{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T03:58:14Z","timestamp":1789703894608,"version":"4.0.1"},"reference-count":58,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T00:00:00Z","timestamp":1750118400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T00:00:00Z","timestamp":1750118400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2025,7]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Over the years, prognostic indexes have been developed to help clinicians stratify patients with biliary tract cancers (BTC) into risk groups. This study aims to identify a new prognostic index for patients with BTC treated with cisplatin, gemcitabine and durvalumab (CGD) in the first\u2010line setting.<\/jats:p>\n <\/jats:sec>\n \n Patients and Methods<\/jats:title>\n The study population consisted of patients with BTC from 11 Eastern and Western Countries. Using multivariate analysis for overall survival (OS), we identified 5 baseline statistically significant variables: stage, carcinoembryonic antigen (CEA) levels, albumin levels, gamma glutamyl transferase (GGT) levels, neutrophil\u2010to\u2010lymphocyte ratio (NLR). Metastatic disease is a prognostic factor with a superior weight considering the HR of 3.62, while all the others can be considered prognostic factors with equivalent weight as the HRs are quite similar (HRs between 1.55 and 1.92). Based on these reasons, we developed a prognostic model called the MAGIC\u2010D index by assigning a score of 2 for metastatic disease, and a score of 1 for CEA increased levels, albumin decreased levels, GGT increased levels, NLR \u2265\u20093. Patients were stratified into three risk groups as follows: low\u2010risk group (Score from 0 to 2), intermediate\u2010risk group (Score from 3 to 4) and high\u2010risk group (Score from 5 to 6). At the first data cutoff (April 2024), these data were available for 319 patients that composed the training cohort used for the analysis. At the second data cutoff (May 2025), 79 patients were further enrolled and composed the validation cohort.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Median progression\u2010free survival was 11.7\u2009months in low\u2010risk group (20.7%), 8.7\u2009months in intermediate\u2010risk group (46.4%) and 5.4\u2009months in high\u2010risk group (32.9%) [low\u2010risk hazard ratio (HR): 0.27, intermediate\u2010risk HR: 0.55, high\u2010risk HR: 1,\n p<\/jats:italic>\n \u2009<\u20090.0001]. Median OS was 18.4\u2009months in low\u2010risk group,15.9\u2009months in intermediate\u2010risk group and 7.8\u2009months in high\u2010risk group (low\u2010risk HR: 0.17, intermediate\u2010risk HR: 0.43, high\u2010risk HR: 1,\n p<\/jats:italic>\n \u2009<\u20090.0001). There was no difference in overall response rate (low\u2010risk: 31.8%, intermediate\u2010risk: 36.5% and high\u2010risk: 25.7%;\n p<\/jats:italic>\n \u2009=\u20090.0718), while disease control rate was significantly different across the three risk groups (low\u2010risk: 83.3%, intermediate\u2010risk: 70.9% and high\u2010risk: 60.9%;\n p<\/jats:italic>\n \u2009<\u20090.0001) as well as the rate of patients receiving a second\u2010line therapy (low\u2010risk: 54.5%, intermediate\u2010risk: 48.6% and high\u2010risk: 25.7%;\n p<\/jats:italic>\n \u2009=\u20090.0061). Finally, the prognostic role in terms of OS and PFS of the MAGIC\u2010D index was confirmed in a validation cohort of 79 patients.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The MAGIC\u2010D index is an easy\u2010to\u2010use tool able to stratify patients with BTC with different prognoses undergoing first\u2010line therapy with CGD.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/liv.70181","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T06:13:43Z","timestamp":1750140823000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["A Prognostic Index for Advanced Biliary Tract Cancer Treated With Cisplatin, Gemcitabine and Durvalumab: The\n MAGIC<\/scp>\n \u2010D Index"],"prefix":"10.1111","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3600-0232","authenticated-orcid":false,"given":"Mara","family":"Persano","sequence":"first","affiliation":[{"name":"Department of Oncology Vita\u2010Salute San Raffaele University, IRCCS San Raffaele Scientific Institute Hospital Milan Italy"},{"name":"Department of Biomedical Sciences University of Cagliari Cagliari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4047-2585","authenticated-orcid":false,"given":"Margherita","family":"Rimini","sequence":"additional","affiliation":[{"name":"Department of Oncology Vita\u2010Salute San Raffaele University, IRCCS San Raffaele Scientific Institute Hospital Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7749-8634","authenticated-orcid":false,"given":"Francesca","family":"Salani","sequence":"additional","affiliation":[{"name":"Unit of Medical Oncology 