. Patients receiving treatment in higher-risk groups exhibited a more than twofold increased risk of mortality (HR = 2.19; 95% CI: 1.37–3.49; p = 0.001). Notably, Supportive care appeared protective in univariate analysis (HR = 0.29; 95% CI: 0.14–0.63; p = 0.002); however, in the multivariate Cox regression model, supportive care was not independently associated with survival (HR = 0.85; 95% CI: 0.40–1.80; p = 0.670), suggesting the initial protective effect was confounded by factors such as disease stage and treatment allocation. In multivariate Cox regression analysis (Table. 4), only disease stage and treatment group remained independent predictors of overall survival. Advanced disease stage increased the hazard of death by approximately 4.85 times (HR = 4.85; 95% CI: 1.70–13.80; p = 0.010), and patients in the higher-risk treatment group had a 2.21-fold greater mortality risk compared to lower-risk groups (HR = 2.21; 95% CI: 1.30–3.75; p = 0.003). The non-significance of ECOG status and supportive care in the multivariate model suggests these factors may exert their effects indirectly through disease stage and treatment allocation. The overall treatment group was a significant predictor of survival in multivariate analysis (HR = 2.21; 95% CI: 1.30–3.75; p = 0.003). Furthermore, patients receiving combined surgery and chemotherapy had a 73% reduced risk of death compared to those treated with chemotherapy alone (HR = 0.27; 95% CI: 0.09–0.81; p = 0.019), highlighting the benefit of multimodal therapy. Table 4 UNIVARIATE AND MULTIVARIATE COX REGRESSION ANALYSES OF OVERALL SURVIVAL OF PATIENTS WITH GALLBLADDER CANCER Variable / Comparison Analysis Type Hazard Ratio (HR), 95% Confidence Interval (CI) p-value Age Univariate 1.18 (0.78–1.79) 0.439 Gender Univariate 1.17 (0.61–2.25) 0.631 Family History Univariate 1.64 (0.60–4.47) 0.336 Smoking Univariate 0.90 (0.42–1.91) 0.780 Gall stones Univariate 0.66 (0.34–1.27) 0.210 CA 19-9 Univariate 1.00 (1.00–1.00) 0.130 Tumor Size Univariate 1.01(0.89–1.15) 0.883 ECOG Performance Status Univariate 1.69 (1.02 – 2.80) 0.0042 Disease Stage Univariate 5.48 (1.51 – 19.90) 0.003 Multivariate 0.010 Treatment Group overall Univariate 2.19 (1.37 – 3.49) 0.001 Multivariate 2.21 (1.30 – 3.75) 0.003 Surgery + Chemotherapy vs Chemo Multivariate 0.27 (0.09 – 0.81) 0.019 Supportive Care Univariate 0.29 (0.14–0.63) 0.002 F. mRECIST & SURVIVAL ANALYSIS BY TREATMENT AND DISEASE STAGE Treatment response and survival outcomes were evaluated across both gallbladder cancer (GBC) and cholangiocarcinoma (CCA) cohorts (shown in Table. 5). RECIST-based response assessment showed no significant differences between the two groups, with overall response rates (ORR) of 18.7% in GBC and 15.0% in CCA (p = 0.621), and comparable disease control rates (DCR) of 34.7% and 32.5%, respectively (p = 0.815). TABLE 5: TREATMENT RESPONSE (mRECIST CRITERIA) mRECIST GBC (n=99) Cholangiocarcinoma (n=42) P value CR 9 (9.1%) 3 (7.1%) PD 50 (50.5%) 27 (64.3%) PR 5 (5.1%) 3 (7.1%) SD 12 (12.1%) 7 (16.7%) ORR 14 (18.7%) 6 (15.0%) 0.621 DCR 26 (34.7%) 13 (32.5%) 0.815 Kaplan–Meier survival analyses demonstrated significant differences in overall survival based on both treatment modality and disease stage. Among GBC patients (Figure.2A), survival varied significantly across treatment groups (log-rank χ² = 21.088, df = 2, p < 0.001), and a similar pattern was observed in CCA (Figure.2B) (log-rank χ² = 24.042, df = 2, p < 0.001), emphasizing the prognostic impact of treatment strategy in both tumor types. Stage-wise comparisons revealed a clear survival advantage in early-stage disease (Stage I–III). In GBC (Figure. 3A), patients with early-stage disease had a median survival of 28.6 months (95% CI: 22.98–34.28), compared to a median survival of 12.0 months (95% CI: 10.85–13.15) in Stage IV disease, with a mean survival of 19.3 months for Stage IV. This indicates a significant survival advantage in early-stage disease (log-rank χ² = 4.233, df = 1, p = 0.040). In CCA GBC (Figure. 3B), Stage IV patients had a median survival of 19.0 months, while the median survival for Stage I–III was not reached due to censoring; the difference in survival was statistically significant (log-rank χ² = 8.409, df = 1, p = 0.004). These findings underscore the importance of early detection and aggressive treatment in improving survival outcomes for biliary tract cancers. G. Patient Outcomes and Follow-Up: Table 6 showed patient outcomes and follow-up status for gallbladder cancer (GB) and cholangiocarcinoma (CCA) patients. The 30-day mortality rates were similar between the two groups (GB: 3.0%, CCA: 2.4%; p = 0.355). One-year overall survival was higher in GB patients (66.7%) compared to CCA patients (54.8%), while two-year overall survival was slightly lower in GB (30.3%) than in CCA (42.8%). At the last follow-up, a significantly greater proportion of CCA patients were alive (76.2%) compared to GB patients (38.4%; p < 0.001). Loss to follow-up was notably higher in the GB group (31.3%) compared to the CCA group (4.8%), which may introduce bias in survival estimates and should be considered when interpreting outcomes. Disease progression during treatment was more frequent among CCA patients (64.3%) than GB patients (50.5%). Referral to palliative care was comparable between groups (GB: 56.6%, CCA: 61.9%). TABLE 6: PATIENT OUTCOMES AND FOLLOW-UP STATUS Overall Survival (DAYS OS) GB (n=99) Cholangiocarcinoma (n=42) P-value 30-day Mortality (Died ≤30 days) 3 (3.0%) 1 (2.4%) 0.355 1-Year Overall Survival (OS) 66 (66.7%) 23 (54.8% 2-Year Overall Survival (OS) 30 (30.3%) 18 (42.8%) Currently Alive (At Last Follow-up) 38 (38.4%) 32 (76.2%) <0.001 Lost to Follow-up 31 (31.3%) 2 (4.8%) Progression During Treatment 50 (50.5%) 27 (64.3%) Palliative Care Referral 34 (56.6) 13 (61.9%) DISCUSSION This retrospective analysis of 141 patients with biliary tract malignancies provides critical insights into the clinicopathological spectrum, treatment patterns, and survival outcomes of gallbladder carcinoma (GBC) and cholangiocarcinoma (CCA) in a real-world tertiary care setting. Consistent with global epidemiological trends, GBC was the more prevalent subtype in our cohort, aligning with its known higher incidence in certain geographic regions, including Northern and Eastern India [ 6 ]. CCA cases demonstrated a gradual year-wise increase during the study period, possibly reflecting improved diagnostic capabilities and rising awareness, though the etiology of this trend warrants further investigation [ 7 ]. Our retrospective analysis revealed a median age of 55 years, with a predominant female representation (M:F ratio 1:3), consistent with regional and global epidemiological trends. Global data indicating peak incidence in the sixth decade of life [ 8 , 9 ]. Female predominance observed in both cohorts’ parallels established epidemiologic trends, particularly in GBC, which is known for a higher incidence among women, possibly due to hormonal and reproductive factors [ 10 , 11 ]. The significantly higher prevalence of gallstones in GBC patients (46.5%) corroborates the well-documented association of gallstones as a major risk factor in gallbladder carcinogenesis [ 12 ]. The higher prevalence of hypertension among CCA patients (47.6%) observed in this cohort is notable and may reflect underlying comorbidities influencing disease progression or patient survival. While hypertension is not directly implicated as a risk factor for CCA, recent studies suggest that metabolic syndrome components, including hypertension, might contribute to biliary tract cancer risk through chronic inflammation and altered bile acid metabolism [ 13 , 14 ]. Tumor size and differentiation varied significantly, with GBC tumors presenting larger (mean > 8 cm in > 60% cases) and more frequently poorly differentiated compared to CCA. Despite this, adenocarcinoma remained the predominant histological subtype in both groups, consistent with global epidemiology [ 18 ]. However, the higher proportion of rare histologies (e.g., non-keratinizing and ampullary subtypes) in CCA (16.7%) may warrant further genomic and molecular profiling to guide precision therapies. Immunohistochemical (IHC) profiling, available for a subset of cases, revealed a predominance of CK7 and CK19 expression in both GBC and CCA, supporting their biliary epithelial origin. CDX2 positivity, although less frequent, was primarily noted in GBC cases and may indicate intestinal differentiation in a subset of tumors, as reported in previous studies [ 19 , 20 ]. These markers not only aid in diagnosis but may also serve as potential therapeutic or prognostic indicators in future targeted approaches. A concerning majority of patients presented with advanced disease, with 74.7% of gallbladder cancer (GBC) and 50.0% of cholangiocarcinoma (CCA) cases diagnosed at AJCC Stage IV, highlighting the silent progression characteristic of GBC and poor early detection. This is consistent with reports from other low- and middle-income countries (LMICs), where delays in diagnosis are driven by limited healthcare access and non-specific symptomatology [ 17 ]. The average delay of 2.3 months from symptom onset to diagnosis in our cohort reflects both systemic and patient-level barriers to early detection. This pattern mirrors global data from GLOBOCAN 2022, which identifies late presentation as a key factor contributing to poor outcomes, especially in LMICs [ 21 ]. Consistent with these findings, patients diagnosed at early stages (I–III) showed significantly better overall survival compared to those with metastatic disease (p = 0.001). Advanced disease stage was the strongest independent predictor of poor survival in multivariate Cox analysis (HR = 5.48; p = 0.010), consistent with global literature [ 27 ]. ECOG performance status also impacted survival in univariate analysis, reaffirming its value in treatment selection and prognostication [ 28 ]. Surgical resection remains the only curative option for BTMs [ 22 ]. However, curative surgery was limited to a minority of patients, particularly those with Stage I–III disease (53.6% in GBC and 76.2% in CCA). The significantly lower rate of surgery in Stage IV (23.9% in GBC and 28.6% in CCA) reflects the advanced stage at diagnosis and distant metastasis [ 4 ]. Similar patterns are observed in LMICs due to diagnostic delays and limited access to hepatobiliary surgical expertise. Adjuvant chemotherapy, particularly capecitabine-based regimens, was the most commonly used systemic therapy. This follows evidence from the BILCAP trial, which supports capecitabine as adjuvant therapy post-resection in BTC [ 23 ]. In advanced-stage disease, palliative chemotherapy using gemcitabine–cisplatin was more frequently employed, in line with the ABC-02 trial, which established this regimen as standard of care in unresectable BTC [ 24 ]. Use of neoadjuvant therapy was limited in our cohort, although growing evidence supports its role in borderline resectable cases, especially for perihilar and distal CCA [ 25 ]. Similarly, stereotactic body radiotherapy (SBRT) was underutilized, despite its promising role in local control for unresectable disease [ 26 ]. Advanced disease stage was the strongest independent predictor of poor survival in multivariate Cox analysis (HR = 5.48; p = 0.010), consistent with global literature [ 27 ]. ECOG performance status also impacted survival in univariate analysis, reaffirming its value in treatment selection and prognostication [ 28 ]. Survival analysis showed clear benefits of early-stage diagnosis and multimodal treatment. In gallbladder cancer, patients receiving combined surgery and chemotherapy had a 73% reduced mortality risk compared to those receiving chemotherapy alone (HR = 0.27; p = 0.019). This finding strongly supports a multidisciplinary approach in eligible patients. Despite the aggressive biology of BTCs, treatment response rates remained modest, with ORR and DCR under 35% for both cancers, underscoring the need for novel therapeutic strategies. Immunotherapy and targeted agents (e.g., IDH1 inhibitors, FGFR2 fusions, and HER2-targeted therapies) are emerging as promising options in selected subgroups and may improve outcomes if implemented in local practice [ 29 , 30 ]. FUTURE PERSPECTIVES Molecular profiling and targeted therapies, such as IDH1 inhibitors, FGFR2 fusions, and HER2-targeted