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Ethics declarations Ethics approval and consent to participate This research received approval from the National Center for Health Statistics Research Ethics Review Board, and participants signed informed consent forms (Protocol #201117)

Signalling within the cancer cells Numerous molecular pathways affecting malignant cholangiocytes have been identified, leading to the sub-classification of CCA into inflammatory or proliferative classes characterized by the induction of pro-inflammatory signals and the activation of oncogenic cascades 1,80,123

Multivariable Cox proportional hazards regression was used to identify factors associated with overall survival, defined as the time from diagnosis to death or last follow-up