Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score.
Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score.
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DOI：
10.1136/thoraxjnl-2014-205285
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发表时间：
2014-12
期刊：
影响因子：
10
通讯作者：
Maskell NA
中科院分区：
文献类型：
--
作者：
Clive AO;Kahan BC;Hooper CE;Bhatnagar R;Morley AJ;Zahan-Evans N;Bintcliffe OJ;Boshuizen RC;Fysh ET;Tobin CL;Medford AR;Harvey JE;van den Heuvel MM;Lee YC;Maskell NA
恶性胸腔积液（MPE）导致虚弱的呼吸困难，预测生存率具有挑战性。本研究旨在获得MPE患者潜在肿瘤类型的当代生存数据，确定总生存期的预后指标，并开发和验证预后评分系统。三个大型MPE患者国际队列用于计算细胞类型的生存率（单变量考克斯模型）。在最完整的数据集（多变量考克斯模型）中评价了14个预定义变量的预后价值。临床预后评分系统，然后开发和验证。基于国际数据和多变量生存分析的结果，开发了LENT预后评分（胸水乳酸脱氢酶、东部肿瘤协作组（ECOG）体能评分（PS）、嗜中性粒细胞/淋巴细胞比率和肿瘤类型），随后使用独立数据集进行了验证。将患者风险分层为低风险、中等风险和高风险组，中位（IQR）生存期分别为319天（228-549; n=43）、130天（47-467; n=129）和44天（22-77; n=31）。 只有65%（20/31）的高风险LENT评分患者从诊断后存活1个月，只有3%（1/31）存活6个月。 受试者工作曲线下面积分析显示，LENT评分在预测1个月（0.77 vs 0.66，p<0.01）、3个月（0.84 vs 0.75，p<0.01）和6个月（0.85 vs 0.76，p<0.01）时的生存率方面上级ECOG PS。 LENT评分系统是MPE中第一个经验证的预后评分，其预测生存率的准确性显著优于单独的ECOG PS。这可能有助于在这种多样化的患者人群中做出临床决策。
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. 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. 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). 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.
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