Malignant pleural effusion survival prognostication in an Asian population. Issue 12 (11th May 2020)

• Record Type: Journal Article
• Authors: Quek, Jonathan Caleb; Tan, Qiao Li; Allen, John Carson; Anantham, Devanand
• Is Part Of: Respirology. Volume 25:Issue 12(2020)
• Page Start: 1283
• Page End: 1291
• Publication Date: 2020-05-11
• Subjects: cancer -- malignant pleural effusion -- mortality -- prognosis -- therapy; Respiratory organs -- Diseases -- Periodicals; Respiratory organs -- Periodicals; 612.2
• DOI: 10.1111/resp.13837
• Languages: English
• ISSNs: 1323-7799

Abstract

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), S ex, E astern Cooperative Oncology Group status, L eukocyte count, E GFR mutation, C hemotherapy and primary T umour 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 cut‐off 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. Abstract : This is the largest Asian study to date to evaluate the performance of the LENT prognostic score and the first study to validate the modified‐LENT and clinical PROMISE prognostication scores in an Asian population of patients with MPE for pleuroscopy. An improved prognostication score (SELECT) is also proposed. See related Editorial