{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:20:06Z","timestamp":1791908406207,"version":"4.3.4"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2025,9,6]],"date-time":"2025-09-06T00:00:00Z","timestamp":1757116800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,6]],"date-time":"2025-09-06T00:00:00Z","timestamp":1757116800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Gastroenterol"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Systemic chemotherapy with gemcitabine plus S-1 (GEM\u2009+\u2009S-1), GEM\u2009+\u2009CDDP plus S-1 (GEM\u2009+\u2009CDDP\u2009+\u2009S-1), or gemcitabine plus cisplatin (GEM\u2009+\u2009CDDP) is standard treatment for advanced biliary tract cancer (aBTC). We aimed to evaluate the efficacy and safety of combination chemotherapy in older patients with aBTC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter prospective observational study (JON2104-B, UMIN000045156) included patients aged\u2009\u2265\u200970\u00a0years with aBTC. Inverse-probability weighting propensity-score analyses (IPW) were used to compare overall survival (OS) as the primary endpoint and progression-free survival (PFS) across treatment groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>This study included 305 patients between August 2021 and January 2023. Of them, 75, 131, 26, 52, and 10 received GEM\u2009+\u2009CDDP\u2009+\u2009S-1, GEM\u2009+\u2009CDDP, GEM\u2009+\u2009S-1, gemcitabine, and S-1; their median ages were 74, 75, 77.5, 80, and 80\u00a0years, and approximately 24%, 16.8%, 23.1%, 9.6%, and 0% had G-8 scores of\u2009&gt;\u200914, respectively. GEM\u2009+\u2009CDDP had a safety profile comparable to that of GEM\u2009+\u2009CDDP\u2009+\u2009S-1 but was more toxic than gemcitabine. Per IPW, the hazard ratio (HR) for GEM\u2009+\u2009CDDP\u2009+\u2009S-1 versus GEM\u2009+\u2009CDDP was 0.80 for OS (95% confidence interval [CI], 0.55\u20131.17) and 0.55 for PFS (95% CI 0.38\u20130.80). The HR for GEM\u2009+\u2009CDDP versus gemcitabine was 0.74 for OS (95% CI 0.42\u20131.29) and 0.79 for PFS (95% CI 0.42\u20131.49).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>GEM\u2009+\u2009CDDP\u2009+\u2009S-1 was associated with longer PFS without additional toxicity than GEM\u2009+\u2009CDDP for fit older patients. However, the OS for both were not statistically different. The efficacies of GEM\u2009+\u2009CDDP and gemcitabine for vulnerable older patients did not also differ significantly. These findings highlight the importance of vulnerability in patients with aBTC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00535-025-02294-0","type":"journal-article","created":{"date-parts":[[2025,9,6]],"date-time":"2025-09-06T13:19:27Z","timestamp":1757164767000},"page":"1584-1595","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Combination chemotherapy for older patients with unresectable biliary tract cancer: a prospective observational study using propensity-score matched analysis 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