In conclusion, strong expression of ANXA1 was observed in CCA, but was low in HCC. In diagnosis of primary liver cancer, ANXA1 could be a new immunohistochemical marker for differential diagnosis of CCA from HCC. ANXA1 expression increased along with cholangiocarcinogenesis in hamsters induced by O. viverrini infection and NDMA administration. Its expression was positively correlated with TGF-β and MMPs but negatively correlated with the NF-κB signaling pathway, suggesting that ANXA1 is involved in inflammation-associated CCA, and a potential for therapeutic drug targeting