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 U.S.; however, the burden of CCA disproportionately impacts 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 hazard ratios (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 6 studies (n=87,938) reporting overall survival, Black patients had worse survival (pooled HR 1.05, 95%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 to 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. Conclusion: There are racial and ethnic differences in CCA prognosis in the US, 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 exists racial discrepancies in survival and treatment for cholangiocarcinoma; more studies are needed to better understand the extent and causes of discrepancies.