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VOLUME 11 , ISSUE 2 ( April-June, 2022 ) > List of Articles

Original Article

Role of LENT Score in Prognosis of Malignant Pleural Effusions

Yellapu Gayatri Devi, Preethi Koyyana, Vathada Nookaraju, Balla Padmaja, Pudi Mounika, Papayagari Alekya

Keywords : Eastern Cooperative Oncology Group Performance Status, LENT score, malignant pleural effusions, pleural fluid lactate dehydrogenase, serum neutrophil-to-lymphocyte ratio

Citation Information : Devi YG, Koyyana P, Nookaraju V, Padmaja B, Mounika P, Alekya P. Role of LENT Score in Prognosis of Malignant Pleural Effusions. Indian J Respir Care 2022; 11 (2):106-111.

DOI: 10.4103/ijrc.ijrc_119_21

License: CC BY-NC-SA 4.0

Published Online: 06-12-2022

Copyright Statement:  Copyright © 2022; Indian Journal of Respiratory Care.


Abstract

Background: Detection of exfoliated malignant cells in the pleura, i.e., malignant pleural effusion (MPE), is an advanced form of the disease with poor outcome and limited survival in both primary lung and nonlung primary carcinomas. LENT score, the first validated prognostic score, was developed to predict such survival in MPE. The aim of the study is to assess the role of LENT score to predict the survival in MPE along with Eastern Cooperative Oncology Group Performance Status (ECOG PS) score. Materials and Methods: A prospective observational study was conducted on 30 patients who presented with MPE. LENT score along with ECOG PS was calculated, and survival prediction at 1, 3, and 6 months was done using receiver operating characteristic (ROC) analysis. Results: Out of 30 patients, 22 had primary lung and 8 had nonlung primary malignancy. Fourteen patients were in the high-risk group (LENT score 5-7), 15 in the moderate-risk group (LENT score 2-4), and 1 in the low-risk group (LENT score 0-1). Overall median survival was 45 days. Analysis of the area under the ROC curve for LENT and ECOG PS score at predicting survival at 1 month (0.763 vs. 0.855), 3 months (0.889 vs. 0.938), and 6 months (0.920 vs. 0.976) showed no significant difference though ECOG PS was slightly better as a prognostic variable. Kaplan-Meier survival analysis with log-rank test showed that there is a significant difference in survival between the risk groups based on LENT score (Chi-square 20.5469, P ≤ 0.0001). Conclusion: Both LENT and ECOG PS scores are equally good at predicting survival rates in MPE; however, the LENT score is potent, easy to compute, clinically applicable up to the point and helps in guiding treatment selection.


