Introduction and objectives Reliable 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.
Methods Our 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.
Results The 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).
Conclusions The 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.
Reference 1 Clive AO, et al. Thorax 2014;69(12):1098–104