treatments, show promise for improving BTC outcomes. Immunotherapy is also emerging as a potential option. Expanding access to these therapies, along with better use of neoadjuvant treatments and SBRT, could enhance survival, especially in low-resource settings. Strengthening diagnostic and treatment infrastructure and fostering multidisciplinary care are key for future progress. LIMITATIONS This study’s retrospective design and single-center setting inherently limit the generalizability of our findings. Potential selection biases and incomplete data capture, especially regarding molecular and immunohistochemical profiling, may impact the comprehensiveness of the clinicopathological correlations. The absence of uniform molecular testing restricted the assessment of emerging targeted biomarkers across the entire cohort. Additionally, treatment decisions were influenced by resource availability and patient factors, which may differ from protocols in other healthcare systems. Despite these limitations, our real-world data provide valuable insights into the challenges and outcomes of BTC in a tertiary care setting typical of low- and middle-income countries. CONCLUSION This study demonstrates that advanced disease stage is the most significant independent predictor of poor survival in patients with gallbladder cancer and cholangiocarcinoma. While demographic factors showed no significant impact, multimodal treatment combining surgery and chemotherapy markedly improved overall survival, highlighting the importance of a multidisciplinary approach. Despite these interventions, response rates remain low, emphasizing the urgent need for novel targeted therapies and immunotherapy. The high rate of advanced-stage presentation and patient loss to follow-up, particularly in resource-limited settings, underscores the necessity for improved early diagnosis, better healthcare access, and expanded treatment options to enhance outcomes for biliary tract cancers. Declarations Ethics Approval and Consent to Participate: The study was approved by the Institutional Review Board of Dow University of Health Sciences (Meeting No. 221st, held on 13th September 2025; IRB Ref: IRB-4230DUHS/EXEMPTION/2025/434). This study was conducted in accordance with the principles of the Declaration of Helsinki. Written informed consent was not obtained because this was a retrospective study using anonymized patient data, and the requirement for consent was waived by the Institutional Review Board of Dow University of Health Sciences. Consent for Publication: Not applicable. Availability of Data and Materials: The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request . Competing Interests: The authors declare no competing interests. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors’ Contributions: Dr. Batool Aslam Memon(PI) and Dr. Maryum Nouman designed the study and supervised the research process. Dr. Maryum Nouman, Dr Batool Asalm Memon and Dr Kiran Marvi collected the data Dr Maryam NasrumminAllah performed the statistical analyses, data interretation and manuscipt drafting. Dr. Mohsin also contributed to data interpretation and manuscript drafting. Dr. Batool Aslam Memon(PI) critically revised the manuscript for important intellectual content. All authors reviewed and approved the final version of the manuscript. References Alvi AR, Rehman A, et al. Risk factors of gallbladder cancer in Karachi–a case-control study. World J Surg Oncol. 2011;9:164. 10.1186/1477-7819-9-164] . [PMID: 21859496. Malik H, Izwan S, Ng J, Teng R, Chan E, Damodaran Prabha R, Puhalla H. Incidence and management of gallbladder cancer in cholecystectomy specimens: a 5-year tertiary centre experience. ANZ J Surg. 2023;93:2481–6. 10.1111/ans.18577] . [PMID: 36987042. Kumar S, et al. Clinical presentation and outcomes of patients with biliary malignancies: the Aga Khan University experience. Asian Pac J Cancer Prev. 2009;10:463–6. [PMID: 19662255]. Bhurgri Y, Bhurgri A, Hasan SH, et al. Cancer patterns in Karachi division (1998–1999). J Pak Med Assoc. 2002;52:244–6. [PMID: 11941654]. 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16:08:50","extension":"png","order_by":28,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":11773,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8219764/v1/91c2c1bc57f94dffac4d274e.png"},{"id":98845820,"identity":"a676797c-860b-4b9a-a012-f3b2167f492f","added_by":"auto","created_at":"2025-12-23 04:29:40","extension":"png","order_by":29,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":10711,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8219764/v1/ffbafd2dd2353629e357f48f.png"},{"id":99308299,"identity":"cc0585d1-9233-4a68-bc33-2d1f7a9ca256","added_by":"auto","created_at":"2025-12-31 16:08:14","extension":"png","order_by":30,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":10331,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-8219764/v1/3f7852d059902323d394887c.png"},{"id":98845818,"identity":"6c2cb84b-d6ac-4887-b1dd-2a6aaa9b099d","added_by":"auto","created_at":"2025-12-23 04:29:40","extension":"xml","order_by":31,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":232463,"visible":true,"origin":"","legend":"","description":"","filename":"438ec1881ec14d98928576fbddb10b7d1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8219764/v1/a041ab5b4c08d10231ed8061.xml"},{"id":98845814,"identity":"7f8d8fbb-d9ec-476d-b805-1d23da87f073","added_by":"auto","created_at":"2025-12-23 04:29:39","extension":"html","order_by":32,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":253113,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8219764/v1/cc0e44550d328dbc2bb9d2a4.html"},{"id":99308329,"identity":"cb2723fd-6d2c-446c-9d04-033cb4a74b77","added_by":"auto","created_at":"2025-12-31 16:08:16","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":137346,"visible":true,"origin":"","legend":"\u003cp\u003eAnnual distribution of biliary tract malignancies. The figure summarizes the number and percentage of patients diagnosed with each type of malignancy—gallbladder cancer (GBC) and cholangiocarcinoma (CCA)—per year over the study period.\u003c/p\u003e","description":"","filename":"FIG1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8219764/v1/386fb0533cc71c9d5871db89.jpg"},{"id":99308201,"identity":"0986348d-5050-4c1f-95d2-55e3de54498b","added_by":"auto","created_at":"2025-12-31 16:07:59","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":89735,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTreatment-based Survival Analysis\u003c/strong\u003e\u003cbr\u003e\n \u003cstrong\u003e2A.\u003c/strong\u003e Kaplan–Meier survival curve for gallbladder cancer (GBC) patients stratified by treatment modality, showing significant differences in overall survival (log-rank χ² = 21.088, df = 2, p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2B.\u003c/strong\u003e Kaplan–Meier survival curve for cholangiocarcinoma (CCA) patients stratified by treatment modality, also demonstrating significant survival differences (log-rank χ² = 24.042, df = 2, p \u0026lt; 0.001).\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8219764/v1/bd08e13b17def262c58cb11f.png"},{"id":98845786,"identity":"bb0d7620-7a25-4874-89c0-304003b9eaf2","added_by":"auto","created_at":"2025-12-23 04:29:38","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":75569,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStage-based Survival Analysis\u003c/strong\u003e\u003cbr\u003e\n \u003cstrong\u003e3A.\u003c/strong\u003e Kaplan–Meier survival curve for gallbladder cancer (GBC) patients stratified by disease stage. Early-stage patients (I–III) showed significantly better survival compared to stage IV (log-rank χ² = 4.233, df = 1, p = 0.040). Mean survival was 28.6 months (95% CI: 22.98–34.28) for early stages, versus 19.3 months (median 12.0 months; 95% CI: 10.85–13.15) for stage IV.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3B.\u003c/strong\u003e Kaplan–Meier survival curve for cholangiocarcinoma (CCA) patients stratified by disease stage, with significantly improved survival for early-stage patients compared to stage IV (log-rank χ² = 8.409, df = 1, p = 0.004). Median survival was 19.0 months for stage IV; median survival for early stages was not reached due to censoring.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8219764/v1/de3eadc96cf6148ad7fbb061.png"},{"id":99787958,"identity":"57123567-859c-4d11-bf91-955106873ac6","added_by":"auto","created_at":"2026-01-08 12:42:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2376754,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8219764/v1/b5084f7d-70f7-4c4c-abec-00f6a37a288c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Management patterns and survival outcomes in biliary tract malignancies: a 3-year retrospective cohort from Karachi, Pakistan","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eBiliary tract malignancies (BTMs) include carcinoma of the gallbladder (GBC) and cholangiocarcinoma. Gallbladder carcinoma was first documented by Austrian physician Maximilian Stoll in 1777\u003csup\u003e1\u003c/sup\u003e. Despite being relatively uncommon overall, GBC is the most common biliary tract malignancy, accounting for eighty to nine-five percent of all biliary tract malignancies. It is the 5th most common gastrointestinal malignancy worldwide\u003csup\u003e2\u003c/sup\u003e. Geographically, GBC incidence varies significantly, with countries like Chile, Japan, and northern India reporting markedly higher rates\u003csup\u003e1\u003c/sup\u003e. Gallstones, porcelain GB, GB poly and congenital cysts and chronic S.typii infections are known risk factors\u003csup\u003e1\u003c/sup\u003e. Cholangiocarcinoma, on the other hand, refers to malignancies arising from the bile ducts, which can be classified as intrahepatic, perihilar (also called Klatskin tumors), or distal depending on their location. It accounts for a smaller proportion of biliary tract cancers but is associated with aggressive behavior and late-stage diagnosis\u003csup\u003e5\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe incidence of gallbladder cancer (GBC) varies significantly across different geographic regions and ethnic groups, ranging from 1 to 23 cases per 100,000 individuals\u003csup\u003e1\u003c/sup\u003e. Over the past two decades, both the incidence and prevalence of GC have reportedly increased in South-East Asia compared to Western countries\u003csup\u003e1,3\u003c/sup\u003e. Unfortunately, Pakistan lacks a formal tumor registry; however, sporadic hospital-based studies indicate that gallbladder cancer (GBC) is a common malignancy in the country, particularly among females. For instance, a study by Bhurgri \u003cem\u003eet al.\u003c/em\u003e (up to 2002) in Karachi South reported that gallbladder cancer (GBC) was the second most common malignancy among females and ranked ninth overall among all cancers\u003csup\u003e1,4\u003c/sup\u003e. However, according to the GLOBOCAN 2022 estimates, gallbladder cancer now ranks 20th among females and 22nd overall worldwide in terms of incidence\u003csup\u003e21\u003c/sup\u003e. The prognosis for gallbladder and Cholangiocarcinoma remains poor, with a five-year survival rate of less than 5%\u003csup\u003e2\u003c/sup\u003e. Several factors contribute to this unfavorable outcome, including the absence of specific clinical symptoms, diagnosis at an advanced stage, and the tumor's tendency for early spread\u003csup\u003e1\u003c/sup\u003e. By the time of diagnosis, the cancer is often inoperable, leading most patients to receive only palliative care\u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe aim of our study is to assess the frequency, clinical characteristics, diagnostic methods, treatment approaches, and analyze outcomes and survival patterns in patients with biliary tract malignancies treated at a tertiary care center over a three-year period.\u003c/p\u003e"},{"header":"METHODS \u0026 MATERIALS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design, Data Sources \u0026amp; Collection:\u003c/h2\u003e \u003cp\u003eThis is a cross-sectional, retrospective study of biopsy proven gallbladder carcinoma or cholangiocarcinoma patients presented during the last 3 years from 1st May 2022 till 1st May 2025 to the Department of Medical Oncology at Dow University Hospital, Karachi, Pakistan.