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Original article
Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score
  1. Amelia O Clive1,2,
  2. Brennan C Kahan3,
  3. Clare E Hooper1,2,
  4. Rahul Bhatnagar1,2,
  5. Anna J Morley2,
  6. Natalie Zahan-Evans2,
  7. Oliver J Bintcliffe2,
  8. Rogier C Boshuizen4,
  9. Edward T H Fysh5,6,
  10. Claire L Tobin5,
  11. Andrew R L Medford2,
  12. John E Harvey2,
  13. Michel M van den Heuvel4,
  14. Y C Gary Lee5,6,
  15. Nick A Maskell1,2
  1. 1Academic Respiratory Unit, University of Bristol, Bristol, UK
  2. 2North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
  3. 3Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
  4. 4Thoracic Oncology, The Netherlands Cancer Institute, Antonie van Leeuwenhoek Hospital, Amsterdam, The Netherlands
  5. 5Respiratory Department, Sir Charles Gairdner Hospital, Perth, Australia
  6. 6Centre for Asthma, Allergy & Respiratory Research, School of Medicine & Pharmacology, University of Western Australia, Perth, Australia
  1. Correspondence to Dr Nick A Maskell, Academic Respiratory Unit, Second Floor, Learning and Research Building, Southmead Hospital, University of Bristol, Bristol BS10 5NB, UK; nick.maskell{at}


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.

  • Pleural Disease
  • Lung Cancer
  • Mesothelioma

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • PostScript
    James Murray Richard Turner Graham H Bothamley Angshu Bhowmik
  • PostScript
    Amelia O Clive Brennan C Kahan Nick A Maskell