Noninvasive detection and prognostic stratification of biliary tract cancer using cell-free DNA fragmentomics: a model development and validation study.

Although the improvement over CNV did not reach statistical significance in the validation cohorts, the ensemble model consistently outperformed both FSD and PFE in the internal (q = 0.006 and < 0.001) and external (q = 0.002 and < 0.001) validation datasets.

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Model-derived risk scores were significantly higher in BTC than in non-cancer controls across cohorts and showed an increasing trend with advancing stage in the external validation set, suggesting an association with tumor burden.

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