# Real-world analysis of ctDNA and other biomarkers in patients with curatively resected stage I-III biliary tract cancer

Source: https://onco.cc/key-papers/paper-malla-ctdna-resected-biliary-tract-cancer-esmo-gi-onc-2026/  
OnCo record `paper-malla-ctdna-resected-biliary-tract-cancer-esmo-gi-onc-2026` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

In 167 people whose bile duct or gallbladder cancer had been removed, a blood test for tumour DNA in the weeks after surgery picked out those whose cancer would return far better than the standard blood markers.

## Summary

Retrospective real-world analysis of 167 patients with stage I to III resectable biliary tract cancer tested with a personalised, tumour-informed 16-plex PCR next-generation sequencing assay (Signatera) between July 2020 and February 2024; 751 plasma samples were drawn before surgery, in a 2 to 12 week post-surgical window and during surveillance, and compared with CA 19-9 and CEA. Median follow-up was 21 months. ctDNA detection rates were 23 percent (19 of 82) in the residual disease window and 38 percent (31 of 82) in surveillance. Positivity in either window was associated with worse relapse-free and overall survival; in the residual disease window it was the strongest prognostic factor for relapse-free survival (hazard ratio 15.86, 95 percent CI 4.69 to 53.6), and ctDNA outperformed the conventional markers.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: gallbladder-evidence
- Journal: ESMO Gastrointestinal Oncology
- Year: 2026
- DOI: 10.1016/j.esmogo.2026.100344
- Authors: Malla M, Esmail A, Tin A, et al.
- Findings: ctDNA detected in 23 percent (19 of 82) in the 2 to 12 week residual disease window and 38 percent (31 of 82) during surveillance.; Residual disease window positivity: relapse-free survival hazard ratio 15.86 (95 percent CI 4.69 to 53.6).; ctDNA outperformed CA 19-9 and CEA for prognosis.
- What it means: Together with the JCO Precision Oncology cohort this makes residual disease testing in biliary cancer prognostic to the same degree as in colon cancer. Nobody has yet shown that acting on it helps; that is the trial gap the ideas on this page name.
- Caveats: Retrospective commercial testing cohort; testing was ordered selectively.; Mixed biliary sites; gallbladder numbers are not given in the abstract.

## Sources

- ESMO Gastrointest Oncol 2026: https://doi.org/10.1016/j.esmogo.2026.100344
- PubMed: https://pubmed.ncbi.nlm.nih.gov/42583118/

## Connected records

- cancers: [Biliary tract cancer (all types)](https://onco.cc/cancers/biliary-tract-cancer/), [Biliary tract cancer (cholangiocarcinoma)](https://onco.cc/cancers/cholangiocarcinoma/), [Gallbladder cancer](https://onco.cc/cancers/gallbladder/)
- technologies: [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/), [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/)
- drugs: [Signatera](https://onco.cc/drugs/signatera/)
- companies: [Natera](https://onco.cc/companies/natera/)
- terms: [CA 19-9](https://onco.cc/terms/ca19-9/), [Circulating tumour DNA (ctDNA)](https://onco.cc/terms/ctdna/), [Minimal / molecular residual disease (MRD)](https://onco.cc/terms/mrd/)
- bottlenecks: [Dormant cells and minimal residual disease](https://onco.cc/bottlenecks/b-dormancy-mrd/)
- roadmaps: [Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials](https://onco.cc/roadmaps/gallbladder-cancer-roadmap/)
- ideas: [A ctDNA residual disease-guided adjuvant trial after gallbladder cancer resection](https://onco.cc/ideas/idea-gbc-ctdna-residual-disease-guided-adjuvant-trial/)

---
JSON: https://onco.cc/api/v1/entities/paper-malla-ctdna-resected-biliary-tract-cancer-esmo-gi-onc-2026.json