Cholangiocarcinoma 2026: status quo, unmet needs and priorities

Banales JM, Rodrigues PM, Affò S, Andersen JB, Aspichueta P, Boulter L, Bridgewater J, Calvisi DF, Cardenas A, Cardinale V, Carpino G, Coulouarn C, Dopazo C, Edeline J, Fabris L, Folseraas T, Forner A, Goeppert B, Heikenwalder M, Kendall TJ, Khan SA, Klümpen HJ, Koerkamp BG, Lamarca A, Lindsey S, Lleo A, Luedde T, Macias RI, Morement H, Nault JC, Olaizola P, Perugorria MJ, Raggi C, Rimassa L, Saborowski A, Valle JW, Vithayathil M, Vogel A, Braconi C, Lopez-Lopez V, Megdanova V, Cillo U, Mahmood U, Patel T, Mocan T, Greten TF, Tian TV, Gruenberger T, Macarulla T, Pereira SP, Chan SL, Roessler S, Caruso S, Jirawatnotai S, Vicent S, Maithel SK, Gradilone S, Xue R, Kelley RK, Montal R, Shroff R, Guest R, Milkiewicz P, Olthof PB, Acedo P, Padilla-Machaca PM, Scatton O, Detry O, Azad N, Bardeesy N, Verstegen M, Niger M, Meneses-Medina MI, El-Kassas M, Bouattour M, Borad M, Komuta M, Evert M, Avila MA, Mandea M, Colombo M, Salati M, Cadamuro M, Peck-Radosavljevic M, Strazzabosco M, Ponz M, Deutsch MM, Rengo M, Marzioni M, Carbone M, McNamara MG, Bujanda L, Maroni L, Da Fonseca LG, Izquierdo-Sanchez L, Goff L, Heij L, Zieniewicz K, Kupcinskas J, Busquets J, Roa JC, Marin JJ, Erdmann J, Adeva J, Santo JE, Marquardt JU, Vaquero J, Ferrer JD, Jonas JP, Malik H, Jansson H, Gores G, Lesinski GB, Sapisochin G, Vidili G, Lammert F, Ratti F, Troisfontaine F, Rocha F, De La Tijera FH, Gaudio E, Sparrelid E, Estupinan EC, Boleslawski E, Lozano E, Gutierrez E, Balderramo D, Malka D, Pinato DJ, Fondevila C, Neuzillet C, Schramm C, Sangro B, Ungureanu BS, Dwyer B, Valsan A, Jusakul A, Ustav A, Turpin A, Munoz A, Landa-Magdalena A, Link A, Parisi A, Elvevi A, Montano-Loza AJ, La Casta A, Sanchez A (2026)

Publication Type: Journal article, Review article

Publication year: 2026

Journal

Book Volume: 23

Pages Range: 65-96

Journal Issue: 1

DOI: 10.1038/s41575-025-01153-w

Abstract

Cholangiocarcinoma (CCA) is a cancer that originates within the bile ducts. Traditionally considered to be a rare neoplasm, increased awareness of CCA alongside advancements in diagnosis and the rising prevalence of certain risk factors have contributed to a global increase in incidence and mortality. CCAs are highly heterogeneous from the clinical, histomorphological and molecular perspectives but commonly share a poor prognosis. These tumours usually develop and progress silently; by the time they are detected, it is often too late for curative surgical intervention. In such cases, current therapeutic approaches offer modest survival improvements and are generally considered palliative. Although well-known risk factors predispose individuals to developing CCA, the majority of cases are considered sporadic, occurring without any identifiable underlying condition. Over the past decade, substantial collaborative efforts have been made to improve our understanding of the aetiopathogenesis of these tumours, aiming to identify novel biomarkers and therapeutic targets to develop more effective treatments. The ultimate goal is to improve patient outcomes and overall well-being. However, there are significant gaps in our understanding of the molecular mechanisms that drive cholangiocarcinogenesis. In this international Consensus Statement, which is endorsed by the European Network for the Study of Cholangiocarcinoma, we provide a critical overview of the latest advancements in the field of CCA. We highlight the key aspects of CCA aetiopathogenesis and clinical management and provide insights into promising new treatments. Finally, we provide a set of consensus recommendations and future research priorities for CCA based on a Delphi panel questionnaire involving international experts.

