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This study evaluates the operational cleaner-production performance of automotive vehicle segments using a Prospect Theory-enhanced Data Envelopment Analysis (PTE-DEA) framework. The unit of analysis is defined from manufacturer-level decision-making units to manufacturer-vehicle segment-level decision-making units to capture heterogeneity across vehicle portfolios. Using the 2024 dataset, 50 decision-making units (DMUs) are considered, each of them represents a specific combination of manufacturer, regulatory class, and vehicle type. The selected inputs are vehicle weight, horsepower, and footprint, representing operational vehicle burdens, while the selected outputs are real-world MPG, real-world MPG city, and real-world MPG highway, representing fuel-efficiency-based cleaner-performance outcomes. The baseline PTE-DEA results indicate that Mazda (Sedan/Wagon), Subaru (Sedan/Wagon), Stellantis (SUV), Volkswagen (Sedan/Wagon), and Kia (Sedan/Wagon) form the leading segment-level group. Production-weighted manufacturer-level aggregation further shows that Subaru, Volkswagen, Nissan, Honda, Mazda, Toyota, and Kia demonstrate relatively strong portfolio-level cleaner-performance outcomes. Robustness analyses, including 600 behavioral parameter scenarios, rank-correlation assessment, and Monte Carlo perturbation, confirm that the leading segment-level patterns are generally stable. The study contributes to cleaner-production benchmarking by demonstrating how segment-level heterogeneity, behavioral assumptions, and fuel-efficiency-based operational indicators can be integrated into a more discriminative PTE-DEA framework. The findings provide a scenario-based decision-support perspective for automotive manufacturers and policymakers seeking to evaluate operational cleaner performance across heterogeneous vehicle segments.

The detection limit of astronomical imaging observations is limited by several noise sources. Some of that noise is correlated between neighboring pixels and exposures, so in principle it could be learned and corrected. We present the Astronomical Self-supervised Transformer-based Denoising (ASTERIS) algorithm, which integrates spatiotemporal information across multiple exposures. Benchmarking on mock data indicated that ASTERIS improves detection limits by 1.0 magnitude at 90% completeness and purity while preserving the point spread function and photometric accuracy. Observational validation using data from the James Webb Space Telescope (JWST) and the Subaru Telescope identified previously undetectable features, including low-surface-brightness galaxy structures and gravitationally lensed arcs. Applied to deep JWST images, ASTERIS identified three times more redshift ≳9 galaxy candidates than previous methods, with rest-frame ultraviolet luminosity 1.0 magnitude fainter.

This study aimed to evaluate the safety and effectiveness of the Kanshas drug-coated balloon (DCB) with paclitaxel for the treatment of atherosclerotic lesions in the superficial femoral artery (SFA) and/or proximal popliteal artery (PA) over a 3-year period. A prospective, multicenter, single-arm trial enrolled 121 patients with symptomatic lower extremity artery disease (LEAD). At 3 years, the primary patency rate was 63.4%, and freedom from clinically driven target lesion revascularization (CD-TLR) was 83.2%. Sustained improvements were observed in Rutherford classification, ankle brachial index (ABI), and walking impairment questionnaire (WIQ) scores. No device- or procedure-related deaths or major amputations occurred. The Kanshas DCB showed favorable safety and effectiveness for treating atherosclerotic lesions in the SFA and/or proximal PA over 3 years. Registration ID: UMIN000034122. Registration Date: September 13, 2018. Registration site URL: https://center6.umin.ac.jp/cgi-openbin/ctr/ctr.cgi?function=brows&action=brows&recptno=R000038612&type=summary&language=J .

