The rise in cholangiocarcinoma (CCA) cases and deaths in China necessitates new treatments. This investigation is designed to establish the comparative efficacy between the coupling of immune checkpoint inhibitors (ICIs) paired with chemotherapy and chemotherapy alone for Chinese individuals diagnosed with CCA. Web of Science, Embase, Scopus, the Cochrane Library and PubMed databases were scanned systematically, spanning their initial establishment through June 2025. Overall survival (OS) and progression-free survival (PFS), the primary outcome measures, were demonstrated by the included studies. Included studies specified objective response rate (ORR), adverse events (AEs), and disease control rate (DCR) as secondary endpoints. Engauge Digitizer 11. 3 extracted survival curve data points for studies with sole curve data. Calculated: log (HR) = ln (HR), \ (\: SE (log (HR) ) =V\), \ (\: V=Var (log (HR) ) \). The synthesis of the research incorporated findings from eight studies, which altogether assessed 802 cases of cholangiocarcinoma. Combining ICIs with chemotherapy markedly enhanced survival duration. OS had a hazard ratio of 0. 46 (95% CI, 0. 30–0. 58; P < 0. 001). PFS had a HR of 0. 56 (95% CI, 0. 46–0. 67; P < 0. 001). Higher ORR and DCR were also noted with combination therapy (ORR: risk ratio RR, 1. 34; 95% CI, 1. 22–1. 48; P < 0. 001; DCR: RR, 2. 46; 95% CI, 1. 84–3. 29; P < 0. 001). Combination therapy was found, via Kaplan-Meier curves, to significantly increase OS (HR = 0. 46, 95% CI 0. 39–0. 53; P < 0. 001) ; PFS (HR = 0. 38, 95% CI 0. 35–0. 46; P < 0. 001). Sensitivity analysis validated stable, OS: HR = 0. 46 (95% CI 0. 36–0. 58, P < 0. 001) ; PFS: HR = 0. 56 (95% CI 0. 46–0. 67, P < 0. 001) for ICIs plus chemotherapy treatment. Adding ICIs to chemotherapy for advanced CCA in China enhances treatment response and survival, without added adverse effects, offering a beneficial and tolerable therapeutic alternative for advanced and recurrent CCA.
Shi et al. (Sat,) studied this question.