{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T09:42:22Z","timestamp":1792662142144,"version":"4.5.0"},"reference-count":36,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100007514","name":"Universit\u00e0 di Pisa","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007514","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2026,12,15]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Surgery after response to first\u2010line chemoimmunotherapy may offer a potential curative option for patients with locally advanced biliary tract cancer (BTC) initially considered unresectable. However, robust real\u2010world evidence in this setting remains limited. We retrospectively analyzed patients with locally advanced BTC treated with first\u2010line cisplatin, gemcitabine, and durvalumab (CGD) across 55 centers in 12 countries. Endpoints included overall survival (OS), progression\u2010free survival (PFS), disease\u2010free survival (DFS) among resected patients, objective response rate (ORR), and the prognostic impact of surgery. A multivariable logistic regression model was developed to predict surgical conversion using baseline clinical and laboratory variables. Among 1358 screened patients, 219 had locally advanced disease and were included in the analysis. Median follow\u2010up was 14.5\u2009months. ORR was 34.6%, with median PFS and OS of 10.0 and 20.7\u2009months, respectively. Twenty\u2010four patients (10.9%) underwent surgical resection after systemic therapy. Median OS was 22.5\u2009months in resected patients versus 19.9\u2009months in those who did not undergo surgery. Median DFS after resection was 15.8\u2009months. Pathological lymph node involvement was independently associated with shorter DFS. Larger baseline tumor size correlated with higher odds of radiological response but not with OS. An exploratory elastic\u2010net model retained four baseline variables and showed moderate discriminative ability for surgical conversion, with an apparent AUC of 0.72 and an optimism\u2010corrected AUC of 0.65. First\u2010line CGD enabled secondary resection in approximately 11% of patients with locally advanced BTC. A simple baseline model may support patient selection for conversion surgery, although prospective validation is needed.<\/jats:p>","DOI":"10.1002\/ijc.70641","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T14:27:13Z","timestamp":1785335233000},"page":"2973-2986","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Exploring the Role of Surgery After Systemic Therapy in Locally Advanced Biliary Tract Cancer: Outcomes From a Large Retrospective Multinational Real\u2010World Cohort Treated With Cisplatin, Gemcitabine, and Durvalumab"],"prefix":"10.1002","volume":"159","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4047-2585","authenticated-orcid":false,"given":"Margherita","family":"Rimini","sequence":"first","affiliation":[{"name":"IRCCS San Raffaele Hospital  Milan Italy"},{"name":"Vita\u2010Salute San Raffaele University  Milan 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