Nivolumab combined with chemotherapy has been approved as the first-line treatment for HER2-negative, unresectable, advanced, or recurrent gastric cancer. Patients aged &#x2265;75 years have impaired organ function and comorbidities that increase the risk of adverse events, including immune-related adverse events more often than younger patients, potentially limiting the continuation of treatment. In this multicenter study, we aimed to evaluate the safety and efficacy of first-line nivolumab chemotherapy in older patients. We retrospectively analyzed data from 103 patients treated with first-line nivolumab combination chemotherapy for unresectable, advanced, or recurrent gastric cancer at 12 institutions between November 2021 and January 2023. The participants were divided into groups A (<75 years, n = 67) and B (&#x2265;75 years, n = 36). The mean age was 63.9 years in Group A and 78.6 years in Group B. Body weight was significantly lower (p = 0.041), and performance status 0-1 and hypertension were more prevalent in Group B (both p < 0.01). Chemotherapy regimens and incidence of grade &#x2265;3 immune-related adverse events were similar between the groups. The median overall survival was 15.2 months in Group A and was not reached in Group B; this difference was not significant (p = 0.689). First-line chemotherapy with nivolumab is safe and effective in patients aged &#x2265;75 years with a good performance status, as in younger patients, suggesting that it is a valid treatment option for the former subgroup.

To evaluate the efficacy and safety of balloon-only venous arterialization (BOVA) in patients with chronic limb-threatening ischemia (CLTI) and refractory ischemic ulcers after failed or no feasible conventional revascularization. This multicenter retrospective cohort study included 56 limbs treated with BOVA at five Japanese institutions between May 2021 and December 2023. The primary efficacy outcome was 12-month complete wound healing, and the primary safety outcomes were 12-month freedom from major amputation and overall survival. The cohort was high-risk: 76.8% had diabetes, 87.5% were on hemodialysis, 50.0% were Rutherford category 6, and 85.7% were Wound, Ischemia, and foot Infection stage 4. All pedal arteries were occluded in 80.4% of limbs. The 12-month complete wound healing rate was 45.5% (median time: 128&#xa0;days). Freedom from major amputation, overall survival, and amputation-free survival were 83.5%, 54.6%, and 43.9%, respectively. Reintervention incidence was 5.58 procedures per person-year. BOVA appears to be a feasible limb salvage strategy for patients with CLTI without conventional revascularization options. Level 3b.

A retrospective cohort study. While numerous studies have investigated surgical outcomes for cervical spondylosis, limited research has examined the impact of surgical techniques in patients with unilateral upper extremity proximal muscle weakness. This study compares clinical outcomes between anterior cervical decompression and fusion (ACDF) and posterior decompression (PD) with foraminotomy in patients with cervical spondylosis presenting with unilateral proximal muscle weakness. This study included 45 patients diagnosed with either cervical spondylotic amyotrophy (CSA) or cervical spondylotic radiculopathy (CSR) with unilateral proximal muscle weakness. Twenty CSA and five CSR patients underwent ACDF (anterior group), whereas 16 CSA and four CSR patients underwent PD with foraminotomy (posterior group). Muscle strength was assessed using the Manual Muscle Test (MMT) in the most improved muscle. Preoperative and postoperative MMT scores, Japanese Orthopaedic Association (JOA) scores, and imaging findings were analyzed. The mean age at surgery was 63.2 years in the anterior group and 61.3 years in the posterior group (p = 0.31). No significant differences were observed in preoperative MMT (2.0 vs. 2.1, p = 0.75), JOA scores (13.9 vs. 13.5, p = 0.60), or C2-C7 angles (2.3&#xb0; vs. -0.9&#xb0;, p = 0.55). Postoperative JOA scores (15.6 vs. 15.1, p = 0.19) and C2-C7 angles (3.0&#xb0; vs. 3.9&#xb0;, p = 0.78) were comparable. Both groups showed significant improvement in MMT (p < 0.01); however, the difference in improvement between the ACDF and PD groups (2.5 vs. 1.9) did not reach statistical significance (p = 0.06). Postoperative outcomes were similarly favorable for both ACDF and PD with foraminotomy, suggesting that each procedure represents an effective treatment option for cervical spondylotic disease presenting with unilateral proximal upper limb muscle weakness.

