Cholangiocarcinoma in Latin America: a multicentre observational study alerts on ethnic disparities in tumour presentation and outcomes

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas Pub Date : 2024-11-25 DOI:10.1016/j.lana.2024.100952

Leonardo G. da Fonseca , Laura Izquierdo-Sanchez , Pedro H. Hashizume , Yanina Carlino , Estefanía Liza Baca , Cristina Zambrano , Santiago A. Sepúlveda , Andrea Bolomo , Pedro M. Rodrigues , Ioana Riaño , Andre Boonstra , Jose D. Debes , Luis Bujanda , Flair J. Carrilho , Marco Arrese , Juan C. Roa , Enrique Carrera , Javier Díaz Ferrer , Domingo Balderramo , Claudia P. Oliveira , Jesus M. Banales

{"title":"Cholangiocarcinoma in Latin America: a multicentre observational study alerts on ethnic disparities in tumour presentation and outcomes","authors":"Leonardo G. da Fonseca , Laura Izquierdo-Sanchez , Pedro H. Hashizume , Yanina Carlino , Estefanía Liza Baca , Cristina Zambrano , Santiago A. Sepúlveda , Andrea Bolomo , Pedro M. Rodrigues , Ioana Riaño , Andre Boonstra , Jose D. Debes , Luis Bujanda , Flair J. Carrilho , Marco Arrese , Juan C. Roa , Enrique Carrera , Javier Díaz Ferrer , Domingo Balderramo , Claudia P. Oliveira , Jesus M. Banales","doi":"10.1016/j.lana.2024.100952","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Cholangiocarcinoma (CCA) represents a global health challenge, with rising incidence and mortality rates. This study aimed to elucidate the clinical course and practices of CCA in Latin America.</div></div><div><h3>Methods</h3><div>This observational cohort study investigated individuals diagnosed with CCA between 2010 and 2023 at five referral centres across Latin America. Demographic, biochemical, and clinical data were analysed.</div></div><div><h3>Findings</h3><div>A total of 309 patients were enrolled, demonstrating a balanced distribution of CCA subtypes (intrahepatic, perihilar, and distal), with Hispanics and Caucasians as the predominant ethnic groups, followed by Africans. Major risk factors identified included age, diabetes, obesity, MASLD, bile duct stones, and cholecystitis. Disparities in overweight/obesity prevalence were noted among CCA subtypes and ethnicities, with higher rates in extrahepatic CCA and among Hispanics and Caucasians. At diagnosis, 72% of patients had ECOG-PS scores of 0–1, with disease presentations ranging from localized (47%) to locally advanced (19%) and metastatic (34%). Patients who did not receive any anti-cancer therapy exhibited a median survival of 2.3 months. Survival rates significantly improved across treatment modalities, with surgery yielding the longest (34 months), followed by chemotherapy (8 months). Notably, Africans presented with worse ECOG-PS scores and more advanced disease, while Hispanics were less frequently treated with chemotherapy for advanced disease, contributing to lower survival rates (8.3 and 6 months, respectively) compared to Caucasians (12.6 months).</div></div><div><h3>Interpretation</h3><div>The high prevalence of late-stage CCA diagnosis in Latin America, particularly among individuals of African ethnicity, coupled with a significant proportion of Hispanic patients not receiving chemotherapy, underscores the dismal prognosis for these patients. These findings reveal structural challenges in cancer screening and healthcare access among diverse ethnic backgrounds and lower socioeconomic statuses in the region. Urgent measures are needed, including the identification of preventable risk factors, raising awareness among high-risk populations, and establishing equitable health coverage to address these disparities.</div></div><div><h3>Funding</h3><div><span>European Union’s Horizon 2020 R&I Program</span>, <span>Incyte Bioscience International Sàrl</span>, and <span>European Association for the Study of the Liver</span> (EASL).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"40 ","pages":"Article 100952"},"PeriodicalIF":7.0000,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lancet Regional Health-Americas","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2667193X24002795","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Cholangiocarcinoma (CCA) represents a global health challenge, with rising incidence and mortality rates. This study aimed to elucidate the clinical course and practices of CCA in Latin America.

