An ABC score may flag perihilar cholangiocarcinoma patients unlikely to benefit from surgery

A three-factor preoperative score identified patients at much higher risk of early death and recurrence after resection for perihilar cholangiocarcinoma.

• Patients with the highest score had 21% 90-day mortality, versus 6% in the lowest-risk group.
• Six-month recurrence was 18% versus 5%, and median overall survival was 13 versus 42 months.
• The score uses tumor size of 25 mm or more, CA19-9 of 500 U/mL or more, and WHO performance status of 1 or more.

The score is a candidate tool for preoperative staging, not yet a validated rule. It may help identify patients better served by neoadjuvant systemic treatment than upfront resection, and it needs external validation before it guides individual decisions.