International statements suggest using the Global Leadership Initiative on Malnutrition (GLIM) criteria in intensive care units (ICUs); however, the economic impact of GLIM-defined malnutrition in sepsis remains unclear. This study investigated the association between GLIM-defined malnutrition and in-hospital costs in sepsis. We conducted a sub-analysis of the prospective cohort study, Investing Long-term Outcomes of Sepsis or Septic shock, among medically managed critically ill patients with sepsis in 15 Japanese ICUs. Associations between GLIM-defined malnutrition and cost categories (low, moderate, and high) were assessed using multinomial logistic regression (reference: low-cost group), adjusted for age, sex, Charlson Comorbidity Index, and Sequential Organ Failure Assessment score. Individual GLIM components were also examined. Total in-hospital costs and secondary outcomes were compared between malnutrition and non-malnutrition groups using inverse probability of treatment weighting. Among 259 patients, 111 had GLIM-defined malnutrition. GLIM-defined malnutrition was associated with both the moderate-cost (adjusted odds ratio [AOR]: 2.03, 95% confidence interval [CI]: 1.05-3.89) and high-cost classifications (AOR: 2.27, 95% CI: 1.20-4.29). Among GLIM components, reduced muscle mass (AOR: 1.95, 95% CI: 1.04-3.68) and reduced food intake (AOR: 2.61, 95% CI: 1.39-4.92) were associated with the high-cost classification. After weighting, the malnutrition group had significantly higher median in-hospital costs (24,959 vs. 18,651 USD), longer hospital stays, and longer ICU stays than the non-malnutrition group. GLIM-defined malnutrition-particularly reduced muscle mass and reduced food intake-was associated with higher in-hospital costs in sepsis and may be a potential indicator of high-cost hospitalization.

The Paris System (TPS) 1.0 for reporting urinary cytology focused on high-grade urothelial carcinoma (HGUC) but included low-grade urothelial neoplasm (LGUN) category by evaluating cell clusters. The 2015 Japan Reporting System for Urinary Cytology (JRSUC 2015) also includes low-grade urothelial carcinoma (LGUC) category. Then, TPS 2.0 deleted the LGUN category and completely focused on HGUC detection by evaluating only individual cells. We aimed to investigate this impact from the perspective of pathologically proven LGUC diagnosis. Voided urine samples, suspected of new-onset bladder cancer, with corresponding pathological diagnosis within 3 months of cytological diagnosis were analyzed. TPS 2.0-based cytology was statistically compared with TPS 1.0- and JRSUC 2015-based ones. 189 cases, consisting of 27 pathologically proven benign lesions, 63 LGUC, 96 HGUC, and 3 other malignancies were analyzed. Cytological diagnosis demonstrated high correlation between TPS 2.0 and JRSUC 2015 (r = 0.972, p < 0.001) and complete coincidence between TPS 2.0 and TPS 1.0 (r = 1.00, p < 0.001). One and none of 63 pathological LGUC was classified as cytological LGUC/LGUN by JRSUC 2015 and TPS 1.0, respectively, validating restricted utility of the LGUC/LGUN category. Cytological diagnosis of pathological LGUC was almost consistent across three reporting systems. These systems demonstrated similar concordance levels with pathological diagnosis (TPS 1.0 and 2.0: both r = 0.483, p < 0.001; JRSUC 2015: r = 0.484, p < 0.001). Even from the perspective of LGUC, TPS 2.0 would not be disadvantageous and is an excellent reporting system because of objectivity and simplicity.

