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Multicenter Study
. 2014 Dec;69(12):1098-104.
doi: 10.1136/thoraxjnl-2014-205285. Epub 2014 Aug 6.

Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score

Amelia O Clive  1 , Brennan C Kahan  2 , Clare E Hooper  1 , Rahul Bhatnagar  1 , Anna J Morley  3 , Natalie Zahan-Evans  3 , Oliver J Bintcliffe  3 , Rogier C Boshuizen  4 , Edward T H Fysh  5 , Claire L Tobin  6 , Andrew R L Medford  3 , John E Harvey  3 , Michel M van den Heuvel  4 , Y C Gary Lee  5 , Nick A Maskell  1
Affiliations
Free PMC article
Multicenter Study

Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score

Amelia O Clive et al. Thorax. 2014 Dec.
Free PMC article

Abstract

Background: Malignant pleural effusion (MPE) causes debilitating breathlessness and predicting survival is challenging. This study aimed to obtain contemporary data on survival by underlying tumour type in patients with MPE, identify prognostic indicators of overall survival and develop and validate a prognostic scoring system.

Methods: Three large international cohorts of patients with MPE were used to calculate survival by cell type (univariable Cox model). The prognostic value of 14 predefined variables was evaluated in the most complete data set (multivariable Cox model). A clinical prognostic scoring system was then developed and validated.

Results: Based on the results of the international data and the multivariable survival analysis, the LENT prognostic score (pleural fluid lactate dehydrogenase, Eastern Cooperative Oncology Group (ECOG) performance score (PS), neutrophil-to-lymphocyte ratio and tumour type) was developed and subsequently validated using an independent data set. Risk stratifying patients into low-risk, moderate-risk and high-risk groups gave median (IQR) survivals of 319 days (228-549; n=43), 130 days (47-467; n=129) and 44 days (22-77; n=31), respectively. Only 65% (20/31) of patients with a high-risk LENT score survived 1 month from diagnosis and just 3% (1/31) survived 6 months. Analysis of the area under the receiver operating curve revealed the LENT score to be superior at predicting survival compared with ECOG PS at 1 month (0.77 vs 0.66, p<0.01), 3 months (0.84 vs 0.75, p<0.01) and 6 months (0.85 vs 0.76, p<0.01).

Conclusions: The LENT scoring system is the first validated prognostic score in MPE, which predicts survival with significantly better accuracy than ECOG PS alone. This may aid clinical decision making in this diverse patient population.

Keywords: Lung Cancer; Mesothelioma; Pleural Disease.

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Figures

Figure 1
Figure 1
Kaplan–Meier survival curves according to cell type for the UK, Australian and Dutch cohorts combined.
Figure 2
Figure 2
Survival curves according to the LENT score. (A) ‘UK Cohort 1’ and (B) ‘UK Cohort 2’. MS, median survival; IQR, interquartile range; HR, hazard ratio; 95% CI, 95% confidence interval; NA*, Unable to provide data as insufficient patients have died.
Figure 3
Figure 3
Proportion of patients surviving to 1, 3 and 6 months according to low-risk, moderate-risk and high-risk LENT scores. (A) ‘UK Cohort 1’ and (B) ‘UK Cohort 2’.
Figure 4
Figure 4
Receiver operating characteristic (ROC) curve analysis for the LENT score and Eastern Cooperative Oncology Group (ECOG) performance score (PS) for the outcome of mortality. (A)‘UK Cohort 1’ at 1 month. (B)‘UK Cohort 1’ at 3 months. (C) ‘UK Cohort 1’ at 6 months. (D)‘UK Cohort 2’ at 1 month. (E) ‘UK Cohort 2’ at 3 months. (F) ‘UK Cohort 2’ at 6 months.
See this image and copyright information in PMC

Comment in

  • A response to the LENT score.
    Murray J, Turner R, Bothamley GH, Bhowmik A. Murray J, et al. Thorax. 2014 Dec;69(12):1144. doi: 10.1136/thoraxjnl-2014-206194. Epub 2014 Sep 22. Thorax. 2014. PMID: 25246667 No abstract available.
  • Authors' response to Murray et al.
    Clive AO, Kahan BC, Maskell NA. Clive AO, et al. Thorax. 2014 Dec;69(12):1144-5. doi: 10.1136/thoraxjnl-2014-206247. Epub 2014 Sep 24. Thorax. 2014. PMID: 25253357 No abstract available.

References

    1. The American Thoracic Society. Management of malignant pleural effusions. Am J Respir Crit Care Med 2000;162:1987–2001. - PubMed
    1. Cancer Statistics Registrations, England (Series MB1): Office of National Statistics, Stationary Office, 2010.
    1. Roberts ME, Neville E, Berrisford RG, et al. Management of a malignant pleural effusion: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010;65(Suppl 2):ii32–40. - PubMed
    1. Tan C, Sedrakyan A, Browne J, et al. The evidence on the effectiveness of management for malignant pleural effusion: a systematic review. Eur J Cardiothorac Surg 2006;29:829–38. - PubMed
    1. Pilling JE, Dusmet ME, Ladas G, et al. Prognostic factors for survival after surgical palliation of malignant pleural effusion. J Thorac Oncol 2010;5:1544–50. - PubMed

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