An Observational Study Evaluating the Performance of LENT Score in the Selected Population of Malignant Pleural Effusion from Lung Adenocarcinoma in Singapore

Abstract

Background: Patients with malignant pleural effusion (MPE) secondary to lung cancer have been associated with poor prognosis historically. LENT score developed to risk-stratify unselected patients with MPE predicts prognosis of < 6 months in patients with lung cancer. Objective: To assess the performance of LENT score in predicting prognosis in selected population of MPE secondary to lung adenocarcinoma alone. Methods: A retrospective observational study was conducted by reviewing the medical records of patients managed for MPE in the year 2012. Results: Seventy patients with lung adenocarcinoma presenting with MPE were studied. The median (range) LENT score at initial diagnosis was 5 (2–7), and the median survival 7.9 (0.13–40) months. Thirty-nine patients received epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKIs). The median LENT score and median survival was 4 (2–7) and 14.4 months, respectively, in this group. Those in high-risk category by LENT in this group (n = 19) had a median survival and 6-month survival of 17.4 months and 73.6%, respectively. Thirty-one patients were treated with conventional chemotherapy. The median LENT score and median survival was 5 (2–7) and 4.1 (0.13–34.3) months, respectively, in this group. The median survival and 6-month survival rate in patients in high-risk category and moderate-risk category by LENT score was 6.2 months and 52.7%, and 11.4 months and 70.5%, respectively. Conclusion: LENT score underestimates prognosis in patients having MPE secondary to lung adenocarcinoma. This disparity particularly applies to the lung adenocarcinoma patients carrying EGFR mutation. Hence, LENT score may not be applicable to, or may need modification before applying to such patients.

Thymidine kinase 1 concentration in pleural effusion is a diagnostic marker and survival predictor for malignant pleural effusion

“…The LENT score system was calculated by four variables, including pleural fluid lactate dehydrogenase (LDH) level, ECOG PS, neutrophil‐to‐lymphocyte ratio (NLR), and tumor type, and it is widely used in risk stratification of MPE patients. However, a recent study suggested that it underestimates the prognosis in patients with MPE caused by lung adenocarcinoma . The recently published PROMISE score system includes a clinical score method and a biological score method, which is a clinical score plus tissue inhibitor of metalloproteinases 1 (TIMP1).…”

“…However, a recent study suggested that it underestimates the prognosis in patients with MPE caused by lung adenocarcinoma. 20 The recently published PROMISE score system 21 includes a clinical score method and a biological score method, which is a clinical score plus tissue inhibitor of metalloproteinases 1 (TIMP1). However, this system can only predict the 3-month mortality, and adding TIMP1 to the score system only contributed very modest effects, which limited its clinical value.…”

Is the LENT Score Already Outdated?

“…In the present issue of Respiration, Abisheganaden et al [12] reports the application of the LENT score in a selected population of patients with MPE secondary to lung adenocarcinoma in Singapore. The key finding is that the LENT score considerably underestimated the prognosis for the selected patients with MPE and therefore needed modification in order to be applicable.…”

“…The prevalence of EGFR mutations in Abisheganaden's population was 55.7%, and all patients with EGFR mutations also received TKI treatment [12]. The population of patients from which the LENT score was derived consisted of a UK, Dutch, and Australian cohort, where the prevalence of EGFR mutations was estimated between 12 and 15% [15].…”

“…Although Abisheganaden et al [12] modified the risk score for adenocarcinoma in the "T" domain of the LENT score to better match the prognosis for the group as a whole, it is fairly obvious that the population consists of two distinct prognostic groups: those with EGFR mutations treated with TKIs and those without EGFR mutations treated with chemotherapy. Keeping all patients together better serves to prolong the life of the LENT score, but it is a poor service to the accuracy of prognosis for a particular individual if crucial data have been excluded.…”