\u003c/p\u003e \u003cp\u003ePrimary Data source was our hospital-based registry of the Medical Oncology Department initially collected manually on the Google excel doc. The diagnosis and staging were done in accordance with international guidelines. Author\u0026rsquo;s retrospectively collected data from unique hospital MR number regarding demographic characteristics for each individual (Age, gender, comorbidities, BMI, smoking, any other malignancy, family history), symptoms at presentation, LFTs and CA 19.9, association of gallstones, imaging studies, mode of diagnoses (radiological or histologic), stage at presentation, metastasis if any, treatment offered (surgical or chemotherapy or chemoradiotherapy), palliative procedure undertaken and overall survival was recorded. The senior registrars conduct monthly audits to ensure the quality of the registration data, and cross-checking is carried out to improve database consistency.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInclusion \u0026 Exclusion Criteria:\u003c/h3\u003e\n\u003cp\u003eInclusion criteria include the following: histopathologic evidence of GB or Cholangiocarcinoma, age 16 years and above \u0026amp;complete medical record.\u003c/p\u003e \u003cp\u003eSuspected GB or cholangiocarcinoma, a history of any other malignant tumor, biliary trauma, bilio-enteric fistula, and other hepatobiliary malignancies are among the exclusion criteria. Patients with insufficient medical records are also not included.\u003c/p\u003e\n\u003ch3\u003eData Collection \u0026 Statistical Analysis:\u003c/h3\u003e\n\u003cp\u003ePatient data will be compiled in Microsoft Excel and analyzed using SPSS version 27.0. Descriptive statistics summarized demographic and clinical characteristics. Group comparisons for categorical variables were made using Chi-square or Fisher\u0026rsquo;s exact tests. Overall survival was estimated with Kaplan\u0026ndash;Meier analysis, and differences between groups were assessed using the log-rank test. Cox proportional hazards regression was applied for univariate and multivariate analyses to identify independent predictors of survival. Treatment responses were compared using RECIST criteria. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eA. \u0026nbsp; Patient Demographics and Clinical Characteristics:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 141 patients with BTMs were included in the study, comprising 99 patients with gallbladder carcinoma (GBC) and 42 with cholangiocarcinoma (CCA). The baseline characteristics are summarized in Table 1. The median age was comparable between groups (GBC: 58.1 \u0026plusmn; 11.8 years vs. CCA: 58.5 \u0026plusmn; 11.5 years; p = 0.971). Female patients predominated in both cohorts (GBC: 58.6%; CCA: 64.3%; p = 0.527).\u003c/p\u003e\n\u003cp\u003eFamily history of cancer was infrequent and showed no significant difference between the groups (GBC: 10.1% vs. CCA: 11.9%; p = 0.751). Comorbidities differed significantly, with hypertension more prevalent in CCA patients (47.6%) compared to GBC (13.1%; p = 0.025). Conversely, gallstones were significantly more common in the GBC group (46.5% vs. 26.2%; p = 0.025), consistent with established etiological associations.\u003c/p\u003e\n\u003cp\u003ePresenting symptoms varied by tumor type. Abdominal pain was more frequently reported in GBC patients (84.8%) than in those with CCA (52.4%), whereas obstructive jaundice was more common in CCA (47.6% vs. 20.2%). Other symptoms, including weight loss, anorexia, and constitutional complaints, were distributed similarly between groups. ECOG performance status was generally favorable in both groups, with ECOG 0\u0026ndash;1 seen in 73.7% of CCA and 73.7% of GBC patients (p = 0.269).\u003c/p\u003e\n\u003cp\u003eLaboratory parameters such as bilirubin levels were markedly elevated in CCA patients (median: 6.46 mg/dL) compared to GBC (0.56 mg/dL), likely reflecting a higher incidence of biliary obstruction. Tumor markers and liver enzymes showed high variability but were not statistically different between the two groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTABLE 1\u0026ensp;\u0026thinsp;BASELINE DEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF PATIENTS WITH BILLIARY TRACT MALAGNANCIES\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGB (n=99)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCHOLANGIOCARCINOMA (n=42)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, median (range), years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e58.1 \u0026plusmn; 11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e58.5 \u0026plusmn; 11.5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e0.971\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026lt;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e8(8.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e3 (7.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e40-59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e43 (43.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e19 (45.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026ge;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e48 (48.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e20 (47.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e0.527\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e41 (41.4%).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e15 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e58 (58.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e27 (64.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily History\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e0.751\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003ePositive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e10 (10.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e5 (11.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eNegative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e89 (89.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e37 (88.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.025\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eLiver diseases (HBV, HCV, NBNC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e5 (5.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e3 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eHypertension (HTN)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e13 (13.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e20 (47.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eDiabetes (DM)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e21 (21.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e7 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eIschemic Heart Disease (IHD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e4 (4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eNKCM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e56 (56.56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e12 (28.57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAddictions History\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.502\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e23 (23.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e12 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e76 (76.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e30 (71.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGall Stones\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.025\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003ePresent\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e46 (46.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e11 (26.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eAbsent\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e53 (53.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e31 (73.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePresenting Symptoms\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eObstructive Jaundice\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e20 (20.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e20 (47.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eAbdominal Pain\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e84 (84.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e22 (52.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eWeight loss\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e33 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e20 (47.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eNausea / Vomiting / Anorexia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e19 (19.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e13 (31.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eEpigastric / Dyspeptic symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e11 (11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e10 (23.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eConstitutional symptoms (weakness, fatigue, constipation, breathlessness, general malaise)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e15 (15.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e9 (21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eOther / Non-specific (back pain, hematuria, dysphagia, SOB)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e10 (10.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e6 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eECOG Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.269\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e21 (21.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e15 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;52 (52.5%)\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e20 (47.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e20 (20.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e6 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e6 (6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e1 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline Labs\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCA-19-9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e700 (356, 7459.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e1.0 (0.6, 221)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCEA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e2.89 (2.40, 4.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e2.38 (1.48, 2.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAFP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e5.0 (2.13, 5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e3.8 (3.1, 194.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBilirubin (mg/dL) median, (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e0.56 (0.48, 2.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e6.46 (3.45, 17.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e0.602\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eALT IU/L (\u0026mu;mol/L), median (Q1, Q3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e21 (13, 67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e59 (38, 139)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e0.852\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eALP (\u0026mu;mol/L), median (Q1, Q3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e671 (345, 1526)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e338 (323.5, 504.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.468\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAST IU/L (\u0026mu;mol/L), median (Q1, Q3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e29 (28, 56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e118 (73, 120.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e0.877\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGGT IU/L (\u0026mu;mol/L), median (Q1, Q3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e96 (66.5, 383)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e388 (239.5, 580.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.206\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eB. \u0026nbsp; Year-wise Distribution of Cases:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYear-wise trend shows that gallbladder carcinoma (GB) cases were highest in 2023 (n = 34, 34.3%), followed by 2025 (n = 30, 30.3%) and 2024 (n = 27, 27.3%) (shown in Fig. 1). In contrast, cholangiocarcinoma cases showed a gradual increase over time, with the highest number recorded in 2025 (n = 16, 38.1%), and equal counts in 2023 and 2024 (n = 9, 21.4% each). In 2022, both GB and cholangiocarcinoma had 8 cases each. Although the data for 2025 were available only up to May 2025, the observed counts already indicate a higher incidence of both GB and cholangiocarcinoma, suggesting a continuing upward trend.