2 Azienda Ospedaliero\u2010Universitaria Pisana Pisa Italy"},{"name":"Department of Translational Research and new Technologies in Medicine and Surgery University of Pisa Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica Lo","family":"Prinzi","sequence":"additional","affiliation":[{"name":"Operative Research Unit of Medical Oncology Fondazione Policlinico Universitario Campus Bio\u2010Medico Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Nichetti","sequence":"additional","affiliation":[{"name":"Department of Oncology Veneto Institute of Oncology IOV\u2014IRCCS Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Saborowski","sequence":"additional","affiliation":[{"name":"Hannover Medical School Hannover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Antonuzzo","sequence":"additional","affiliation":[{"name":"Clinical Oncology Unit Careggi University Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence Florence Italy"},{"name":"Department of Experimental and Clinical Medicine University of Florence, Florence, Italy; Thoracic Surgery Unit, Careggi University Hospital Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Passeri","sequence":"additional","affiliation":[{"name":"Department of Oncology Vita\u2010Salute San Raffaele University, IRCCS San Raffaele Scientific Institute Hospital Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoyuki","family":"Satake","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital East Kashiwa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik","family":"Peeters","sequence":"additional","affiliation":[{"name":"Digestive Oncology University Hospitals Leuven Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Vivaldi","sequence":"additional","affiliation":[{"name":"Unit of Medical Oncology 2 Azienda Ospedaliero\u2010Universitaria Pisana Pisa Italy"},{"name":"Department of Translational Research and new Technologies in Medicine and Surgery University of Pisa Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiziana","family":"Pressiani","sequence":"additional","affiliation":[{"name":"Medical Oncology and Hematology Unit, Humanitas Cancer Center IRCCS Humanitas Research Hospital Rozzano (Milan) Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Lucchetti","sequence":"additional","affiliation":[{"name":"Operative Research Unit of Medical 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Department University of Pavia Pavia Italy"},{"name":"Medical Oncology Unit Fondazione IRCCS Policlinico San Matteo of Pavia Pavia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1802-5671","authenticated-orcid":false,"given":"Ilario Giovanni","family":"Rapposelli","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology IRCCS Istituto Romagnolo per Lo Studio Dei Tumori (IRST) \u201cDino Amadori\u201d Meldola Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Tamberi","sequence":"additional","affiliation":[{"name":"Medical Oncology Santa Maria Delle Croci Hospital, Ravenna AUSL Romagna Ravenna Italy"},{"name":"Department of Medical and Surgical Sciences (DIMEC) University of Bologna Bologna 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Melo","family":"Alvim","sequence":"additional","affiliation":[{"name":"Medical Oncology Department Hospital de Santa Maria, Centro Hospitalar Universit\u00e1rio Lisboa Norte Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Roque","sequence":"additional","affiliation":[{"name":"Portuguese Institute of Oncology of Coimbra Coimbra Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Farinea","sequence":"additional","affiliation":[{"name":"Department of Oncology University of Turin, San Luigi Hospital Turin Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Fornaro","sequence":"additional","affiliation":[{"name":"Unit of Medical Oncology 2 Azienda Ospedaliero\u2010Universitaria Pisana Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"De Rosa","sequence":"additional","affiliation":[{"name":"Department of Oncology Veneto Institute of Oncology IOV\u2014IRCCS Padua Italy"},{"name":"Department of Surgery, Oncology and Gastroenterology University of Padua Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Lanzetta","sequence":"additional","affiliation":[{"name":"Internal Medicine and Medical Therapy Department University of Pavia Pavia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Balsano","sequence":"additional","affiliation":[{"name":"Medical Oncology and Hematology Unit, Humanitas Cancer Center IRCCS Humanitas Research Hospital Rozzano (Milan) Italy"},{"name":"Department of Biomedical Sciences Humanitas University Pieve Emanuele (Milan) Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Lavacchi","sequence":"additional","affiliation":[{"name":"Clinical Oncology Unit Careggi University Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of 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