Malignant pleural effusion survival prognostication in an Asian population

Abstract

Background and objective: LENT and PROMISE scores prognosticate survival in patients with MPE. Prognostication guides the selection of interventions and management. However, the predictive value of these scores and their refinements (modified-LENT) in Asians remain unclear. We aim to evaluate the performance of LENT, modified-LENT and clinical PROMISE scores; identify predictors of survival; and develop an alternative prognostication tool should current scores lack accuracy. Methods: Retrospective medical record review of an Asian pleuroscopy database from 2011 to 2018 of patients with MPE was conducted. The prognostic capability of current available scores were evaluated using C-statistics. Demographic and clinical variables as predictors of survival were assessed, and an alternative model was developed using logistic regression. Results: In 130 patients, the C-statistics for modified-LENT was not significantly different from LENT (0.59 (95% CI: 0.52-0.67) vs 0.56 (95% CI: 0.49-0.63); P = 0.403). In 57 patients, the PROMISE C-statistics was 0.72 (95% CI: 0.53-0.91). In our alternative prognostication model (n = 147), Sex, Eastern Cooperative Oncology Group status, Leukocyte count, EGFR mutation, Chemotherapy and primary Tumour type (SELECT) were predictors of 90-day mortality (C-statistic = 0.87 (95% CI: 0.79-0.95)). SELECT sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios using a predicted probability of 90-day mortality cutoff point of 10% were 0.91, 0.68, 0.34, 0.98, 2.83 and 0.13, respectively. Conclusion: The LENT, modified-LENT and PROMISE scores have poor accuracy of survival prognostication in Asian patients with MPE undergoing pleuroscopy. The proposed SELECT prognostication model is accurate at identifying patients with high probability of survival at 90 days.

Pleural effusions associated with squamous cell lung carcinoma have a low diagnostic yield and a poor prognosis

“…However, in LENT score, distinction was not made between adenocarcinoma and squamous cell cancer. In another study evaluating the pleuroscopy experience in 149 MPE patients, a score (SELECT) for prognosis was suggested, including EGFR mutation and tumor type (23). Lung cancer was grouped in the high-risk category, without the differentiation of subtypes, and targetable mutations other than EGFR were not accounted for.…”

Development and Validation of a Scoring System for Early Diagnosis of Malignant Pleural Effusion Based on a Nomogram

“…In China, the majority of BPE arises from tuberculous pleural effusion (TPE), parapneumonic effusion (PPE), and heart failure (HF) ( 4 ). With regard to MPE, lung cancer, breast cancer, and lymphomas account for over 75% of MPE cases ( 1 , 2 , 5 ). The presence of MPE indicates systemic cancer dissemination and a reduction of life expectancy and quality in patients ( 6 ).…”

Personalized Prognostication in Malignant Pleural Effusion

“…3 Despite their simplicity and external validation, there has been the suggestion that alternative scoring systems are necessary to correct for regional demographic variations, for example, in areas with high rates of estimated glomerular filtration rate adenocarcinoma mutations. 4 In this issue of CHEST, Molina et al 5 report their development and validation of a breast and lung effusion survival score (BLESS). The authors selected variables likely to have predictive value from the existing literature.…”