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eC. \u0026nbsp; Tumor Characteristics:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTumor characteristics are presented in Table 2. GBC tumors tended to be larger at presentation than CCA tumors. Tumors \u0026ge;5 cm were more prevalent in GBC (60.6%) compared to CCA (19.0%; p \u0026lt; 0.001), with a significantly higher mean tumor size among GBC patients across all categories.\u003c/p\u003e\n\u003cp\u003eStaging at presentation revealed a higher proportion of advanced disease (Stage IV) among GBC patients (74.7%) than CCA patients (50.0%; p = 0.037). Histologically, adenocarcinoma was the most common subtype in both groups (GBC: 70.7%; CCA: 64.3%), followed by squamous and mucinous carcinoma. Notably, rare histologies (e.g., ampullary carcinoma, non-keratinizing subtypes) were more frequent in the CCA cohort (16.7% vs. 4.0%; p = 0.022). Poorly differentiated tumors were more common in CCA (50.0%) compared to GBC (40.4%), though this was not statistically significant (p = 0.078).\u003c/p\u003e\n\u003cp\u003eLymph node involvement and metastases were common in both groups, with liver being the most frequent site of metastasis (GBC: 46.5%; CCA: 54.8%). Time from symptom onset to diagnosis averaged 2.33 \u0026plusmn; 2.83 months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTABLE 2: MALIGNANCY AND TUMOR CHARACTERISTICS OF PATIENTS WITH BILIARY TRACT CANCERS\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"636\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMALIGNANCY DETAILS\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFREQUENCY (n=)/\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eMEAN \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eP VALUE\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTumor size (cm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026lt;3 cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eGB Cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e22 (2.42 \u0026plusmn; 0.57 cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eCholangiocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e28 (\u003c/strong\u003e1.65 \u0026plusmn; 0.58 cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e3\u0026ndash;5 cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eGB Cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e17 (\u003c/strong\u003e4.03 \u0026plusmn; 0.48 cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eCholangiocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6 (\u003c/strong\u003e3.88 \u0026plusmn; 0.46 cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026gt;5 cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eGB Cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e60 (8.19 \u0026plusmn; 2.57 cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eCholangiocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e8 (5.85 \u0026plusmn; 0.74 cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of Malignancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"11\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003eGallbladder carcinoma (8140/3 | C23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e92 (65.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003eCholangiocarcinoma\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e42 (34.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003e\u0026middot; Intrahepatic (8160/3 | C22.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e11 (7.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003e\u0026middot; Hilar (8162/3 | C24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e5 (3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003e\u0026middot; Perihilar (Klatskin tumor) (8162/3 | C24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e7 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003e\u0026middot; Klatskin (8162/3 | C24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e3 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003e\u0026middot; Distal extrahepatic (8160/3 | C24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e14 (9.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003e\u0026middot; Ampullary carcinoma (8144/3 | C24.1) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e6 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003e\u0026middot; Non-keratinizing cholangiocarcinoma (8072/3 | C24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e2 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003eLarge Cell Neuroendocrine Carcinoma (8013/3 | C23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e1 (0.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTumor Stage at Presentation\u003c/strong\u003e \u003cem\u003e(AJCC TNM)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"10\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.037\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eStage I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eGB Cancer\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e3 (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eCholangiocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eStage II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eGB Cancer\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e4 (4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eCholangiocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e8 (19.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eStage III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eGB Cancer\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e21 (21.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eCholangiocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e13 (31.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eStage IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eGB Cancer\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e74 (74.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eCholangiocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e26 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistopathological Type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eAdenocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eGB Cancer\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e70 (70.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"10\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.022\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eCholangiocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e27 (64.3%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eSquamous cell carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eGB Cancer\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e7 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eCholangiocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e2 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eMucinous carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eGB Cancer\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e3 (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eCholangiocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2 (4.8%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eNeuroendocrine carcinoma\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eGB Cancer\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003cstrong\u003e1 (1.0%)\u003c/strong\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eCholangiocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0 (0.0%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eOther / Rare types\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eGB Cancer\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e4 (4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eCholangiocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e7 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistological Grade\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.078\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003eWell-differentiated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eGB Cancer\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e18 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eCholangiocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e2 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003eModerately differentiated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eGB Cancer\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;40 (40.4%)\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eCholangiocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e16 (38.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003ePoorly differentiated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eGB Cancer\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e40 (40.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eCholangiocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e21 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eImmunohistochemical Markers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"15\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.376\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" rowspan=\"9\" valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGB\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eCK7\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e17 (17.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eCK19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e15 (15.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eCK20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e8 (8.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eAE1/AE3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e3 (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eCDX2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e3 (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eP63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e2 (2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eKi-67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e1 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eSynaptophysin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e1 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eCK5/6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e1 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" rowspan=\"5\" valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCholangiocarcinoma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eCK7\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e2 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eCK19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e5 (11.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eCK20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e2 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eAE1/AE3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e3 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eCDX2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e1 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLymph Node Involvement\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.379\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eGB Cancer\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e83 (83.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eCholangiocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e32 (76.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eGB Cancer\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e16 (16.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eCholangiocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e10 (23.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMetastasis at Diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"16\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.756\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" rowspan=\"11\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eLiver\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e46 (46.