Role of LENT score in prognosis of malignant pleural effusions

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.

Keywords

• eastern cooperative oncology group performance status
• lent score
• malignant pleural effusions
• pleural fluid lactate dehydrogenase
• serum neutrophil-to-lymphocyte ratio