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This case report describes conversion surgery in an unresectable cholangiocarcinoma following durvalumab combined with gemcitabine and cisplatin (Dur+GC). A 77-year-old man with borderline resectable disease underwent pancreaticoduodenectomy after stable disease was achieved. Pathology evaluated immune contexture using immunohistochemistry, highlighting CD3+ and CD8+ lymphocyte infiltration, including CD103 expression, and weak stromal PD-L1 positivity.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/conversion-surgery-performed-following-durvalumab-combined-with-gemcitabine-and-cisplatin-in-cholangiocarcinoma-a-case-report/370500/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/conversion-surgery-performed-following-durvalumab-combined-with-gemcitabine-and-cisplatin-in-cholangiocarcinoma-a-case-report/370500.png","ImageObject",300,407,{"name":92,"@type":93},"Connor ","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-28","2026-09-23",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why was conversion surgery considered in this case?","Question",{"text":112,"@type":113},"The patient with borderline resectable distal bile duct cancer and hilar cholangiocarcinoma received four courses of Dur+GC and evaluation showed stable disease, making surgery feasible given the patient’s risk assessment.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What immune cell markers were examined after surgery?",{"text":117,"@type":113},"Detailed pathological examinations using immunohistochemistry assessed tumor immune microenvironment, including lymphocytes positive for CD3 and CD8, with subsets expressing CD103, and related marker patterns such as weak stromal PD-L1 positivity.",{"name":119,"@type":110,"acceptedAnswer":120},"What did the pathology suggest about the anticancer immune response?",{"text":121,"@type":113},"Marked infiltration of lymphocytes was observed in both cancer core and margin areas. CD103+ CD8+ T cells are discussed as tissue-resident memory T cells that may be critical for ICI-induced anticancer responses in cholangiocarcinoma.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},370500,1790434918,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":34,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144},687207022233,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","doi: 10.21873/invivo.13974  \nConversion Surgery Performed Following Durvalumab Combined With Gemcitabine and Cisplatin in Cholangiocarcinoma: A Case Report  \nYOSHIYUKI TAGAYASU1,2, RIN YAMADA1, KOSUKE KANEMITSU1, YOSHIHIKO KONDO1,  \nRUMI ITOYAMA2, HIROMITSU HAYASHI2, YOSHIHIRO KOMOHARA1 and MASAAKI IWATSUKI2  \n1 Department of Cell Pathology, Graduate School of Medicine, Kumamoto University, Kumamoto, Japan;  \n2 Department of Gastroenterological Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto, Japan  \nAbstract  \nBackground/Aim: Immunotherapy using immune checkpoint inhibitors (ICIs) has been widely approved for many cancers. ICI therapy has also been performed for unresectable bile duct cancer in recent years. However, there are few reports of conversion surgery following ICI therapy for unresectable or borderline resectable bile duct cancer. Herein, we present a case of conversion surgery following immune checkpoint ICI therapy for unresectable cholangiocarcinoma, focusing on the cancer immune microenvironment of this case.  \nCase Report: A 77‑year‑old man was diagnosed with borderline resectable, distal bile duct cancer and hilarcholangiocarcinoma. The patient underwent four courses of durvalumab combined with gemcitabine and cisplatin (Dur+GC) therapy. Evaluation of disease progression showed stable disease (SD), and considering the patient’s surgical risk, a pancreaticoduodenectomy was performed. Adenocarcinoma components remained, and detailed pathological examinations using immunohistochemistry were performed. Marked infiltration of lymphocytes was observed in both the cancer core area and the margin area. The lymphocytes were positive for CD3 and CD8, with a subset also expressing CD103 . PD‑L1 expression was weakly positive in the stromal area, and positive cells were likely to be infiltrating macrophages in morphological features. Cancer cells were positive for HLA‑A/B/C and beta‑2.  \nConclusion: CD103+ CD8+ T cells, recently referred to as tissue‑resident memory T cells, might be a critical immune cell population involved in ICI‑induced anticancer immune responses in cholangiocarcinoma.  \nKeywords: Prognostic biomarker, immune checkpoint inhibitor, tumor‑infiltrating lymphocytes, bile duct cancer.  \n✉Yoshihiro Komohara, Department of Cell Pathology, Graduate School of Medicine, Kumamoto University, 1‑1‑1 Honjo, Chuo‑  \nku, Kumamoto 860‑8556, Japan. Tel: +81 963735095, Fax: +81 963735096, e‑mail: ycomo@kumamoto‑[u.ac.jp](u.ac.jp)  \nReceived January 20, 2025 | Revised February 22, 2025 | Accepted March 4, 2025  \nThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \n©2025 The Author(s) . Anticancer Research is published by the International Institute of Anticancer Research.  \nIntroduction  \nCholangiocarcinoma is an aggressive malignant cancer originating from the biliary epithelium (1, 2). Extrahepatic cholangiocarcinoma (ECC) accounts for approximately 20‑ 30% of all cholangiocarcinomas, and its prognosis remains poor, with an estimated 5‑year survival rate of 11%(localized and regional: 18%; distant: 2%) (3, 4). For non‑ metastatic ECC, surgery remains the only curative treatment. However, less than one‑third of cholangiocarcinoma patients are diagnosed at a stage amenable to surgical resection, with the majority being deemed unresectable or presenting with recurrent disease, both associated with a poor prognosis (5‑8).  \nFor over a decade, the combination of gemcitabine and cisplatin has been the standard first‑line chemotherapy regimen for advanced biliary tract cancer (9), with a median overall survival ranging from 4.6 to 11.7 months (10). The TOPAZ‑1 trial demonstrated that the addition of the immune checkpoint inhibitor (ICI) durvalumabtothe gemcitabine‑cisplatin regimen improved overall survival compared with gemcitabine‑cisplatin alone (11).  \n","cbCairRAew1gVLk6","https://ap.wps.com/l/cbCairRAew1gVLk6","pdf",4157297,"English","# Abstract\n# Introduction\n## Background on cholangiocarcinoma and treatment\n## Role of gemcitabine-cisplatin and durvalumab\n# Case Report\n## Presentation and diagnostic workup\n## Treatment course and surgical decision","[{\"question\":\"Why was conversion surgery considered in this case?\",\"answer\":\"The patient with borderline resectable distal bile duct cancer and hilar cholangiocarcinoma received four courses of Dur+GC and evaluation showed stable disease, making surgery feasible given the patient’s risk assessment.\"},{\"question\":\"What immune cell markers were examined after surgery?\",\"answer\":\"Detailed pathological examinations using immunohistochemistry assessed tumor immune microenvironment, including lymphocytes positive for CD3 and CD8, with subsets expressing CD103, and related marker patterns such as weak stromal PD-L1 positivity.\"},{\"question\":\"What did the pathology suggest about the anticancer immune response?\",\"answer\":\"Marked infiltration of lymphocytes was observed in both cancer core and margin areas. CD103+ CD8+ T cells are discussed as tissue-resident memory T cells that may be critical for ICI-induced anticancer responses in cholangiocarcinoma.\"}]","Conversion Surgery Performed Following Durvalumab Combined With Gemcitabine and Cisplatin in Cholangiocarcinoma - A Case Report | PDF",1790188839,18]