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Effect of smoking cessation on quantitative computed tomography in smokers at risk in a lung cancer screening population

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Abstract

Objective

To longitudinally evaluate effects of smoking cessation on quantitative CT in a lung cancer screening cohort of heavy smokers over 4 years.

Methods

After 4 years, low-dose chest CT was available for 314 long-term ex-smokers (ES), 404 continuous smokers (CS) and 39 recent quitters (RQ) who quitted smoking within 2 years after baseline CT. CT acquired at baseline and after 3 and 4 years was subjected to well-evaluated densitometry software, computing mean lung density (MLD) and 15th percentile of the lung density histogram (15TH).

Results

At baseline, active smokers showed significantly higher MLD and 15TH (-822±35 and -936±25 HU, respectively) compared to ES (-831±31 and -947±22 HU, p<0.01–0.001). After 3 years, CS again had significantly higher MLD and 15TH (-801±29 and -896±23 HU) than ES (-808±27 and -906±20 HU, p<0.01–0.001) but also RQ (-813±20 and -909±15 HU, p<0.05-0.001). Quantitative CT parameters did not change significantly after 4 years. Importantly, smoking status independently predicted MLD at baseline and year 3 (p<0.001) in multivariate analysis.

Conclusion

On quantitative CT, lung density is higher in active smokers than ex-smokers, and sustainably decreases after smoking cessation, reflecting smoking-induced inflammation. Interpretations of quantitative CT data within clinical trials should consider smoking status.

Key Points

• Lung density is higher in active smokers than ex-smokers.

• Lung density sustainably decreases after smoking cessation.

• Impact of smoking cessation on lung density is independent of potentially confounding factors.

• Smoke-induced pulmonary inflammation and particle deposition influence lung density on CT.

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Abbreviations

15TH:

15th percentile of lung density histogram

ATS:

American Thoracic Society

BMI:

Body mass index

COPACETIC COPD Pathology:

Addressing Critical Gaps, Early Treatment and Diagnosis and Innovative Concepts.

COPD:

Chronic obstructive pulmonary disease

CS:

Continuous smokers

CT:

Multidetector computed tomography

DFG:

German Research Council

ECSC:

European Coal and Steal Community

EI:

Emphysema index

ES:

Ex-smokers

EV:

Emphysema volume

FEV1%:

Forced expiratory volume in 1 s in percent predicted

FEV1/FVC:

Tiffenau index

FEV1:

Forced expiratory volume in 1 s

FVC:

Forced vital capacity

GOLD:

Global Initiative for Chronic Obstructive Lung Disease

HU:

Hounsfield units

LAA%950 :

Percentage of low attenuation areas at a threshold of -950 HU

LUSI:

Lung Cancer Screening Intervention Trial

LV:

Lung volume

MLD:

Mean lung density

PD15:

15th percentile of lung density histogram

PFT:

Pulmonary function testing

QCT:

Quantitative CT

RB-ILD:

Respiratory bronchiolitis interstitial lung disease

RQ:

Recent quitters

YACTA:

Yet Another CT Analyzer

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Acknowledgements

We thank all participants for their willingness to contribute to this study. The expert technical assistance of Julia Schliebus and Martina Jochim are gratefully appreciated. This work contains parts of the doctoral thesis of Mila Trauth, Heidelberg, Germany.

Funding

This study has received funding by the Dietmar Hopp Foundation (2007–2010) and the German Research Association (DFG) (2007–2013). The COPACETIC study was funded by EU FP7 grant 201379.

Author information

Author notes

  1. BJJ and OW contributed equally as first authors of this paper

Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Bertram J. Jobst, Oliver Weinheimer, Mila Trauth, Monika Eichinger, Hans-Ulrich Kauczor & Mark O. Wielpütz

  2. Translational Lung Research Centre Heidelberg (TLRC), Member of the German Lung Research Centre (DZL), Im Neuenheimer Feld 430, 69120, Heidelberg, Germany

    Bertram J. Jobst, Oliver Weinheimer, Mila Trauth, Monika Eichinger, Hans-Ulrich Kauczor & Mark O. Wielpütz

  3. Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at the University of Heidelberg, Amalienstr. 5, 69126, Heidelberg, Germany

    Bertram J. Jobst, Oliver Weinheimer, Mila Trauth, Monika Eichinger, Hans-Ulrich Kauczor & Mark O. Wielpütz

  4. Department of Radiology, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany

    Bertram J. Jobst, Jan Tremper, Stefan Delorme, Monika Eichinger & Mark O. Wielpütz

  5. Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ Heidelberg), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany

    Nikolaus Becker, Erna Motsch, Marie-Luise Groß & Anke Eigentopf

Authors
  1. Bertram J. Jobst
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  2. Oliver Weinheimer
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Corresponding author

Correspondence to Bertram J. Jobst.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Mark O. Wielpütz.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Ethical approval

Institutional Review Board approval was obtained (approved by the Ethics Committee of the Medical Faculty of the University of Heidelberg (073/2001) and the federal radiation protection authority (22462/2 2006-045)).

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Study subjects or cohorts overlap

The study subjects have been previously reported in J Thorac Oncol. 2015 Jun;10(6):890-6, Am J Respir Crit Care Med. 2015 Mar 1;191(5):547-56, J Cancer Res Clin Oncol. 2012 Sep;138(9):1475-86, and Eur J Radiol. 2014 Mar;83(3):600-5, investigating data or aspects that were significantly different from the present study.

Methodology

• prospective

• randomised controlled trial

• observational

• performed at one institution

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Jobst, B.J., Weinheimer, O., Trauth, M. et al. Effect of smoking cessation on quantitative computed tomography in smokers at risk in a lung cancer screening population. Eur Radiol 28, 807–815 (2018). https://doi.org/10.1007/s00330-017-5030-6

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  • DOI: https://doi.org/10.1007/s00330-017-5030-6

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