Mounsey, Craig A;
Kanellakis, Nikolaos I;
Addala, Dinesh N;
Mawhinney, Jamie A;
Freemantle, Nick;
Rahman, Najib M;
(2025)
External validation of the LENT and PROMISE prognostic scores for malignant pleural effusion.
ERJ Open Research
10.1183/23120541.01019-2024.
(In press).
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Abstract
Background: Accurate survival estimation in malignant pleural effusion is essential to guide clinical management strategies and inform patient discussion. The LENT and PROMISE scores were developed to aid prognostication in malignant pleural effusion, however their uptake in practice has been limited. We aimed to conduct a detailed external validation of the LENT and PROMISE scores to develop recommendations regarding clinical utility, and to highlight factors limiting performance. / Methods: Medical records of patients diagnosed with malignant pleural effusion between 2015–2023 at Oxford University Hospitals were retrospectively reviewed to determine length of survival and the LENT and PROMISE scores at diagnosis. Performance of the scores in predicting overall survival and chance of survival at 3-, 6- and 12-months was assessed using measures of discrimination, calibration and overall model performance. Kaplan-Meier analysis and Cox models were utilised to further investigate individual score variables. / Results: 773 patients with malignant pleural effusion were included. Both scores showed predictive ability for overall survival, however median survival estimates lacked precision. Score performance in predicting survival at 3-, 6- and 12-months was stronger, with C-indices around 0.8 for both at each time-point, and the models appearing well-calibrated. Limited stratification of tumour types and lack of consideration of sensitising mutations were demonstrated to be potential factors restricting performance. / Conclusions: Both scores have ability to prognosticate in malignant pleural effusion, and greater use in practice should be considered. However, areas to improve score performance were also highlighted, and these may aid future model development.
| Type: | Article |
|---|---|
| Title: | External validation of the LENT and PROMISE prognostic scores for malignant pleural effusion |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1183/23120541.01019-2024 |
| Publisher version: | https://doi.org/10.1183/23120541.01019-2024 |
| Language: | English |
| Additional information: | Copyright © The authors 2025. This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions@ersnet.org. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > Comprehensive CTU at UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10203999 |
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