Racial and Ethnic Disparities in Survival among Patients with Cholangiocarcinoma in the United States: A Systematic Review and Meta-analysis.

BACKGROUND

Cholangiocarcinoma (CCA) is an increasing cause of mortality in the United States; however, the burden of CCA disproportionately affects racial and ethnic minority groups. We aimed to characterize racial and ethnic differences in stage, treatment, and survival among patients with CCA.

METHODS

We systematically searched MEDLINE and Embase through March 2023 for all studies reporting clinical outcomes among patients with CCA stratified by race and ethnicity. We calculated pooled HRs using the DerSimonian and Laird method for a random-effects model.

RESULTS

Of 292 articles, 16 met inclusion criteria (n = 248,109 patients). Among six studies (n = 87,938) reporting overall survival, Black patients had worse survival [pooled HR, 1.05; 95% confidence interval (CI), 1.01-1.10], whereas Hispanic (pooled HR, 0.86; 95% CI, 0.83-0.89) and Asian/Pacific Islander (pooled HR, 0.88; 95% CI, 0.85-0.90) patients had better survival than White patients. Compared with White patients, Black and Hispanic patients were less likely to present at an early stage, and Black patients were less likely to undergo resection (pooled OR, 0.69; 95% CI, 0.63-0.75). The limitations of studies were lack of granularity on subtype and risk of residual confounding.

CONCLUSIONS

There are racial and ethnic differences in CCA prognosis in the United States, with Black patients having worse survival and Hispanic and Asian patients having better survival than White patients. Studies are needed to identify actionable factors underlying this disparity to promote health equity and improve outcomes for patients.

IMPACT: There exist racial discrepancies in survival and treatment for CCA; more studies are needed to better understand the extent and causes of discrepancies.