戒烟与肝内和肝外胆管癌（iCCA 和 eCCA）风险之间的关联尚不清楚。此外，个体与先前存在的危险因素之间的关联尚不清楚。我们的目的是根据个人的血糖状况调查吸烟状况（尤其是戒烟）与 CCA 风险之间的关联。在这项全国性队列研究中，对 2009 年韩国国民健康保险局接受全国健康筛查的 9,520,629 名未患癌症的成年人进行了跟踪调查截至 2018 年。在调整潜在混杂因素后，估计了 CCA 的风险比 (HR) 和 95% 置信区间 (CI)。在 78.3 人年的随访期间，有 16,236 人新诊断出患有 CCA。在所有血糖状态组中，与当前吸烟者相比，戒烟者的 iCCA 和 eCCA 风险显着降低（所有 p < 0.01）。当前吸烟者和戒烟者中 iCCA 的 HR (95% CI) 分别为 1.33 (1.24-1.43) 和血糖正常个体中的 0.98 (0.90-1.06)，糖尿病前期个体中分别为 1.49 (1.37-1.63) 和 1.17 (1.06-1.28)与血糖正常的从不吸烟者相比，糖尿病患者的这一比例为 2.15 (1.96-2.37) 与 1.58 (1.42-1.75)。目前患有糖尿病或糖尿病前期的吸烟者 iCCA 风险协同增加（所有 p < 0.01）。然而，患有糖尿病和糖尿病前期的戒烟者的 iCCA 风险与从不吸烟者相当。 eCCA 分析得出了类似的结果。吸烟与壶腹部 Vater 癌的风险并不独立相关。然而，吸烟合并糖尿病或糖尿病前期与 Vater 壶腹癌的风险增加相关（所有 p < 0.05）。戒烟与 CCA 风险降低相关，尽管目前吸烟者患有糖尿病和糖尿病前期的风险会协同增加。我们的研究结果表明这是降低 CCA 风险的重要机会。针对 CCA 需要进行更加个性化和强化的癌症预防教育。© 2023 作者。由巴塞尔 S. Karger AG 出版。

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.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.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).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.© 2023 The Author(s). Published by S. Karger AG, Basel.