Methods

This observational cohort study investigated individuals diagnosed with CCA between 2010 and 2023 at five referral centres across Latin America. Demographic, biochemical, and clinical data were analysed.

Findings

A total of 309 patients were enrolled, demonstrating a balanced distribution of CCA subtypes (intrahepatic, perihilar, and distal), with Hispanics and Caucasians as the predominant ethnic groups, followed by Africans. Major risk factors identified included age, diabetes, obesity, MASLD, bile duct stones, and cholecystitis. Disparities in overweight/obesity prevalence were noted among CCA subtypes and ethnicities, with higher rates in extrahepatic CCA and among Hispanics and Caucasians. At diagnosis, 72% of patients had ECOG-PS scores of 0–1, with disease presentations ranging from localized (47%) to locally advanced (19%) and metastatic (34%). Patients who did not receive any anti-cancer therapy exhibited a median survival of 2.3 months. Survival rates significantly improved across treatment modalities, with surgery yielding the longest (34 months), followed by chemotherapy (8 months). Notably, Africans presented with worse ECOG-PS scores and more advanced disease, while Hispanics were less frequently treated with chemotherapy for advanced disease, contributing to lower survival rates (8.3 and 6 months, respectively) compared to Caucasians (12.6 months).

Interpretation

The high prevalence of late-stage CCA diagnosis in Latin America, particularly among individuals of African ethnicity, coupled with a significant proportion of Hispanic patients not receiving chemotherapy, underscores the dismal prognosis for these patients. These findings reveal structural challenges in cancer screening and healthcare access among diverse ethnic backgrounds and lower socioeconomic statuses in the region. Urgent measures are needed, including the identification of preventable risk factors, raising awareness among high-risk populations, and establishing equitable health coverage to address these disparities.

Funding

European Union’s Horizon 2020 R&I Program, Incyte Bioscience International Sàrl, and European Association for the Study of the Liver (EASL).

查看原文本刊更多论文

拉丁美洲的胆管癌：一项多中心观察研究，警示肿瘤发病和预后方面的种族差异

背景胆管癌（CCA）是一项全球性健康挑战，其发病率和死亡率不断上升。这项研究旨在阐明拉丁美洲 CCA 的临床过程和治疗方法。方法这项观察性队列研究调查了 2010 年至 2023 年期间在拉丁美洲五个转诊中心确诊的 CCA 患者。研究结果共登记了 309 名患者，显示了 CCA 亚型（肝内型、肝周型和远端型）的均衡分布，主要种族为西班牙裔和白种人，其次是非洲人。发现的主要风险因素包括年龄、糖尿病、肥胖、MASLD、胆管结石和胆囊炎。CCA亚型和种族之间的超重/肥胖发生率存在差异，肝外CCA以及西班牙裔和白种人的超重/肥胖发生率较高。确诊时，72%的患者ECOG-PS评分为0-1分，疾病表现从局部（47%）到局部晚期（19%）和转移性（34%）不等。未接受任何抗癌治疗的患者的中位生存期为 2.3 个月。各种治疗方式的生存率都有明显提高，其中手术治疗的生存期最长（34 个月），其次是化疗（8 个月）。值得注意的是，非洲人的 ECOG-PS 评分较低，病情较晚，而西班牙裔晚期患者接受化疗的比例较低，因此与白种人（12.6 个月）相比，非洲人的生存率较低（分别为 8.3 个月和 6 个月）。这些发现揭示了该地区不同种族背景和社会经济地位较低的人群在癌症筛查和医疗服务方面面临的结构性挑战。需要采取紧急措施，包括识别可预防的风险因素、提高高危人群的意识以及建立公平的医疗保险来解决这些差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Lancet Regional Health-Americas Multiple-

CiteScore

8.00

自引率

0.00%

发文量

期刊介绍： The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.