Biliary inflammatory pseudotumor (IPT) of the liver is a rare benign tumor of which radiographic images, such as biliary stricture and dilatation, resemble those of cholangiocarcinoma (CC). Although repeated biliary cytology via endoscopic nasobiliary drainage (ENBD) is performed for differential diagnosis, a correct diagnosis remains difficult. The present study describes the case of a 76-year-old female patient with chronic liver disease. During surveillance, intrahepatic CC was suspected by imaging analyses; however, the carcinoembryonic antigen and CA19-9 levels were within normal ranges. Percutaneous core needle biopsy was not performed due to technical reasons; however, a left lobectomy was performed based on the diagnosis of malignancy by ENBD bile cytology. A pathological examination of the resected liver demonstrated biliary IPT. Reflecting on the cytological diagnosis of this case, a multi-reviewer re-evaluation of the biliary cytology of this IPT case and 2 cases of well-differentiated CC was then performed, which demonstrated difficulty in distinguishing between them. On the whole, ENBD cytology can play a limited role in differentiation between benign and malignant bile strictures. Surgical indication should be carefully determined and percutaneous core needle biopsy may be warranted in patients with normal tumor marker levels.

Background: Atezolizumab plus bevacizumab (ATZ/BEV) is widely used as first-line therapy for advanced hepatocellular carcinoma (HCC); however, optimal subsequent treatment after ATZ/BEV failure remains unclear. Methods: Between October 2020 and August 2024, 165 patients with unresectable HCC treated with first-line ATZ/BEV were retrospectively analyzed. After excluding patients with insufficient follow-up, outcomes were compared between those who received lenvatinib (LEN) as second-line therapy (n = 49) and those who did not (n = 95). Results: Median overall survival (OS) was significantly longer in the LEN group than in the non-LEN group (20.9 vs. 8.47 months, p < 0.01). LEN administration was independently associated with improved OS (hazard ratio 0.48), and this benefit remained significant after inverse probability weighting adjustment (adjusted hazard ratio 0.50). Among LEN-treated patients, a lower albumin-bilirubin score before ATZ/BEV and a total LEN dose &#x2265; 400 mg were independent prognostic factors. Conclusions: Lenvatinib as second-line therapy after ATZ/BEV was associated with improved survival in unresectable HCC. Preservation of liver function and the ability to maintain adequate lenvatinib exposure were associated with favorable outcomes, likely reflecting baseline prognosis and treatment feasibility rather than lenvatinib-specific predictive factors.

Post-bronchoscopy sputum cytology (PBS) is traditionally considered a supplementary diagnostic tool for lung cancer; however, its prognostic relevance in bronchoscopically confirmed cases remains unclear. This study evaluated the clinicopathological characteristics and prognostic value of PBS positivity in patients with bronchoscopically diagnosed lung cancer. This single-center retrospective cohort study included 625 patients with newly diagnosed, bronchoscopically confirmed lung cancer, who underwent PBS between May 2007 and December 2024. Patients were classified as PBS-positive and PBS-negative. Clinical characteristics, tumor features, and overall survival (OS) were compared. Factors associated with PBS positivity were evaluated using multivariate logistic regression. Prognostic factors for OS were assessed using univariate and multivariate Cox proportional hazards models. Survival was estimated using the Kaplan-Meier method. Among the 625 patients, 82 (13.1%) were PBS-positive. PBS-positive patients were significantly younger and more likely to have advanced T-factor tumors, larger primary tumors, and proximal airway involvement. Younger age and advanced T-factor were independently associated with PBS positivity. Median OS was significantly shorter in the PBS-positive group than in the PBS-negative group (median 14.3 vs. 25.3 months; log-rank P<0.001). In the multivariate analysis, PBS positivity remained an independent predictor of poor OS, along with sex, performance status, nodal status, and histological subtype. PBS positivity was associated with aggressive tumor characteristics and independently predicted poor OS in bronchoscopically confirmed lung cancer. Although its diagnostic value may be limited, PBS positivity represents a simple, noninvasive prognostic marker that may support risk stratification and clinical decision-making.