Authors with CRIS profile

Involved external institutions

Biogipuzkoa Health Research Institute Spain (ES) Università degli Studi di Firenze / University of Florence Italy (IT) Mayo Clinic in Arizona United States (USA) (US) Regionale Kliniken Holding RKH Germany (DE) Université de Rennes 1 / University of Rennes 1 France (FR) University College London Hospitals (UCLH) United Kingdom (GB) Hospital Universitario Fundación Jiménez Díaz Spain (ES) Humanitas University Italy (IT) University of Paris 13 - Paris-Nord / Université Paris XIII Paris-Nord France (FR) Paris-Est Créteil University / Université Paris-Est Créteil Val-de-Marne (UPEC) / Université Paris XII-Val-de-Marne / University Paris 12 Marne la Vallée France (FR) National Cancer Institute (NCI) United States (USA) (US) Universitätsklinikum Heidelberg Germany (DE) University of Navarra / Universidad de Navarra Spain (ES) University College London (UCL) United Kingdom (GB) Università degli studi "La Sapienza" Italy (IT) University of Padua / Universita degli Studi di Padova Italy (IT) Johns Hopkins Hospital United States (USA) (US) Hospital General de México Mexico (MX) Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Spain (ES) Ospedale Niguarda Ca' Granda / ASST Grande Ospedale Metropolitano Niguarda Italy (IT) Deutsches Krebsforschungszentrum (DKFZ) Germany (DE) Ospedale San Raffaele (früher: Centro San Raffaele del Monte Tabor Foundation) Italy (IT) Azienda Ospedaliero Universitaria Ospedali Riuniti Ancona Italy (IT) Universitätsklinikum Düsseldorf Germany (DE) Sigmund-Freud-Privatuniversität Wien (SFU) / Sigmund Freud University Austria (AT) Hospital Universitario 12 de Octubre Spain (ES) Universität Regensburg Germany (DE) Imperial College London / The Imperial College of Science, Technology and Medicine United Kingdom (GB) University of Copenhagen Denmark (DK) Imperial College Healthcare NHS Trust United Kingdom (GB) Cholangiocarcinoma Foundation CCF United States (USA) (US) Centro de Investigación Biomédica en Red - Enfermedades Hepáticas y Digestivas (CIBERHD) Spain (ES) University of Edinburgh United Kingdom (GB) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Beaujon Hospital / Hôpital Beaujon France (FR) International University of Health and Welfare (IUHW) / 国際医療福祉大学 Japan (JP) Carol Davila University of Medicine and Pharmacy / Universitatea de Medicină și Farmacie „Carol Davila” (UMF București) Romania (RO) Universitätsklinikum Essen Germany (DE) University of Arizona United States (USA) (US) Vall d'Hebron Institute of Oncology: VHIO Spain (ES) University of São Paulo / Universidade de São Paulo (USP) Brazil (BR) Amsterdam University Medical Centers (Amsterdam UMC) / Amsterdam Universitair Medische Centra Netherlands (NL) Helwan University Egypt (EG) University of Glasgow United Kingdom (GB) Mayo Clinic Hospital United States (USA) (US) Yale University United States (USA) (US) Vanderbilt University United States (USA) (US) National University of San Marcos / Universidad Nacional Mayor de San Marcos Peru (PE) Centre Hospitalier Universitaire de Liège (CHU Liège) Belgium (BE) European Association for the Study of the Liver EASL Switzerland (CH) National and Kapodistrian University of Athens Greece (GR) Karolinska University Hospital / Karolinska Universitetssjukhuset Sweden (SE) Mayo Clinic United States (USA) (US) Università degli Studi di Sassari (UNISS) Italy (IT) University of Medicine and Pharmacy of Craiova / Universitatea de Medicină şi Farmacie din Craiova Romania (RO) University of Amsterdam Netherlands (NL) University