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

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

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.

BibTeX: Download