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  1. Heffner JE, Klein JS. Recent advances in the diagnosis and management of malignant pleural effusions. Mayo Clin Proc 2008;83:235-50.
  2. Shaw PH, Agarwal R. WITHDRAWN: Pleurodesis for malignant pleural effusions. Cochrane Database Syst Rev 2013;11:CD002916.
  3. Desai NR, Lee HJ. Diagnosis and management of malignant pleural effusions: State of the art in 2017. J Thorac Dis 2017;9 Suppl 10:S1111-22.
  4. Penz E, Watt KN, Hergott CA, Rahman NM, Psallidas I. Management of malignant pleural effusion: Challenges and solutions. Cancer Manag Res 2017;9:229-24.
  5. Psallidas I, Kalomenidis I, Porcel JM, Robinson BW, Stathopoulos GT. Malignant pleural effusion: From bench to bedside. Eur Respir Rev 2016;25:189-98.
  6. Roberts ME, Neville E, Berrisford RG, Antunes G, Ali NJ; BTS Pleural Disease Guideline Group. Management of a malignant pleural effusion: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010;65 Suppl 2:i32-40.
  7. Dresler CM, Olak J, Herndon JE 2nd, Richards WG, Scalzetti E, Fleishman SB, et al. Phase III intergroup study of talc poudrage vs. talc slurry sclerosis for malignant pleural effusion. Chest 2005;127:909-15.
  8. Davies HE, Mishra EK, Kahan BC, Wrightson JM, Stanton AE, Guhan A, et al. Effect of an indwelling pleural catheter vs. chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: The TIME2 randomized controlled trial. JAMA 2012;307:2383-9.
  9. Tan C, Sedrakyan A, Browne J, Swift S, Treasure T. The evidence on the effectiveness of management for malignant pleural effusion: A systematic review. Eur J Cardiothorac Surg 2006;29:829-38.
  10. Pilling JE, Dusmet ME, Ladas G, Goldstraw P. Prognostic factors for survival after surgical palliation of malignant pleural effusion. J Thorac Oncol 2010;5:1544-50.
  11. Bielsa S, Salud A, Martínez M, Esquerda A, Martín A, Rodríguez-Panadero F, et al. Prognostic significance of pleural fluid data in patients with malignant effusion. Eur J Intern Med 2008;19:334-9.
  12. Ozyurtkan MO, Balci AE, Cakmak M. Predictors of mortality within three months in the patients with malignant pleural effusion. Eur J Intern Med 2010;21:30-4.
  13. Burrows CM, Mathews WC, Colt HG. Predicting survival in patients with recurrent symptomatic malignant pleural effusions: An assessment of the prognostic values of physiologic, morphologic, and quality of life measures of extent of disease. Chest 2000;117:73-8.
  14. Pinato DJ, Mauri FA, Ramakrishnan R, Wahab L, Lloyd T, Sharma R. Inflammation-based prognostic indices in malignant pleural mesothelioma. J Thorac Oncol 2012;7:587-94.
  15. Proctor MJ, Morrison DS, Talwar D, Balmer SM, Fletcher CD, O'Reilly DS, et al. A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study. Eur J Cancer 2011;47:2633-41.
  16. Kao SC, Pavlakis N, Harvie R, Vardy JL, Boyer MJ, van Zandwijk N, et al. High blood neutrophil-to-lymphocyte ratio is an indicator of poor prognosis in malignant mesothelioma patients undergoing systemic therapy. Clin Cancer Res 2010;16:5805-13.
  17. Anevlavis S, Kouliatsis G, Sotiriou I, Koukourakis MI, Archontogeorgis K, Karpathiou G, et al. Prognostic factors in patients presenting with pleural effusion revealing malignancy. Respiration 2014;87:311-6.
  18. Clive AO, Kahan BC, Hooper CE, et al. Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic scoreThorax 2014;69:1098-1104.
  19. American Thoracic Society. Management of malignant pleural effusions. Am J Respir Crit Care Med 2000;162:1987-2001.
  20. Zamboni MM, da Silva CT Jr., Baretta R, Cunha ET, Cardoso GP. Important prognostic factors for survival in patients with malignant pleural effusion. BMC Pulm Med 2015;15:29.
  21. Lee YS, Nam HS, Lim JH, Kim JS, Moon Y, Cho JH, et al. Prognostic impact of a new score using neutrophil-to-lymphocyte ratios in the serum and malignant pleural effusion in lung cancer patients. BMC Cancer 2017;17:557.
  22. Kasapoglu US, Arınç S, Gungor S, Irmak I, Guney P, Aksoy F, et al. Prognostic factors affecting survival in non-small cell lung carcinoma patients with malignant pleural effusions. Clin Respir J 2016;10:791-9.
  23. Vijayakumar B, Hosack T. LENT score - Useful clinical tool?. Eur Respir J 2019;54:PA3083.
  24. Martínez-Moragón E, Aparicio J, Sanchis J, Menéndez R, Cruz Rogado M, Sanchis F. Malignant pleural effusion: Prognostic factors for survival and response to chemical pleurodesis in a series of
  25. Respiration 1998;65:108-13.
  26. Amin Z, Iskandar SD, Sibli. Prognostic factors of 30-day survival of patients with malignant pleural effusion. Indian J Palliat Care 2017;23:321-4.
  27. Arnoud J. Templeton, Mairéad G. McNamara, Boštjan Šeruga, Francisco E. Vera-Badillo, Priya Aneja, et al. Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Solid Tumors: A Systematic Review and Meta- Analysis, JNCI: Journal of the National Cancer Institute, 2014; Volume
  28. [https://doi.org/10.1093/jnci/dju124].
  29. Sweeney CJ, Zhu J, Sandler AB, Schiller J, Belani CP, Langer C, et al. Outcome of patients with a performance status of 2 in Eastern Cooperative Oncology Group Study E1594: A Phase II trial in patients with metastatic nonsmall cell lung carcinoma. Cancer 2001;92:2639-47.
  30. Ando M, Ando Y, Hasegawa Y, Shimokata K, Minami H, Wakai K, et al. Prognostic value of performance status assessed by patients themselves, nurses, and oncologists in advanced non-small cell lung cancer. Br J Cancer 2001;85:1634-9.
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