Abioye Oyepeju F, Kaufman Rebekah, Greten Tim F, Monge Cecilia
Dana Farber Cancer Institute, Boston, MA.
Allegheny Health Network, Pittsburgh, PA.
JCO Glob Oncol. 2025 Mar;11:e2400537. doi: 10.1200/GO-24-00537. Epub 2025 Mar 13.
Cancer disparities are well-established across measures of cancer incidence and mortality. Cholangiocarcinoma, a common hepatic malignancy, is no exception to these inequities. Globally and within the United States, Asian, Hispanic, and Indigenous peoples of the Americas, Alaskan Natives, and Pacific Islander populations experience higher incidence rates of cholangiocarcinoma. These same groups and non-Hispanic Black individuals simultaneously experience lower disease-specific survival, highlighting the role of social factors in cholangiocarcinoma outcome inequities. Higher age-standardized death rates from cholangiocarcinoma are associated with a lower social determinant index (SDI) in Andean Latin America, Southern Latin America, and Central sub-Saharan Africa. SDI, which evaluates education, fertility, and income, can be used to model the social determinants of health (SDOH). The SDOH also affect cholangiocarcinoma survival in the United States as factors such as migratory status, insurance status, and geographic location can cause treatment delays and worsened outcomes. Despite these inequities, limited research exists on the topic of disparities in cholangiocarcinoma when compared with other malignancies, and clinical trial under-representation remains a significant concern. Representing diverse populations in cholangiocarcinoma clinical trials is exceedingly important as populations with the highest incidence are simultaneously under-represented in clinical trials. Diversity in clinical trial enrollment and research regarding cholangiocarcinoma is needed to create robust databases and biobanks that can be used to develop targeted treatments and guidelines. In addition, risk factors, including parasitic infections, infectious diseases, and environmental exposures, are associated with cholangiocarcinoma but vary by global region, highlighting the need to study unique risk factors for cholangiocarcinoma across diverse populations. Without research that represents the populations that suffer most from this cancer, incidence and mortality inequities will continue to have a disproportionate burden.
癌症差异在癌症发病率和死亡率的各项指标中已得到充分证实。胆管癌作为一种常见的肝脏恶性肿瘤，也存在这些不平等现象。在全球范围内以及美国国内，亚洲人、西班牙裔、美洲原住民、阿拉斯加原住民和太平洋岛民群体的胆管癌发病率较高。这些群体以及非西班牙裔黑人同时经历着较低的疾病特异性生存率，凸显了社会因素在胆管癌结局不平等中的作用。在安第斯拉丁美洲、南美洲南部和撒哈拉以南非洲中部，胆管癌年龄标准化死亡率较高与社会决定因素指数（SDI）较低相关。SDI评估教育、生育率和收入，可用于模拟健康的社会决定因素（SDOH）。在美国，SDOH也会影响胆管癌的生存率，因为移民身份、保险状况和地理位置等因素可能导致治疗延迟和预后恶化。尽管存在这些不平等现象，但与其他恶性肿瘤相比，关于胆管癌差异的研究仍然有限，临床试验代表性不足仍然是一个重大问题。在胆管癌临床试验中纳入不同人群极其重要，因为发病率最高的人群在临床试验中的代表性同时不足。需要在胆管癌临床试验招募和研究中实现多样性，以创建强大的数据库和生物样本库，用于开发靶向治疗方法和指南。此外，包括寄生虫感染、传染病和环境暴露在内的风险因素与胆管癌有关，但因全球区域而异，这凸显了研究不同人群中胆管癌独特风险因素的必要性。如果没有针对受这种癌症影响最严重人群的研究，发病率和死亡率的不平等将继续带来不成比例的负担。
