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PDOs-based drug resistance on RFS but also yield a Author contributions
practical, clinician-friendly tool to estimate recurrence
risk. For instance, in patients with a single tumor and no Conceptualization: Feng Shen, Kui Wang
Formal analysis: Wei Zhai, Zhilin Sha, Tao Yuan, Zhishi
tumor vascular invasion, the probability of 12-month PFS
for patients with unmatched PDO-based drug test was Yang
approximately 28%, while for patients with matched PDT- Investigation: Shichao Zhang, Hao Shen, Wenxin Wei
based drug test, the probability increased to approximately Methodology: Jin Lv, Zhihao Xie, Jinhuan Liu
Writing – original draft: Shichao Zhang, Hao Shen, Wenxin
46%. By combining features such as vascular invasion,
tumor multiplicity, and PDO-derived drug sensitivity, Wei
the nomogram offers a useful framework for tailoring Writing – review & editing: Yong Xia, Chen Liu, Jun Li, Feng
post-operative surveillance and adjuvant therapy to each Shen, Kui Wang
patient’s unique risk profile. Future work may extend these Ethics approval and consent to participate
computational approaches by incorporating genomic and
immune profiles to optimize precision oncology strategies This study received ethical approval from the Ethics
for ICC. Committee of the Shanghai Eastern Hepatobiliary Surgery
Hospital and the Shanghai Tenth People’s Hospital (approval
However, this study still has several limitations. no.: EHBHKY2021-K-029). All procedures involving
First, although our cohort is comparatively large for an human participants were carried out in accordance with
ICC-related PDO study, the overall sample size remains the Declaration of Helsinki.
constrained, and our findings should be validated in larger,
multicenter cohorts. Second, the observational study design Consent for publication
limits our ability to draw causal inferences regarding the
direct benefit of PDO-guided regimens. Third, our current Written informed consent was obtained from each
approach focused on chemotherapy regimens commonly participant.
used in adjuvant settings; exploring newer modalities Availability of data
such as targeted therapeutics or immunotherapies was
beyond the scope of this investigation. Finally, although Data are available from the corresponding author on
our fluorescence-based drug sensitivity assessment reasonable request.
demonstrated good concordance with dose-response
determinations, further validation in prospective trials with References
standardized cutoffs and assay conditions would bolster its 1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA,
clinical applicability. Jemal A. Global cancer statistics 2018: GLOBOCAN estimates
of incidence and mortality worldwide for 36 cancers in 185
5. Conclusion countries. CA Cancer J Clin. 2018;68(6):394-424.
The PDOs-based drug sensitivity testing can serve as doi: 10.3322/caac.21492
a promising tool to guide the adjuvant chemotherapy 2. Brindley PJ, Bachini M, Ilyas SI, et al. Cholangiocarcinoma.
decision and predict the prognosis of ICC patients with Nat Rev Dis Primers. 2021;7(1):65.
high recurrence risk after surgery.
doi: 10.1038/s41572-021-00300-2
Acknowledgments 3. Wang K, Zhang H, Xia Y, Liu J, Shen F. Surgical options for
intrahepatic cholangiocarcinoma. Hepatobiliary Surg Nutr.
None. 2017;6(2):79-90.
Funding doi: 10.21037/hbsn.2017.01.06

This research was funded by the National Natural Science 4. Moris D, Palta M, Kim C, Allen PJ, Morse MA,
Foundation of China (82403243 to Hao Shen), Clinical Lidsky ME. Advances in the treatment of intrahepatic
Research Projects of Shanghai Shenkang Hospital cholangiocarcinoma: An overview of the current and future
Development Center (SHDC2024CRI062 to Wenxin Wei), therapeutic landscape for clinicians. CA Cancer J Clin.
2023;73(2):198-222.
and the Tengfei Project of Third Affiliated Hospital of Naval
Medical University (TF2024XSJJ004 to Wenxin Wei) the doi: 10.3322/caac.21759
Clinical Research Cultivation. 5. Benson AB, D’Angelica MI, Abrams T, et al. NCCN
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Guidelines insights: Biliary tract cancers, Version 2.2023.
Conflict of interest J Natl Compr Canc Netw. 2023;21(7):694-704.
The authors declare that they have no competing interests. doi: 10.6004/jnccn.2023.0035

Volume 1 Issue 1 (2025) 11 doi: 10.36922/or.8571