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eLung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e3 (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eAbdomen (peritoneal, omental, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e6 (6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eAdrenal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e3 (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eduodenum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e3 (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003epancreas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e1 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eCecum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e2 (2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003ecervix\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e1 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eAdnexal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e1 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003ePortal vein\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e1 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eNo Metastasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e25 (27.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" rowspan=\"4\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCholangiocarcinoma\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eLiver\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e23 (54.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eLung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e1 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eBone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e\u0026nbsp;2 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eNo Metastasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e16 (38.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime from Symptom Onset to Diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e2.33 \u0026plusmn; 2.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eD. \u0026nbsp; Treatment Modalities:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 141 patients with biliary tract cancers were included, comprising 49 with Stage I\u0026ndash;III and 92 with Stage IV disease (Table 3). Among these, gallbladder (GB) cancer patients accounted for 28 in Stage I\u0026ndash;III and 74 in Stage IV, while cholangiocarcinoma patients included 21 in both Stage I\u0026ndash;III and Stage IV groups. Among GB cancer patients, surgical intervention was significantly more frequent in early-stage disease, with 53.6% (15/28) undergoing curative resection compared to 23.9% (16/67) in Stage IV (p = 0.032). The most common procedure in Stage I\u0026ndash;III GB cases was extended cholecystectomy with lymphadenectomy (35.7%), followed by cholecystectomy (10.7%) and hepatic resection with hepaticojejunostomy (10.7%). A single patient (3.6%) underwent laparoscopic cholecystectomy with lymph node harvest, completion cholecystectomy with extrahepatic biliary tree excision, lymphadenectomy, and billio-enteric anastomosis. In comparison, among Stage IV GB patients, extended cholecystectomy with lymphadenectomy was performed in only 7.0%, cholecystectomy in 11.3%, and Whipple\u0026rsquo;s procedure in 1.4%, while 76.1% did not undergo any surgical intervention. For cholangiocarcinoma, surgical management was also more frequent in early stages, with 76.2% (16/21) of Stage I\u0026ndash;III patients undergoing resection versus 28.6% (6/21) in Stage IV (p = 0.005). The most common operations included extended hepatic resections and Whipple\u0026rsquo;s procedures, performed in 9.5% of early-stage and 19.1% of advanced-stage cases. Two patients (2.8%) underwent laparoscopic excision of a liver lesion. No surgical procedure was recorded in 23.8% of Stage I\u0026ndash;III and 71.4% of Stage IV cholangiocarcinoma patients, demonstrating a substantial decline in curative surgery with disease advancement. Notably, in patients classified as Stage IV, surgery was performed prior to the recognition of disease progression, and the diagnosis of advanced disease was made incidentally on postoperative histopathological examination rather than as part of a planned resection for known metastasis.\u003c/p\u003e\n\u003cp\u003eAmong Stage I\u0026ndash;III GB patients, adjuvant chemotherapy was predominantly capecitabine (64.3%), while gemcitabine + cisplatin was administered to 3.6% and gemcitabine alone to 0%. In contrast, Stage I\u0026ndash;III cholangiocarcinoma patients received capecitabine in 47.6% and gemcitabine + cisplatin in 9.5%; no patients received gemcitabine alone. Neoadjuvant chemotherapy was infrequently used: 3 Stage I\u0026ndash;III cholangiocarcinoma patients received gemcitabine + cisplatin, while no Stage I\u0026ndash;III GB patients received neoadjuvant therapy. These findings highlight that curative-intent chemotherapy was largely restricted to early-stage disease.\u003c/p\u003e\n\u003cp\u003ePalliative chemotherapy was predominantly administered to Stage IV patients. In GB cancer, gemcitabine + cisplatin was used in 11.3%, gemcitabine alone in 8.5%, gemcitabine + cisplatin + pembrolizumab in 4.2%, and less frequently capecitabine, FOLFOX, gemcitabine + nab-paclitaxel, or carboplatin + etoposide. For cholangiocarcinoma, Stage IV patients received gemcitabine + cisplatin in 28.6%, gemcitabine + cisplatin + pembrolizumab in 19.0%, FOLFOX in 14.3%, Cape OX in 9.5%, and individual patients received gemcitabine alone, gemcitabine + nab-paclitaxel, or gemcitabine + oxaliplatin. Radiotherapy was infrequently used, with only one Stage IV GB patient receiving SBRT and 14.3% of Stage IV cholangiocarcinoma patients receiving SBRT (p = 0.072).\u003c/p\u003e\n\u003cp\u003eEndoscopic or percutaneous biliary drainage was more frequently performed in Stage IV GB cancer patients, with ERCP plus stenting utilized in 32.4% compared to 10.7% of Stage I\u0026ndash;III patients (p = 0.057). Percutaneous transhepatic biliary drainage (PTBD) was rare, performed in 0% of Stage I\u0026ndash;III and 1.4% of Stage IV GB patients, while percutaneous cholangiography (PTC) was done in 7.1% of Stage I\u0026ndash;III and 1.4% of Stage IV GB patients. In cholangiocarcinoma, ERCP with stenting was used in 42.9% of Stage I\u0026ndash;III and 33.3% of Stage IV patients, with PTBD performed in 4.8% of Stage I\u0026ndash;III and 9.5% of Stage IV cases; PTC was not performed in either group. These interventions likely reflect the increased need for biliary decompression in advanced disease to manage obstructive symptoms and improve quality of life.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSupportive care measures were significantly more utilized in advanced disease: 42.3% of Stage IV GB and 52.4% of Stage IV cholangiocarcinoma patients received supportive care compared to 14.3% and 9.5% in Stage I\u0026ndash;III, respectively (p = 0.029 for GB, p = 0.003 for cholangiocarcinoma).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTABLE 3: TREATMENT MODALITIES RECEIVED BY PATIENTS WITH BILIARY TRACT CANCERS\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 60.4269%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment Modality\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1068%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSTAGE I-III\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=49)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSTAGE IV\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=92)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP VALUE\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSURGICAL INTERVENTION\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCurative resection (R0/R1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 29.5567%;\"\u003e\n \u003cp\u003eCholecystectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e3 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e8 (11.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 29.5567%;\"\u003e\n \u003cp\u003eExtended Cholecystectomy with Lymphadenectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e10 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5 (7.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 29.5567%;\"\u003e\n \u003cp\u003eHepatic Resection + Hepaticojejunostomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e3 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 29.5567%;\"\u003e\n \u003cp\u003eWhipple\u0026rsquo;s Procedure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 29.5567%;\"\u003e\n \u003cp\u003eLaparoscopic cholecystectomy with lymph node harvest (LNH), Completion cholecystectomy + extrahepatic biliary tree excision + lymphadenectomy + bilioenteric anastomosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e1 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;0 (0.0%)\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eLaparoscopic excision of liver lesion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e\u0026nbsp;0 (0.0%)\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4795%;\"\u003e\n \u003cp\u003e2 (2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eNO Surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e13 (46.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4795%;\"\u003e\n \u003cp\u003e54 (76.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCholangiocarcinoma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 29.5567%;\"\u003e\n \u003cp\u003eCholecystectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e4 (19.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 29.5567%;\"\u003e\n \u003cp\u003eExtended Left Hepatic Resection, Caudate Lobe Resection, Excision of Extrahepatic Bile Ducts, Right Hepatic Artery \u0026amp; Portal Vein Resection and Reconstruction, Roux-en-Y Hepaticojejunostomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e2 (9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 29.5567%;\"\u003e\n \u003cp\u003eExtrahepatic Biliary Tree Excision, Duodenal Repair, Roux-en-Y Hepaticojejunostomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e4 (19.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;0 (0.0%)\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 29.5567%;\"\u003e\n \u003cp\u003eHepatectomy, Excision of Extrahepatic Biliary Tree, Hepaticojejunostomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e4 (19.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;2 (9.5%)\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eWhipple\u0026rsquo;s Procedure (Pancreaticoduodenectomy)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e2 (9.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4795%;\"\u003e\n \u003cp\u003e4 (19.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eNo Surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e5 (23.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4795%;\"\u003e\n \u003cp\u003e15 (71.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eADJUVANT CHEMOTHERAPY\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" rowspan=\"3\" valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eGB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.422%;\"\u003e\n \u003cp\u003eCapecitabine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e18 (64.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.422%;\"\u003e\n \u003cp\u003eGemcitabine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e\u0026nbsp;0 (0.0%)\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2 (2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eGemcitabine + Cisplatin\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4 (5.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" rowspan=\"3\" valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCholangiocarcinoma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.422%;\"\u003e\n \u003cp\u003eCapecitabine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e10 (47.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5 (23.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.371\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.422%;\"\u003e\n \u003cp\u003eGemcitabine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.422%;\"\u003e\n \u003cp\u003eGemcitabine + Cisplatin\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e2 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNEOADJUVANT CHEMOTHERAPY\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\" valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.422%;\"\u003e\n \u003cp\u003eGemcitabine + Cisplatin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.528\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.422%;\"\u003e\n \u003cp\u003eGemcitabine + Cisplatin + Pembrolizumab\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5 (7.