BackgroundLong-term physical dysfunction common among intensive care unit (ICU) survivors and mortality remains a concern even after hospital discharge. Although early identification of patients at risk for these outcomes is essential, few studies have investigated whether physical assessments at ICU discharge can predict physical dysfunction or death at 3, 6, and 12 months after discharge. The purpose of this study was to examine the association between physical assessment at ICU discharge and the incidence of physical functional disability or death within 12 months after discharge.MethodsThis was a multicenter prospective cohort study of 21 ICUs in Japan. Patients with sepsis admitted to the ICU for >48 h were enrolled. The primary outcome was physical dysfunction (Barthel index &#x2264;90) or death at 3, 6, and 12 months after discharge. Physical assessments at the time of ICU discharge included the Medical Research Council (MRC) score, handgrip strength, and the Barthel index. A multiple logistic regression model and area under the curve (AUC) were used.ResultsIn total, 300 ICU patients (median age, 74 years) were included. MRC score (odds ratio [OR]: 0.98, 95% confidence interval [CI]: 0.96-0.99, cut-off: 46), hand grip strength (OR: 0.95, 95%CI: 0.92-0.98, cut-off: 12.0 kg), and Barthel index (OR: 0.96, 95%CI 0.95-0.98, cut-off: 15) were independent predictors of physical dysfunction or death at 12 months after hospital discharge and at 3 and 6 months. The Barthel index at ICU discharge showed the highest AUC for physical function or death at 12 months (0.718). The Barthel index and hand grip strength were also associated with cognitive dysfunction or mental disorders.ConclusionsIn ICU patients with sepsis, clinically available physical and muscle strength assessments at ICU discharge were significantly associated with physical dysfunction incidence or death over the first year of hospital discharge.Trial registration number: UMIN000041433.

Operative management of gastroduodenal ulcers (GDUs) and vagotomy are increasingly rare due to success of medical therapy. Given sociodemographic factors could impact perception of medical therapy adherence and operative management, we sought to investigate the influence of sociodemographic factors on likelihood of vagotomy for patients with GDUs. The 2012-2017 Nationwide Inpatient Sample was queried for adults admitted with GDUs and gastric or duodenal operations. To assess sociodemographic associations, univariable and multivariable comparisons were made between operations with vagotomies and those without. A total of&#xa0;80,980 weighted discharges and 4230 (5.2%) vagotomies were identified. In univariable comparisons, vagotomies were more likely in earlier years, among younger patients, among patients without insurance coverage, and with lower median income. In the adjusted multivariable logistic model, lower median income (OR 1.50 [1.19, 1.90] for lowest vs. highest quartile) and younger age (OR 0.69 [0.48, 0.98] for Age 80+ vs. Age 18-39) were associated with higher odds of vagotomy. Vagotomy remains a rare operative treatment for GDUs. Lower household income and Medicaid or self-pay insurance were significantly associated with performing vagotomy for GDUs. These findings suggest that socioeconomic status may play a role in operative decision-making for these conditions.

Evaluating the risk of out-of-specification (OOS) occurrence before it happens is essential to prevent delays or interruptions in the supply of biological products. This study proposes a practical and quantitative evaluation approach using two indices, S1 and S2, as OOS risk screening and monitoring tools under finite-sample conditions. S1 evaluates whether the variability of data points in a dataset satisfies a low OOS risk criterion, defined as an acceptable level of inherent variability. S2 evaluates whether the observed data range remains within the specification limits with a range-proportional safety margin. Monte Carlo simulations based on normal distributions with sample sizes up to 500 demonstrated that S1&#x202f;>&#x202f;1 effectively identified datasets that deviated from the low OOS risk criterion, whereas S2&#x202f;>&#x202f;1 functioned as an early alert indicator that predicted or coincided with OOS occurrences. Regardless of the distribution type, both indices increase by definition as the spread of data points increases, suggesting their potential applicability as practical monitoring tools even for non-normal datasets. The combined use of S1 and S2 provides complementary and early warning insights into potential quality deviations and supports proactive quality risk management of biological products.