of Tartu Estonia (EE) Clínica Universidad de Navarra Spain (ES) University of San Carlos of Guatemala (USAC) / Universidad de San Carlos de Guatemala Guatemala (GT) Hospital Clínico Universitario Virgen de la Arrixaca Spain (ES) Peking University (PKU) / 北京大学 China (CN) University of California San Francisco (UCSF) United States (USA) (US) Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE) Edgardo Rebagliati Martins National Hospital / Hospital Nacional Edgardo Rebagliati Martins Peru (PE) Universitätsspital Zürich (USZ) Switzerland (CH) Hospital Universitario La Paz Spain (ES) Bellvitge University Hospital / Hospital Universitari de Bellvitge Spain (ES) Emory University United States (USA) (US) Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico (MX) University-Hospital Polyclinic of Modena / Azienda Ospedaliero-Universitaria di Modena Italy (IT) Klinikum Klagenfurt am Wörthersee Austria (AT) Pontificia Universidad Católica de Chile Chile (CL) Oregon Health and Science University (OSHU) United States (USA) (US) Hospital de Especialidades Eugenio Espejo Ecuador (EC) Hospital Privado Argentina (AR) Lithuanian University of Health Sciences / Lietuvos sveikatos mokslų universitetas (LSMU) Lithuania (LT) University of Salamanca / Universidad de Salamanca Spain (ES) Curtin University Australia (AU) Amrita University / Amrita Vishwa Vidyapeetham India (IN) Khon Kaen University / มหาวิทยาลัยขอนแก่น Thailand (TH) Wrocław Medical University / Uniwersytet Medyczny we Wrocławiu Poland (PL) The Chinese University of Hong Kong (CUHK) China (CN) Université Paris-Saclay France (FR) Christie NHS Foundation Trust United Kingdom (GB) Università Politecnica delle Marche (UNIVPM) / Marche Polytechnic University Italy (IT) Royal Liverpool and Broadgreen University Hospitals NHS Trust United Kingdom (GB) Hospital General Universitario Gregorio Marañón Spain (ES) Aleksandrovska University Hospital / университетска болница "Александровска" Bulgaria (BG) Babeș-Bolyai University / Babeș–Bolyai Tudományegyetem / Universitatea Babeș-Bolyai (UBB) Romania (RO) Pitié-Salpêtrière University Hospital / Hôpital universitaire Pitié-Salpêtrière France (FR) Erasmus MC Transplant Institute Netherlands (NL) Fondazione IRCCS: Istituto Nazionale dei Tumori Italy (IT) University of Alberta Canada (CA) Toronto General Hospital (TGH) Canada (CA) Centre Eugène Marquis France (FR) Oslo University Hospital / Oslo Universitetssykehus Rikshospitalet Norway (NO) Centro Hospitalar e Universitário de Coimbra (CHUC) Portugal (PT) Versailles Saint-Quentin-en-Yvelines University / Université de Versailles Saint-Quentin-en-Yvelines (UVSQ) France (FR) Siriraj Hospital Thailand (TH) Erasmus University Medical Center (MC) Netherlands (NL) Massachusetts General Hospital United States (USA) (US) AMMF – The Cholangiocarcinoma Charity United Kingdom (GB) Fondazione IRCCS San Gerardo dei Tintori Italy (IT) Centre Hospitalier Régional Universitaire de Lille (CHRU de Lille) France (FR) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE)

How to cite

APA:

Banales, J.M., Rodrigues, P.M., Affò, S., Andersen, J.B., Aspichueta, P., Boulter, L.,... Sanchez, A. (2026). Cholangiocarcinoma 2026: status quo, unmet needs and priorities. Nature Reviews Gastroenterology & Hepatology, 23(1), 65-96. https://doi.org/10.1038/s41575-025-01153-w

MLA:

Banales, Jesus M., et al. "Cholangiocarcinoma 2026: status quo, unmet needs and priorities." Nature Reviews Gastroenterology & Hepatology 23.1 (2026): 65-96.

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