Patterns of presentation and diagnostic delays in biliary tract cancers: a real-world European study.

Background: Biliary tract cancers (BTCs) often present late due to nonspecific symptoms and a lack of effective population screening. We characterised diagnostic routes, symptom-to-diagnosis intervals, and their relationship with stage and outcomes across three European centres. Materials and methods: We conducted a retrospective observational study of consecutive patients diagnosed with BTC assessed by medical oncology from 1 June 2022 to 31 January 2024 in Spain, Slovenia, and Italy. Demographics, presenting symptoms, route of diagnosis, investigations, treatments, and outcomes were extracted from electronic medical records. Survival was assessed using Kaplan-Meier analysis and Cox regression. The study was approved by local ethics committees. Results: Eighty-six patients were included [Spain 59 (68.6%), Slovenia 16 (18.6%), and Italy 11 (12.8%)]; the median age was 71 years (range 40-96); and 65.1% were male. Tumour types included intrahepatic cholangiocarcinoma (41.9%), distal cholangiocarcinoma (23.3%), gallbladder (12.8%), ampullary (11.6%), and perihilar cholangiocarcinoma (9.3%). Presentation routes included: primary care (46.5%), the emergency department (45.3%), and incidental (8.1%). The median time from symptom onset to diagnosis was 2.56 months [95% confidence interval (CI) 1.78-3.09], which was longer with primary care (versus emergency department) (4.13 months versus 1.37 months, Conclusion: BTC continues to be diagnosed at advanced stages and is frequently associated with diagnostic delays, often presenting with nonspecific symptoms. Strengthening referral pathways and improving early recognition of warning signs, particularly in primary care, may help optimise diagnostic processes and should be further evaluated in future studies.