42Divergent Biliary Tract Cancer Trajectories: ARIMA 2030 Projections and Gender-Stratified Epidemiology Across Asian Countries
Saikat Mandal, Arkadeep Dhali, Manideepa MajiAbstract
Background
Cholangiocarcinoma (CCA) and gallbladder (GB) cancer demonstrate profoundly divergent epidemiological trajectories across two decades (2003–2017), demanding urgent investigation. Population-based registry data from the Cancer Incidence in Five Continents project spanning three periods (2003–2007, 2008–2012, 2013–2017) across 12 Asian countries, reveal exponential acceleration in CCA with striking gender-specific patterns indicating distinct aetiological mechanisms.
Objective
To characterise temporal and gender-stratified trends in CCA and GB cancer incidence across Asian countries and generate ARIMA-based 2030 projections.
Methods
Using population-based registry data from the Cancer Incidence in Five Continents (CI5) across three periods (2003–2007, 2008–2012, 2013–2017) in 12 Asian countries, we compared temporal trends in cholangiocarcinoma and GB cancer and quantified sex-specific incidence and male-to-female ratios. We then applied ARIMA modelling to 2003–2017 incidence series to forecast rates to 2030 with 95% prediction intervals.
Results
Between 2003 and 2017, CCA incidence increased 136.3% whilst GB cancer rose only 7.7%, which is a 128.6 percentage-point differential. Geographic variation was extreme: Iran and Kuwait demonstrated significant CCA escalation, Israel showed 234.7% CCA increase against 35.6% gallbladder cancer decline, whilst Japan, Korea, and China exhibited substantial CCA growth (126.8–144.0%) with gallbladder cancer stagnation. Endemic liver-fluke regions showed attenuated divergence (Thailand: 60.1% CCA vs 26.6% gallbladder, 33.5 percentage- point gap). ARIMA modelling reveals alarming 2030 projections of CCA: Republic of Korea 3.38 per 100,000, Japan 2.19, China 1.09, Thailand 2.02. Gender-stratified analysis reveals striking divergence: CCA demonstrates pronounced male predominance in the non-endemic region, suggesting male-predominant behavioural and metabolic risk factors. Conversely, GB cancer demonstrates universal female predominance (0.38-0.75 ratios) reflecting cholelithiasis epidemiology.
Conclusion
This profound gender divergence provides compelling evidence for independent aetiological mechanisms. These findings mandate urgent investigation of emerging non-parasitic CCA risk factors in developed Asian economies, prospective studies examining smoking, alcohol, metabolic syndrome, and enhanced surveillance infrastructure.