Introduction and objectivesReliable predictors of survival in malignant pleural effusions (MPE) have far reaching applications in clinical practice, not least tailoring individual treatment strategies. The ‘LENT’ score (pleural fluid Lactate dehydrogenase; Eastern Cooperative Oncology Group performance score; Neutrophil-to-lymphocyte ratio; Tumour type) was developed and validated as a clinical prognostic scoring system from three international prospective patient databases.1 The aim of this study was to evaluate the LENT score in a further UK population of patients with MPE, geographically separate from those in the original study.MethodsOur hospital is a large tertiary centre for a physician-led pleural service (including medical thoracoscopy), a regional mesothelioma centre and a regional thoracic surgical centre. A retrospective study of all patients with positive (i.e. diagnostic for malignancy) pleural cytology or histology from 2010 to 2014 was undertaken. This timeframe allowed a minimum of 12 months follow-up for all patients. Survival data was obtained from national death registries. All patients in whom all LENT criteria were available were included in the analysis. A Kaplan-Meier curve and a Cox regression model were used to assess the LENT risk category. Harrell’s C statistic was used to assess the accuracy of the regression model and mortality rates at time points of interest were calculated.ResultsThe LENT score was calculated for 101 patients diagnosed with MPE. The median survival (days, IQR) for the low (n = 18), medium (n = 54) and high risk (n = 29) groups were: 254 (152–602), 102 (40–301) and 16 (7–42). In the high risk group, only 31% of patients survived 1 month and 7% survived 6 months. There is a statistically significant difference in the survival times in the different risk groups according to the log-rank test (p < 0.001). Harrell’s C statistic in this cohort is 0.69 (see Figure 1).Abstract P185 Figure 1 ConclusionsThe LENT scoring system has again been shown to be a good tool for predicting survival in patients with MPE when applied to a geographically distinct cohort of patients to the original study. The LENT score continues to be a clinically valuable tool in the assessment of patients with MPE.Reference1 Clive AO, et al. Thorax 2014;69(12):1098–104
IntroductionThe insertion of indwelling pleural catheters (IPCs) allows outpatient based management of pleural effusions and has been shown to be effective as a primary management strategy and following failed attempts at pleurodesis. The presence of septations may be associated with incomplete drainage and may make the procedure more complex. This study aimed to assess if the presence of septations on thoracic ultrasound changed the outcome of IPC insertion and to review complication rates.MethodProspective data is collected for patients undergoing insertion of IPCs at a tertiary pleural referral centre. Pre-procedure thoracic ultrasound is performed in all patients and a grading of septations made; no septations, mild (<4), moderate (4–9), severe septations (>9). Immediate, early (30 days) complications as well as six month follow-up data are recorded. This study is a retrospective analysis of this prospectively maintained database.ResultsA total of 47 patients with complete datasets were identified between 2013–2014; 34% (16/47) had mild/moderate/severe septations (n = 7, 5, 4 respectively) and 66% (31/47) had no septations. There was no significant difference in the number of patients achieving resolution of pleural effusion and pleurodesis whereby the IPC could be removed according to the presence of septations (pleurodesis in those with no septations 16%, 5/31 vs. 13%, 2/16 in those with septations, p = 1.0). There were no patients in either group in whom the drain was removed due lack of drainage in the context of a persistent pleural collection. There was no significant difference in overall complication rate according to the presence of septations (16%, 5/31, in the no septation group vs 13%, 2/16, in the septation group, p = 1.0).ConclusionThese results suggest that the presence of septations on the pre-insertion thoracic ultrasound do not affect the rate of pleurodesis or drain removal due to lack of drainage and persistent pleural effusion. The numbers in the study are small and a limitation is the lack of assessment of post-procedure breathlessness in our patients (e.g. with a visual analogue scale). The presence of septations should not deter consideration of IPC insertion in the management of malignant pleural effusions.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.