a negative trendP <0.001
80 This pathway has also been studied in relation to liver fluke infestation and one of its components, ubiquitin E3 ligase ring finger 43 ( RNF43 ), was found to be mutated in 9.3% of cases of CCA which were associated with OV, alongside a negative trend for survival in these patients (HR 7.775; P <0.001). 81 However, despite the abovementioned findings, apart from a preclinical study evaluating an inhibitor of the Wnt pathway, ie, Dickkopf-1 (DKK1) in cells lines from various tumor sites, including BTC, which suppressed cell invasion and growth, especially in cell lines which had a high expression of DKK1 gene. 82 Currently in this particular pathway there no current trails in BTC.