Although behavior and alteration mechanisms similar to LUAD, including gene amplification, have been observed in colorectal and breast cancer13,14,39, contrasting recurrent deleterious mutations in ELF3 have been identified in biliary tract cancer, mucinous ovarian carcinoma, and cancers of the cervix, stomach, and bladder, indicating a tumor suppressive role in these cancer types4–8. This evidence concerns the gene ELF3 and biliary tract neoplasm.