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\" valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCholangiocarcinoma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.422%;\"\u003e\n \u003cp\u003eGemcitabine + Cisplatin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e3 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.422%;\"\u003e\n \u003cp\u003eGemcitabine + Cisplatin + Pembrolizumab\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 60.4269%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePALLIATIVE CHEMOTHERAPY\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1068%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" rowspan=\"7\" valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGB\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.422%;\"\u003e\n \u003cp\u003eGemcitabine + Cisplatin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e3 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e8 (11.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.521\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.422%;\"\u003e\n \u003cp\u003eFOLFOX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.422%;\"\u003e\n \u003cp\u003eGemcitabine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e6 (8.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.422%;\"\u003e\n \u003cp\u003eGemcitabine + Cisplatin + Pembrolizumab\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.422%;\"\u003e\n \u003cp\u003eCapecitabine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.422%;\"\u003e\n \u003cp\u003eGemcitabine + Nab-Paclitaxel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e2 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.422%;\"\u003e\n \u003cp\u003eCarboplatin + Etoposide\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" rowspan=\"7\" valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCholangiocarcinoma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.422%;\"\u003e\n \u003cp\u003eGemcitabine + Cisplatin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e2 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e6 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.349\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.422%;\"\u003e\n \u003cp\u003eGemcitabine + Cisplatin + Pembrolizumab\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e1 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4 (19.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.422%;\"\u003e\n \u003cp\u003eFOLFOX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;3 (14.3%)\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.422%;\"\u003e\n \u003cp\u003eCape OX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.422%;\"\u003e\n \u003cp\u003eGemcitabine + Nab-Paclitaxel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eGemcitabine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e2 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eGemcitabine + Oxaliplatin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 60.4269%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRADIOTHERAPY\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1068%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\" valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.422%;\"\u003e\n \u003cp\u003eConventional RT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e1 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.230\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.422%;\"\u003e\n \u003cp\u003eSBRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\" valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCholangiocarcinoma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.422%;\"\u003e\n \u003cp\u003eConventional RT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.422%;\"\u003e\n \u003cp\u003eSBRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1067%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;3 (14.3%)\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eENDOSCOPIC / PERCUTANEOUS DRAINAGE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"4\" valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 28.0788%;\"\u003e\n \u003cp\u003eERCP + Stenting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1068%;\"\u003e\n \u003cp\u003e3 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e23 (32.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 28.0788%;\"\u003e\n \u003cp\u003ePTBD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1068%;\"\u003e\n \u003cp\u003e\u0026nbsp;0 (0.0%)\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003ePTC (Percutaneous Cholangiography)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e2 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4795%;\"\u003e\n \u003cp\u003e1 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003ePigtail Catheter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4795%;\"\u003e\n \u003cp\u003e\u0026nbsp;0 (0.0%)\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCholangiocarcinoma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 28.0788%;\"\u003e\n \u003cp\u003eERCP + Stenting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1068%;\"\u003e\n \u003cp\u003e9 (42.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;7 (33.3%)\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003ePTBD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4795%;\"\u003e\n \u003cp\u003e2 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003ePTC (Percutaneous Cholangiography)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4795%;\"\u003e\n \u003cp\u003e\u0026nbsp;0 (0.0%)\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSUPPORTIVE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 416px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGB\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 28.0788%;\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1068%;\"\u003e\n \u003cp\u003e4 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e30 (42.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 28.0788%;\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1068%;\"\u003e\n \u003cp\u003e24 (85.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e41 (57.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCholangiocarcinoma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 28.0788%;\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1068%;\"\u003e\n \u003cp\u003e2 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e11 (52.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 28.0788%;\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1068%;\"\u003e\n \u003cp\u003e19 (90.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e10 (47.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eSBRT (Stereotactic Body Radiotherapy), ERCP (Endoscopic Retrograde Cholangiopancreatography), PTBD (Percutaneous Transhepatic Biliary Drainage), PTC (Percutaneous Transhepatic Cholangiography).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eE. \u0026nbsp; Univariate And Multivariate Cox Regression Analysis of Survival Predictors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this cohort of patients with gallbladder cancer (GBC), univariate Cox regression analyses (Table. 4) revealed that traditional demographic and clinical factors such as age, gender, family history, smoking status, presence of gallstones and tumor size did not significantly influence overall survival (all p \u0026gt; 0.05). CA 19-9 was analyzed as a continuous variable, showing a non-significant effect on survival with HR = 1.002 (95% CI: 0.999\u0026ndash;1.005), p = 0.130, indicating minimal impact on hazard per unit increase. In contrast, poorer Eastern Cooperative Oncology Group (ECOG) performance status was significantly associated with increased mortality risk (HR = 1.69; 95% CI: 1.02\u0026ndash;2.80; p = 0.042), indicating that functional status is a key determinant of prognosis. Disease stage emerged as a robust predictor of survival, with advanced-stage disease conferring a more than fivefold increase in the hazard of death (Univariate HR = 5.48; 95% CI: 1.51\u0026ndash;19.90; p = 0.003). This finding underscores the aggressive nature of late-stage GBC and the critical importance of early diagnosis. Treatment modality also significantly affected survival outcomes. Patients receiving treatment in higher-risk groups exhibited a more than twofold increased risk of mortality (HR = 2.19; 95% CI: 1.37\u0026ndash;3.49; p = 0.001). Notably, Supportive care appeared protective in univariate analysis (HR = 0.29; 95% CI: 0.14\u0026ndash;0.63; p = 0.002); however, in the multivariate Cox regression model, supportive care was not independently associated with survival (HR = 0.85; 95% CI: 0.40\u0026ndash;1.80; p = 0.670), suggesting the initial protective effect was confounded by factors such as disease stage and treatment allocation.\u003c/p\u003e\n\u003cp\u003eIn multivariate Cox regression analysis (Table. 4), only disease stage and treatment group remained independent predictors of overall survival. Advanced disease stage increased the hazard of death by approximately 4.85 times (HR = 4.85; 95% CI: 1.70\u0026ndash;13.80; p = 0.010), and patients in the higher-risk treatment group had a 2.21-fold greater mortality risk compared to lower-risk groups (HR = 2.21; 95% CI: 1.30\u0026ndash;3.75; p = 0.003). The non-significance of ECOG status and supportive care in the multivariate model suggests these factors may exert their effects indirectly through disease stage and treatment allocation. The overall treatment group was a significant predictor of survival in multivariate analysis (HR = 2.21; 95% CI: 1.30\u0026ndash;3.75; p = 0.003).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFurthermore, patients receiving combined surgery and chemotherapy had a 73% reduced risk of death compared to those treated with chemotherapy alone (HR = 0.27; 95% CI: 0.09\u0026ndash;0.81; p = 0.019), highlighting the benefit of multimodal therapy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 UNIVARIATE AND MULTIVARIATE COX REGRESSION ANALYSES OF OVERALL SURVIVAL OF PATIENTS WITH GALLBLADDER CANCER\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable / Comparison\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 32.184%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnalysis Type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8242%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHazard Ratio (HR), 95% Confidence Interval (CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 32.184%;\"\u003e\n \u003cp\u003eUnivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8242%;\"\u003e\n \u003cp\u003e1.18 (0.78\u0026ndash;1.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.439\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 32.184%;\"\u003e\n \u003cp\u003eUnivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8242%;\"\u003e\n \u003cp\u003e1.17 (0.61\u0026ndash;2.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.631\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily History\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 32.184%;\"\u003e\n \u003cp\u003eUnivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8242%;\"\u003e\n \u003cp\u003e1.64 (0.60\u0026ndash;4.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.336\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 32.184%;\"\u003e\n \u003cp\u003eUnivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8242%;\"\u003e\n \u003cp\u003e0.90 (0.42\u0026ndash;1.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.780\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGall stones\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 32.184%;\"\u003e\n \u003cp\u003eUnivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8242%;\"\u003e\n \u003cp\u003e0.66 (0.34\u0026ndash;1.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.210\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCA 19-9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 32.184%;\"\u003e\n \u003cp\u003eUnivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8242%;\"\u003e\n \u003cp\u003e1.00 (1.00\u0026ndash;1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTumor Size\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 32.184%;\"\u003e\n \u003cp\u003eUnivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8242%;\"\u003e\n \u003cp\u003e1.01(0.89\u0026ndash;1.