Pseudoaneurysm following robot-assisted radical prostatectomy is an infrequent complication. We present a rare case of gross hematuria caused by a pseudoaneurysm. A 76-year-old man was diagnosed with prostatic adenocarcinoma and underwent robot-assisted radical prostatectomy. On postoperative day 9, he presented with gross hematuria and clot retention, accompanied by anemia. Bladder irrigation was performed, resulting in improvement of the hematuria. Contrast-enhanced computed tomography revealed a pseudoaneurysm. As his hematuria improved and his vital signs remained stable, angiography was performed on postoperative day 10. This revealed a pseudoaneurysm arising from the prostatic artery, which was successfully treated with transcatheter arterial embolism. His postoperative course was uneventful, and he was discharged on postoperative day 14. Pseudoaneurysm after robot-assisted prostatectomy is rare but important to consider in patients with delayed hematuria. Early diagnosis and embolization can lead to good outcomes.

Human T-cell leukemia virus type 1 (HTLV-1) and simian T-cell leukemia virus type 1 (STLV-1) primarily infect CD4+ T-cells and spread via cell-to-cell contact in vivo. However, the mechanism underlying viral establishment and persistence in local tissues remain poorly understood. From the perspective of sexually transmitted infections, this study aimed to visualize the infection status of the genital epithelium in relation to sexual STLV-1 infection before and after menopause. In this study, we evaluated viral localization in the genital epithelium of naturally infected female Japanese macaques with STLV-1, which is highly homologous to HTLV-1. A marked increase in the proviral load (PVL) of STLV-1 was observed in both the vaginal epithelium and peripheral blood in post-compared with premenopausal individuals. Immunostaining showed the expression of glucose transporter 1 (GLUT1), a receptor for HTLV-1, in the basal layer of the vaginal epithelium. Additionally, in situ hybridization revealed strong expression of the viral accessory factor SBZ, the STLV-1 homolog of HBZ, relative to the pX region, which contains the Tax and Rex genes within the vaginal epithelium, indicating its involvement in latent infections at that site. In postmenopausal macaques, thinning of the vaginal epithelium was observed in association with decreased estradiol levels. Furthermore, more diverse and unique clones were identified in the vaginal epithelium of postmenopausal macaques than in peripheral blood mononuclear cells. These findings highlight the vaginal epithelium may serve as a site for the maintenance of persistent and de novo STLV-1 infections within the genital tract.

Adaptive optics (AO) systems are critical in any application where highly resolved imaging or beam control must be performed through a dynamic medium. Such applications include astronomy and free-space optical communications, where light propagates through the atmosphere, as well as medical microscopy and vision science, where light propagates through biological tissues. Recent works have demonstrated common-path wavefront sensors (WFSs) for adaptive optics using the photonic lantern (PL), a slowly varying waveguide that can efficiently couple multi-moded light into single-mode fibers (SMFs). We use the SCExAO astrophotonics platform at the 8 m Subaru Telescope to show that spectral dispersion of lantern outputs can improve correction fidelity, culminating with an on-sky demonstration of real-time wavefront control. This is the first, to the best of our knowledge, result for either a spectrally dispersed or a photonic lantern wavefront sensor. Combined with the benefits offered by lanterns in precision spectroscopy, our results suggest the future possibility of a unified wavefront sensing spectrograph using compact photonic devices.

