Association between Smoking Cessation and the Risk of Cholangiocarcinoma and Ampulla of Vater Cancer: A Nationwide Cohort Study.

IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Liver Cancer Pub Date : 2023-02-09 eCollection Date: 2023-10-01 DOI:10.1159/000529609
Joo-Hyun Park, Jung Yong Hong, Kyungdo Han
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Abstract

Introduction: The association between smoking cessation and intrahepatic and extrahepatic cholangiocarcinoma (iCCA and eCCA) risk is unclear. Furthermore, the association in individuals with preexisting risk factors is unknown. We aimed to investigate the association between smoking status (especially smoking cessation) and CCA risk according to individuals' glycemic status.

Methods: In this nationwide cohort study, 9,520,629 adults without cancer who underwent national health screening by the Korean National Health Insurance Service in 2009 were followed up through 2018. The hazard ratios (HRs) and 95% confidence intervals (CIs) for CCA were estimated after adjusting for potential confounders.

Results: During the 78.3 person-years of follow-up, 16,236 individuals were newly diagnosed with CCA. Quitters had a significantly lower risk of iCCA and eCCA compared to current smokers in all glycemic status groups (all p < 0.01). The HRs (95% CIs) for iCCA in current smokers and quitters were 1.33 (1.24-1.43) versus 0.98 (0.90-1.06) in individuals with normoglycemia, 1.49 (1.37-1.63) versus 1.17 (1.06-1.28) in individuals with prediabetes, and 2.15 (1.96-2.37) versus 1.58 (1.42-1.75) in individuals with diabetes, compared to never-smokers with normoglycemia. Current smokers with diabetes or prediabetes had a synergistically increased risk of iCCA (all p < 0.01). However, quitters with diabetes and prediabetes had an iCCA risk comparable to that of never-smokers. Analysis of eCCA yielded similar results. Smoking was not independently associated with the risk of the ampulla of Vater cancer. However, smoking combined with diabetes or prediabetes was associated with an increased risk of the ampulla of Vater cancer (all p < 0.05).

Conclusion: Smoking cessation was associated with a reduced risk of CCA, despite the synergistically increased risk in current smokers with diabetes and prediabetes. Our findings suggest a crucial opportunity to reduce the risk of CCA. More individualized and intensive cancer prevention education is needed against CCA.

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戒烟与癌症胆管癌和壶腹部风险的相关性:一项全国性队列研究。
引言:戒烟与肝内和肝外胆管癌(iCCA和eCCA)风险之间的关系尚不清楚。此外,与先前存在的风险因素相关的个体尚不清楚。我们旨在根据个体的血糖状况,调查吸烟状况(尤其是戒烟)与CCA风险之间的关系。方法:在这项全国性队列研究中,对2009年接受韩国国家健康保险服务局全国健康筛查的9520629名无癌症成年人进行了随访,直至2018年。CCA的危险比(HR)和95%置信区间(CI)是在调整潜在混杂因素后估计的。结果:在78.3人年的随访中,16236人被新诊断为CCA。在所有血糖状态组中,戒烟者患iCCA和eCCA的风险均显著低于当前吸烟者(均p<0.01)。当前吸烟者和戒烟者的iCCA的HR(95%CI)分别为1.33(1.24-1.43)和0.98(0.90-1.06),糖尿病前期患者为1.49(1.37-1.63)和1.17(1.06-1.28),糖尿病患者为2.15(1.96-2.37),而血糖正常的从不吸烟者为1.58(1.42-1.75)。目前患有糖尿病或糖尿病前期的吸烟者患iCCA的风险协同增加(均p<0.01)。然而,患有糖尿病和糖尿病前期的戒烟者患iCCA风险与从不吸烟者相当。eCCA的分析得出了类似的结果。吸烟与癌症壶腹部的风险并没有独立的相关性。然而,吸烟合并糖尿病或糖尿病前期与Vater癌症壶腹部风险增加相关(均p<0.05)。结论:尽管目前糖尿病和糖尿病前期吸烟者的风险协同增加,但戒烟与CCA风险降低相关。我们的研究结果为降低CCA风险提供了一个重要的机会。需要针对CCA进行更个性化和强化的癌症预防教育。
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来源期刊
Liver Cancer
Liver Cancer Medicine-Oncology
CiteScore
20.80
自引率
7.20%
发文量
53
审稿时长
16 weeks
期刊介绍: Liver Cancer is a journal that serves the international community of researchers and clinicians by providing a platform for research results related to the causes, mechanisms, and therapy of liver cancer. It focuses on molecular carcinogenesis, prevention, surveillance, diagnosis, and treatment, including molecular targeted therapy. The journal publishes clinical and translational research in the field of liver cancer in both humans and experimental models. It publishes original and review articles and has an Impact Factor of 13.8. The journal is indexed and abstracted in various platforms including PubMed, PubMed Central, Web of Science, Science Citation Index, Science Citation Index Expanded, Google Scholar, DOAJ, Chemical Abstracts Service, Scopus, Embase, Pathway Studio, and WorldCat.
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