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.883\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eECOG Performance Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 32.184%;\"\u003e\n \u003cp\u003eUnivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8242%;\"\u003e\n \u003cp\u003e1.69 (1.02 \u0026ndash; 2.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.0042\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisease Stage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 32.184%;\"\u003e\n \u003cp\u003eUnivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 22.8242%;\"\u003e\n \u003cp\u003e5.48 (1.51 \u0026ndash; 19.90)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 32.184%;\"\u003e\n \u003cp\u003eMultivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment Group overall\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 32.184%;\"\u003e\n \u003cp\u003eUnivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8242%;\"\u003e\n \u003cp\u003e2.19 (1.37 \u0026ndash; 3.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 32.184%;\"\u003e\n \u003cp\u003eMultivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8242%;\"\u003e\n \u003cp\u003e2.21 (1.30 \u0026ndash; 3.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eSurgery + Chemotherapy vs Chemo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.629%;\"\u003e\n \u003cp\u003eMultivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8242%;\"\u003e\n \u003cp\u003e0.27 (0.09 \u0026ndash; 0.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.019\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eSupportive Care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.629%;\"\u003e\n \u003cp\u003eUnivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8242%;\"\u003e\n \u003cp\u003e0.29 (0.14\u0026ndash;0.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eF. mRECIST \u0026amp; SURVIVAL ANALYSIS BY TREATMENT AND DISEASE STAGE\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment response and survival outcomes were evaluated across both gallbladder cancer (GBC) and cholangiocarcinoma (CCA) cohorts (shown in Table. 5).\u003c/strong\u003e RECIST-based response assessment showed no significant differences between the two groups, with overall response rates (ORR) of 18.7% in GBC and 15.0% in CCA (p = 0.621), and comparable disease control rates (DCR) of 34.7% and 32.5%, respectively (p = 0.815).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTABLE 5: TREATMENT RESPONSE (mRECIST CRITERIA)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"682\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003emRECIST\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGBC (n=99)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCholangiocarcinoma (n=42)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eCR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e9 (9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e3 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003ePD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e50 (50.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e27 (64.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003ePR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e5 (5.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e3 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eSD\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e12 (12.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e7 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eORR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e14 (18.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e6 (15.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e0.621\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eDCR\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e26 (34.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e13 (32.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e0.815\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eKaplan\u0026ndash;Meier survival analyses demonstrated significant differences in overall survival based on both treatment modality and disease stage. Among GBC patients (Figure.2A), survival varied significantly across treatment groups (log-rank \u0026chi;\u0026sup2; = 21.088, df = 2, p \u0026lt; 0.001), and a similar pattern was observed in CCA (Figure.2B) (log-rank \u0026chi;\u0026sup2; = 24.042, df = 2, p \u0026lt; 0.001), emphasizing the prognostic impact of treatment strategy in both tumor types.\u003c/p\u003e\n\u003cp\u003eStage-wise comparisons revealed a clear survival advantage in early-stage disease (Stage I\u0026ndash;III). In GBC (Figure. 3A), patients with early-stage disease had a median survival of 28.6 months (95% CI: 22.98\u0026ndash;34.28), compared to a median survival of 12.0 months (95% CI: 10.85\u0026ndash;13.15) in Stage IV disease, with a mean survival of 19.3 months for Stage IV. This indicates a significant survival advantage in early-stage disease (log-rank \u0026chi;\u0026sup2; = 4.233, df = 1, p = 0.040). In CCA GBC (Figure. 3B), Stage IV patients had a median survival of 19.0 months, while the median survival for Stage I\u0026ndash;III was not reached due to censoring; the difference in survival was statistically significant (log-rank \u0026chi;\u0026sup2; = 8.409, df = 1, p = 0.004). These findings underscore the importance of early detection and aggressive treatment in improving survival outcomes for biliary tract cancers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eG. Patient Outcomes and Follow-Up:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 6 showed patient outcomes and follow-up status for gallbladder cancer (GB) and cholangiocarcinoma (CCA) patients. The 30-day mortality rates were similar between the two groups (GB: 3.0%, CCA: 2.4%; p = 0.355). One-year overall survival was higher in GB patients (66.7%) compared to CCA patients (54.8%), while two-year overall survival was slightly lower in GB (30.3%) than in CCA (42.8%). At the last follow-up, a significantly greater proportion of CCA patients were alive (76.2%) compared to GB patients (38.4%; p \u0026lt; 0.001). Loss to follow-up was notably higher in the GB group (31.3%) compared to the CCA group (4.8%), which may introduce bias in survival estimates and should be considered when interpreting outcomes. Disease progression during treatment was more frequent among CCA patients (64.3%) than GB patients (50.5%). Referral to palliative care was comparable between groups (GB: 56.6%, CCA: 61.9%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTABLE 6: PATIENT OUTCOMES AND FOLLOW-UP STATUS\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall Survival (DAYS OS)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGB (n=99)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCholangiocarcinoma (n=42)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e30-day Mortality (Died \u0026le;30 days)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e3 (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e1 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e0.355\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1-Year Overall Survival (OS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e66 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e23 (54.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2-Year Overall Survival (OS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e30 (30.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e18 (42.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrently Alive (At Last Follow-up)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e38 (38.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e32 (76.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLost to Follow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e31 (31.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e2 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProgression During Treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e50 (50.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e27 (64.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePalliative Care Referral\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e34 (56.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e13 (61.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003e This retrospective analysis of 141 patients with biliary tract malignancies provides critical insights into the clinicopathological spectrum, treatment patterns, and survival outcomes of gallbladder carcinoma (GBC) and cholangiocarcinoma (CCA) in a real-world tertiary care setting. Consistent with global epidemiological trends, GBC was the more prevalent subtype in our cohort, aligning with its known higher incidence in certain geographic regions, including Northern and Eastern India [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. CCA cases demonstrated a gradual year-wise increase during the study period, possibly reflecting improved diagnostic capabilities and rising awareness, though the etiology of this trend warrants further investigation [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Our retrospective analysis revealed a median age of 55 years, with a predominant female representation (M:F ratio 1:3), consistent with regional and global epidemiological trends. Global data indicating peak incidence in the sixth decade of life [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Female predominance observed in both cohorts\u0026rsquo; parallels established epidemiologic trends, particularly in GBC, which is known for a higher incidence among women, possibly due to hormonal and reproductive factors [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The significantly higher prevalence of gallstones in GBC patients (46.5%) corroborates the well-documented association of gallstones as a major risk factor in gallbladder carcinogenesis [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe higher prevalence of hypertension among CCA patients (47.6%) observed in this cohort is notable and may reflect underlying comorbidities influencing disease progression or patient survival. While hypertension is not directly implicated as a risk factor for CCA, recent studies suggest that metabolic syndrome components, including hypertension, might contribute to biliary tract cancer risk through chronic inflammation and altered bile acid metabolism [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTumor size and differentiation varied significantly, with GBC tumors presenting larger (mean\u0026thinsp;\u0026gt;\u0026thinsp;8 cm in \u0026gt;\u0026thinsp;60% cases) and more frequently poorly differentiated compared to CCA. Despite this, adenocarcinoma remained the predominant histological subtype in both groups, consistent with global epidemiology [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. However, the higher proportion of rare histologies (e.g., non-keratinizing and ampullary subtypes) in CCA (16.7%) may warrant further genomic and molecular profiling to guide precision therapies. Immunohistochemical (IHC) profiling, available for a subset of cases, revealed a predominance of CK7 and CK19 expression in both GBC and CCA, supporting their biliary epithelial origin. CDX2 positivity, although less frequent, was primarily noted in GBC cases and may indicate intestinal differentiation in a subset of tumors, as reported in previous studies [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. These markers not only aid in diagnosis but may also serve as potential therapeutic or prognostic indicators in future targeted approaches.