P185 Evaluation of the LENT Prognostic Score in a Large Tertiary Pleural Service

Abstract

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

Malignant pleural effusion survival prognostication in an Asian population

“…Prior validation of the LENT score in Caucasian cohorts do not translate to our patients. The LENT score C‐statistic in our cohort was the lowest when compared to three other studies validating LENT that reported C‐statistics (0.56 vs 0.75, 0.62 and 0.69) (Table S3 in Supplementary Information) 7,8,12 . The reason for this discrepancy may be attributed to the disparate frequency of EGFR mutations seen in Asian cohorts 10 .…”

“…26 Other reasons for the discrepant LENT C-statistic may be attributable to younger patients in our study (65 IQR (56-71) vs 74 IQR (67-80) years), a larger proportion of patients with better functional status (ECOG 0-1) (81% vs 54%) and possibly fewer medical comorbidities as all our patients underwent pleuroscopy. 7 In terms of median survival, our study is the third Asian study validating the LENT score that reports discordant results from other studies [10][11][12]14,15 (Table S4 in Supplementary Information). Clinical use of the existing LENT model is precluded in an Asian population as it significantly underestimates survival.…”

“…The LENT score C-statistic in our cohort was the lowest when compared to three other studies validating LENT that reported C-statistics (0.56 vs 0.75, 0.62 and 0.69) (Table S3 in Supplementary Information). 7,8,12 The reason for this discrepancy may be attributed to the disparate frequency of EGFR mutations seen in Asian cohorts. 10 For instance, the frequency of EGFR mutations in our cohort was approximately four times that of the countries where the LENT score was derived (56% vs 12%, 12% and 15% in the United Kingdom, Australia and Netherlands, respectively).…”

“…7 This score was developed from a prospective multicentre cohort and has been validated in 10 studies to date. 8,[10][11][12][13][14][15][16][17][18] It is also recommended by the European Respiratory Society clinical practice guidelines in the management of malignant effusion. 19 The clinical PROMISE prognostic score was developed from a prospective, multicentre cohort predicting 3-month probability of survival in patients newly diagnosed with malignant effusion.…”

“…The LENT prognostication score is applied to patients with newly diagnosed malignant effusion to estimate median survival based on pleural fluid L actate dehydrogenase (LDH), E astern Cooperative Oncology Group (ECOG) functional status, serum N eutrophil‐to‐lymphocyte ratio and primary T umour type based on histopathology 7 . This score was developed from a prospective multicentre cohort and has been validated in 10 studies to date 8,10–18 . It is also recommended by the European Respiratory Society clinical practice guidelines in the management of malignant effusion 19 .…”