SELECT model predicts survival in Asian patients with malignant pleural effusion

A study has found that the LENT, modified-LENT, and PROMISE scores have poor accuracy of survival prognostication in Asian patients with malignant pleural effusion (MPE) undergoing pleuroscopy.

The new SELECT (sex, Eastern Cooperative Oncology Group status, leukocyte count, EGFR mutation, chemotherapy, and primary tumour type) prognostication model, however, accurately identifies patients with a high chance of survival at 90 days.

The authors retrospectively reviewed the medical records of patients with MPE obtained from an Asian pleuroscopy database from 2011 to 2018 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.

They evaluated the prognostic capability of current available scores using C-statistics and assessed demographic and clinical variables as predictors. An alternative model was also developed using logistic regression.

The C-statistics for modified-LENT (0.59, 95 percent confidence interval [CI], 0.52–0.67) did not significantly differ from LENT (0.56, 95 percent CI, 0.49–0.63) in 130 patients. The C-statistic for PROMISE was 0.72 (95 percent CI, 0.53–0.91) in 57 patients.

In the alternative prognostication model (n=147), SELECT accurately predicted 90-day mortality (C-statistic, 0.87, 95 percent CI, 0.79–0.95). Using a predicted probability of 90-day mortality cutoff point of 10 percent, SELECT sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were 0.91, 0.68, 0.34, 0.98, 2.83, and 0.13, respectively.

“LENT and PROMISE scores prognosticate survival in patients with MPE. Prognostication guides the selection of interventions and management,” the authors said.