\u003c/p\u003e \u003cp\u003eA concerning majority of patients presented with advanced disease, with 74.7% of gallbladder cancer (GBC) and 50.0% of cholangiocarcinoma (CCA) cases diagnosed at AJCC Stage IV, highlighting the silent progression characteristic of GBC and poor early detection. This is consistent with reports from other low- and middle-income countries (LMICs), where delays in diagnosis are driven by limited healthcare access and non-specific symptomatology [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The average delay of 2.3 months from symptom onset to diagnosis in our cohort reflects both systemic and patient-level barriers to early detection. This pattern mirrors global data from GLOBOCAN 2022, which identifies late presentation as a key factor contributing to poor outcomes, especially in LMICs [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Consistent with these findings, patients diagnosed at early stages (I\u0026ndash;III) showed significantly better overall survival compared to those with metastatic disease (p\u0026thinsp;=\u0026thinsp;0.001). Advanced disease stage was the strongest independent predictor of poor survival in multivariate Cox analysis (HR\u0026thinsp;=\u0026thinsp;5.48; p\u0026thinsp;=\u0026thinsp;0.010), consistent with global literature [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. ECOG performance status also impacted survival in univariate analysis, reaffirming its value in treatment selection and prognostication [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSurgical resection remains the only curative option for BTMs [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, curative surgery was limited to a minority of patients, particularly those with Stage I\u0026ndash;III disease (53.6% in GBC and 76.2% in CCA). The significantly lower rate of surgery in Stage IV (23.9% in GBC and 28.6% in CCA) reflects the advanced stage at diagnosis and distant metastasis [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Similar patterns are observed in LMICs due to diagnostic delays and limited access to hepatobiliary surgical expertise. Adjuvant chemotherapy, particularly capecitabine-based regimens, was the most commonly used systemic therapy. This follows evidence from the BILCAP trial, which supports capecitabine as adjuvant therapy post-resection in BTC [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In advanced-stage disease, palliative chemotherapy using gemcitabine\u0026ndash;cisplatin was more frequently employed, in line with the ABC-02 trial, which established this regimen as standard of care in unresectable BTC [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Use of neoadjuvant therapy was limited in our cohort, although growing evidence supports its role in borderline resectable cases, especially for perihilar and distal CCA [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Similarly, stereotactic body radiotherapy (SBRT) was underutilized, despite its promising role in local control for unresectable disease [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdvanced disease stage was the strongest independent predictor of poor survival in multivariate Cox analysis (HR\u0026thinsp;=\u0026thinsp;5.48; p\u0026thinsp;=\u0026thinsp;0.010), consistent with global literature [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. ECOG performance status also impacted survival in univariate analysis, reaffirming its value in treatment selection and prognostication [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Survival analysis showed clear benefits of early-stage diagnosis and multimodal treatment. In gallbladder cancer, patients receiving combined surgery and chemotherapy had a 73% reduced mortality risk compared to those receiving chemotherapy alone (HR\u0026thinsp;=\u0026thinsp;0.27; p\u0026thinsp;=\u0026thinsp;0.019). This finding strongly supports a multidisciplinary approach in eligible patients.\u003c/p\u003e \u003cp\u003eDespite the aggressive biology of BTCs, treatment response rates remained modest, with ORR and DCR under 35% for both cancers, underscoring the need for novel therapeutic strategies. Immunotherapy and targeted agents (e.g., IDH1 inhibitors, FGFR2 fusions, and HER2-targeted therapies) are emerging as promising options in selected subgroups and may improve outcomes if implemented in local practice [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eFUTURE PERSPECTIVES\u003c/h2\u003e \u003cp\u003eMolecular profiling and targeted therapies, such as IDH1 inhibitors, FGFR2 fusions, and HER2-targeted treatments, show promise for improving BTC outcomes. Immunotherapy is also emerging as a potential option. Expanding access to these therapies, along with better use of neoadjuvant treatments and SBRT, could enhance survival, especially in low-resource settings. Strengthening diagnostic and treatment infrastructure and fostering multidisciplinary care are key for future progress.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eLIMITATIONS\u003c/h2\u003e \u003cp\u003eThis study\u0026rsquo;s retrospective design and single-center setting inherently limit the generalizability of our findings. Potential selection biases and incomplete data capture, especially regarding molecular and immunohistochemical profiling, may impact the comprehensiveness of the clinicopathological correlations. The absence of uniform molecular testing restricted the assessment of emerging targeted biomarkers across the entire cohort. Additionally, treatment decisions were influenced by resource availability and patient factors, which may differ from protocols in other healthcare systems. Despite these limitations, our real-world data provide valuable insights into the challenges and outcomes of BTC in a tertiary care setting typical of low- and middle-income countries.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study demonstrates that advanced disease stage is the most significant independent predictor of poor survival in patients with gallbladder cancer and cholangiocarcinoma. While demographic factors showed no significant impact, multimodal treatment combining surgery and chemotherapy markedly improved overall survival, highlighting the importance of a multidisciplinary approach. Despite these interventions, response rates remain low, emphasizing the urgent need for novel targeted therapies and immunotherapy. The high rate of advanced-stage presentation and patient loss to follow-up, particularly in resource-limited settings, underscores the necessity for improved early diagnosis, better healthcare access, and expanded treatment options to enhance outcomes for biliary tract cancers.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Institutional Review Board of Dow University of Health Sciences (Meeting No. 221st, held on 13th September 2025; IRB Ref: IRB-4230DUHS/EXEMPTION/2025/434). This study was conducted in accordance with the principles of the Declaration of Helsinki. Written informed consent was not obtained because this was a retrospective study using anonymized patient data, and the requirement for consent was waived by the Institutional Review Board of Dow University of Health Sciences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials:\u003cbr\u003e\u003c/strong\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u0026nbsp;\u003c/strong\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Batool Aslam Memon(PI) and Dr. Maryum Nouman\u0026nbsp;\u003c/strong\u003edesigned the study and supervised the research process.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Maryum Nouman, Dr Batool Asalm Memon and Dr Kiran Marvi\u003c/strong\u003e collected the data\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr Maryam NasrumminAllah\u003c/strong\u003e performed the statistical analyses, data interretation and manuscipt drafting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Mohsin\u003c/strong\u003e also contributed to data interpretation and manuscript drafting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Batool Aslam Memon(PI)\u0026nbsp;\u003c/strong\u003ecritically revised the manuscript for important intellectual content. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAlvi AR, Rehman A, et al. Risk factors of gallbladder cancer in Karachi\u0026ndash;a case-control study. World J Surg Oncol. 2011;9:164. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/1477-7819-9-164]\u003c/span\u003e\u003cspan address=\"10.1186/1477-7819-9-164]\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. [PMID: 21859496.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMalik H, Izwan S, Ng J, Teng R, Chan E, Damodaran Prabha R, Puhalla H. Incidence and management of gallbladder cancer in cholecystectomy specimens: a 5-year tertiary centre experience. 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[PMID: 38812765.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Biliary tract neoplasms, Gallbladder carcinoma, Cholangiocarcinoma, Survival analysis, Retrospective cohort study, Multimodal treatment","lastPublishedDoi":"10.21203/rs.3.rs-8219764/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8219764/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003cbr\u003e\nBiliary tract malignancies (BTMs), including gallbladder carcinoma (GBC) and cholangiocarcinoma (CCA), are aggressive cancers with poor prognosis. Data from South Asia remain limited.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003e\u003cbr\u003e\nTo evaluate patient characteristics, diagnostic patterns, treatment modalities, and survival outcomes among BTM patients at a tertiary care center in Karachi, Pakistan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003cbr\u003e\nThis retrospective cohort study included patients ≥16 years with histologically confirmed GBC or CCA between May 2022 and May 2025. Data on demographics, clinical presentation, laboratory values, imaging, stage, treatment, and survival were collected. Kaplan–Meier analysis and Cox regression identified survival outcomes and predictors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003cbr\u003e\nA total of 141 patients were included (GBC, n=99; CCA, n=42). Median age was similar between groups (GBC 58.1 vs CCA 58.5 years; p=0.971), with female predominance (GBC 58.6%; CCA 64.3%; p=0.527). Gallstones were more frequent in GBC (46.5% vs 26.2%; p=0.025). Adenocarcinoma was the predominant histology, while rare histologies were more frequent in CCA (16.7% vs 4.0%; p=0.022). Lymph node and liver metastases were common; median time from symptom onset to diagnosis was 2.33 months. Curative surgery was more frequent in Stage I–III GBC (53.6%) than Stage IV (23.9%; p=0.032), whereas CCA surgery was less common and location-specific. Adjuvant capecitabine and palliative gemcitabine-based regimens were used; biliary drainage was more frequent in advanced disease.\u003c/p\u003e\n\u003cp\u003eIn GBC, multivariate Cox analysis identified advanced stage (HR 4.85; p=0.010) and treatment group (HR 2.21; p=0.003) as independent predictors of survival; combined surgery and chemotherapy reduced mortality by 73% compared to chemotherapy alone (HR 0.27; p=0.019). mRECIST response rates were comparable between GBC and CCA (ORR 18.7% vs 15.0%; DCR 34.7% vs 32.5%). Early-stage disease and aggressive treatment were associated with longer survival (median 28.6 vs 12.0 months, p=0.040; log-rank p\u0026lt;0.001). At last follow-up, more CCA patients were alive than GBC patients (76.2% vs 38.4%; p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003cbr\u003e\nAdvanced disease stage is the strongest independent predictor of poor survival in BTMs. Multimodal treatment combining surgery and chemotherapy significantly improves outcomes, though overall response rates remain modest. Early detection, aggressive management, and improved access to care are critical to enhance survival in high-risk South Asian populations.\u003c/p\u003e","manuscriptTitle":"Management patterns and survival outcomes in biliary tract malignancies: a 3-year retrospective cohort from Karachi, Pakistan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-23 04:29:34","doi":"10.21203/rs.3.rs-8219764/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-12-19T07:31:30+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-28T10:56:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-28T05:11:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-28T05:11:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2025-11-27T08:33:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"74e7add2-2c48-488b-a1f7-56171e9d8715","owner":[],"postedDate":"December 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-23T04:29:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-23 04:29:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8219764","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8219764","identity":"rs-8219764","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}