In 2022, 1,105 bicyclists were killed and 46,195 were injured in motor vehicle crashes in the U.S. Automatic emergency braking (AEB) systems that automatically apply the vehicle brakes can avoid or mitigate bicyclist crashes, but the feature is not evaluated or required in the U.S. This study characterized police-reported vehicle-to-bicycle crashes and assessed speed reductions by two AEB systems in controlled tests replicating common crash vehicle-bicycle scenarios. From 2018 to 2022, a total of 159,474 police-reported and 3,305 fatal crashes involving one passenger vehicle and one bicyclist were extracted from the Crash Report Sampling System and Fatality Analysis Reporting System. Crash configuration and pre-impact movement were coded using the Crash Type variable descriptions. Estimated speeds from 93 crashes were extracted from the Vulnerable Road User Injury Prevention Alliance (VIPA) database. AEB system performance in the 2023 Toyota RAV4 and 2023 Subaru Forester was evaluated when approaching a 15&#x2009;km/h crossing bicycle target at 40, 50, and 60&#x2009;km/h during the day and when approaching a slower-moving bicycle target ahead at 50, 60, and 70&#x2009;km/h during the day and night. Crossing path crashes accounted for 56% of police-reported vehicle-to-bicycle crashes. The estimated travel speed in VIPA crossing path crashes was most frequently 0-20&#x2009;km/h for the vehicle and 0-17&#x2009;km/h for the bicycle. Parallel path crashes accounted for 57% of fatal vehicle-to-bicycle crashes. The estimated speed in VIPA parallel path crashes most frequently was 65&#x2009;km/h or higher for the vehicle and 0-17&#x2009;km/h for the bicycle. In controlled evaluations, the AEB systems completely or nearly avoided the bicycle target in the crossing path scenarios during daytime and in parallel path scenarios during daytime and at night with high beams. However, the AEB systems only marginally reduced vehicle speed in the parallel path scenarios at night with low beams. Current AEB systems mitigated crossing and parallel path bicycle crashes during the day but not when approaching a bicycle from behind at night with low beams. AEB systems that perform well in every crossing path and parallel path scenario could address 28,600 police-reported and 600 fatal bicycle crashes each year.

Background/Objectives: The TOPAZ-1 phase III trial reported a survival benefit of using durvalumab, an anti-programmed death ligand 1 (anti-PD-L1) antibody, in combination with gemcitabine and cisplatin (GCD) treatment in patients with advanced biliary tract cancer. This retrospective study investigated the efficacy and safety of GCD treatment for advanced biliary tract cancer in real-world conditions. Methods: The study subjects were 52 patients with biliary tract cancer who received GCD therapy between January 2023 and May 2024. The observation parameters included the modified Glasgow Prognostic Score (mGPS), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), tumor markers (CEA, CA19-9), overall response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and adverse events. Results: The cohort included 36 men and 16 women, with a median age of 73.0 years. There were 36 cases of cholangiocarcinoma (distal: 10, perihilar: 19, intrahepatic: 7), 13 cases of gallbladder cancer, and 3 cases of ampullary carcinoma. The stages were locally advanced in 30 cases and metastatic in 22 cases. Biliary drainage was performed in 30 cases. There were 38 cases receiving first-line therapy and 14 cases receiving second-line or later treatments. The median values at the start of GCD therapy were ALB 3.7 g/dL, CRP 0.39 mg/dL, NLR 2.4, PLR 162.5, CEA 4.8 ng/mL, and CA19-9 255.9 U/mL. The mGPS distribution was 0:23 cases, 1:18 cases, and 2:11 cases. The treatment outcomes were ORR 25.0% (CR 2 cases, PR 11 cases), DCR 78.8% (SD 28 cases, PD 10 cases, NE 1 case), median PFS 8.6 months, and median OS 13.9 months. The PLR was suggested to be useful for predicting PFS. A decrease in CEA at six weeks after the start of treatment was a significant predictor of PFS and OS. Gallbladder cancer had a significantly poorer prognosis compared to other cancers. The immune-related adverse events included hypothyroidism in two cases, cholangitis in one case, and colitis in one case. Conclusions: The ORR, DCR, and PFS were comparable to those in the TOPAZ-1 trial. Although limited by its retrospective design and small sample size, this study suggests that GCD therapy is an effective treatment regimen for unresectable biliary tract cancer in real-world clinical practice.