# Detecting Early Recurrence With Circulating Tumor DNA in Stage I-III Biliary Tract Cancer After Curative Resection

Source: https://onco.cc/key-papers/paper-yu-ctdna-early-recurrence-biliary-tract-cancer-jco-po-2025/  
OnCo record `paper-yu-ctdna-early-recurrence-biliary-tract-cancer-jco-po-2025` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

In 56 people after surgery for bile duct or gallbladder cancer, finding tumour DNA in the blood in the weeks after the operation meant the cancer came back within about seven months on average, while those without it had not relapsed by the end of follow-up.

## Summary

Retrospective multicentre cohort of 56 patients with curatively resected stage I to III biliary tract cancer followed with serial tumour-informed ctDNA testing, median follow-up 12.8 months. ctDNA detection in the molecular residual disease window was associated with a median relapse-free survival of 6.6 months against not reached (hazard ratio 26, 95 percent CI 2.6 to 265); detection during surveillance carried a hazard ratio of 20 (2.6 to 153). Conventional markers were not prognostic (p=0.844). The study also assessed ctDNA sensitivity for confirmed recurrence and the lead time from first detection to confirmed recurrence.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: gallbladder-evidence
- Journal: JCO Precision Oncology
- Year: 2025
- DOI: 10.1200/po-24-00443
- Authors: Yu J, He AR, Ouf M, et al.
- Findings: Residual disease window ctDNA positivity: median relapse-free survival 6.6 months vs not reached; hazard ratio 26 (95 percent CI 2.6 to 265).; Surveillance ctDNA positivity: hazard ratio 20 (2.6 to 153); conventional markers not prognostic (p=0.844).
- What it means: Very wide confidence intervals from a small cohort, but the direction matches the larger 2026 analysis. Gallbladder cancer recurs early and distantly after re-resection, which is exactly the setting where a residual disease test could pick who gets more than capecitabine.
- Caveats: 56 patients, short follow-up, retrospective.; Hazard ratios have very wide confidence intervals.

## Sources

- JCO Precis Oncol 2025: https://doi.org/10.1200/po-24-00443
- PubMed: https://pubmed.ncbi.nlm.nih.gov/39772829/

## 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: [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/)
- journals: [JCO Precision Oncology](https://onco.cc/journals/jco-precision-oncology/)
- 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/)

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