LENT Score Research Articles

Comparison of five scores to predict mortality in malignant pleural effusion.

Malignant pleural effusion (MPE) is a complication of malignancy. Treatment of MPE is based on predicted outcome. The aim of this study was to compare the performance characteristics of LENT, PROMISE, RECLS, AL and pNLR scores for prediction of mortality in lung cancer patients who have MPE. Patients who were diagnosed with MPE that was associated with underlying lung cancer between January 2010 and December 2019 were included and analyzed retrospectively in a single center. Outcomes considered were 30-day, 6 months, and 1-year mortality. A total of 180 patients were examined. For 30-day mortality, the areas under the ROC curves (AUC) (95% CI) were: LENT 0.83 (0.76-0.87), RECLS 0.71 (0.63-0.77), and PROMISE 0.70 (0.17-0.38). For 6-month and 1-year mortality the order of these AUCs was similar. Cox regression showed that none of the scores were significantly associated with 30-day mortality, but LENT and RECLS were significantly associated with 6-month and 1-year mortality. Comparison of - 2log likelihood ratios showed that LENT score was more, strongly associated with 6-month mortality than PROMISE (p = 0.001) or RECLS (p = 0.02). LENT score was also more strongly associated with 1-year mortality than PROMISE (p = 0.001) but there was no difference between LENT and RECLS score (p = 0.64). We observed that the LENT score was more predictive than the other scores in mortality in patients who have lung cancer and MPE. The LENT and RECLS scores have similar performance characteristics for prediction of 1-year mortality in these patients.

Validating LENT score in malignant pleural effusion.

Aim: LENT score was developed to predict survival in malignant pleural effusion (MPE), this study aims to validate this score. Objectives: Validate LENT Prognostic Score for MPE and explore survival in these patients. Methods: Retrospective analysis of 202 patients who had MPE and received drainage between January 2013 and June 2015. Results: Median survival was 2.98months. Patients were classified according to LENT score as low, moderate and high-risk groups: 5 (4.2%), 61 (50.8%), and 54 (45%), respectively. Kaplan-Meier curve showed median survival for each group: 9.41, 5.36 and 0.56months, respectively, p-values <0.001. AUC for 1, 3 and 6months: 0.741, 0.781, 0.790, respectively, p-values <0.001. Conclusion: LENT score is valid for predicting survival in patients with MPE.

Development and validation of the CAIL prognostic score in non-small cell lung cancer patients with malignant pleural effusion.

Patients with malignant pleural effusion (MPE) typically have poor prognoses, and predicting survival is challenging. The present study aimed to identify prognostic factors of overall survival (OS) in non-small cell lung cancer (NSCLC) patients with MPE in the time of immunotherapy and targeted therapy. Data of 344 consecutive NSCLC patients with MPE on clinical, radiological, and molecular characteristics and treatment options were collected. The risk factors in the training cohort were assessed using univariate and multivariate proportional hazards analyses. A clinical prognostic score was established and validated. According to the results of the multivariable survival analysis, the Eastern Cooperative Oncology Group (ECOG) performance score (PS), antiangiogenic therapy, immunotherapy, and lactic dehydrogenase (LDH) in pleural fluid (CAIL) prognostic score was developed (n = 275) and subsequently validated (n = 69). Patients who underwent risk stratification into low-, moderate-, and high-risk groups had median OS of 46.1, 23.1, and 9.6months, respectively (P < 0.0001). The area under the curve (AUC) analysis showed the CAIL score to be superior at predicting survival compared with the LENT score at 6 (0.84 vs. 0.77, P < 0.01), 12 (0.87 vs. 0.82, P < 0.01), and 36 months (0.80 vs. 0.77, P < 0.01). For NSCLC patients with MPE, the validated CAIL prognostic score integrates clinical characteristics and therapeutic modalities to predict survival.

LENT Score as a Prognosis Factor for Overall Survival and Progression-Free Survival in Malignant Pleural Effusion Patients at Tertiary Hospitals in West Sumatera, Indonesia

Background: Malignant pleural effusion (MPE) has a variable survival rate and prognosis. The LENT score is one method for assessing survival rates in patients with MPE. This study aimed to investigate the LENT score as a prognostic factor for overall survival (OS) and progression-free survival (PFS) of patients with MPE at a tertiary hospital in West Sumatera.&#x0D; Methods: This study was an observational analytic study involving several tertiary hospitals in West Sumatera with a minimum observation period of 2 years. Data were collected from medical records. We used Kaplan Meier analysis to assess OS and PFS.&#x0D; Results: A total of 198 subjects met the inclusion criteria. Most MPE patients in this study were aged ≥60 years, male, smokers, pleural fluid lactate dehydrogenase value &lt;1500, ECOG 1, serum NLR value &lt;9, and high-risk cancer, namely lung cancer. The distribution of LENT scores for MPE patients was evenly distributed among the low, medium, and high-risk groups. Kaplan Meier analysis showed that the median OS based on LENT scores were 804 days, 275 days, and 161 days, respectively (log-rank test p = 0.000). The median PFS based on LENT scores were 715 days, 202 days, and 106 days, respectively (log-rank test p=0.000). The OS and PFS findings are longer than previous studies.&#x0D; Conclusion: Based on LENT scores, overall survival and progression-free survival MPE patients at tertiary hospitals in West Sumatera have a better prognosis compared to previous studies.

MA14.09 Lower Paraspinous Muscle Index at First Thoracentesis is Associated with Poor Survival in Non-Small Cell Lung Cancer

Malignant pleural effusions (MPEs) are common and associated with a poor prognosis. Current MPE prognostic tools can be difficult to utilize, such as the LENT score which requires laboratory testing and multiple calculations. Paraspinous muscle cross sectional area measured on computed tomography (CT) has shown to be associated with survival following thoracic surgery and as a prognostic indicator in non-small cell lung cancer (NSCLC). Additionally, the use of paraspinous muscle index (PMI) and other muscle indices have been associated with survival in diabetes and smokers.

The role of LENT and PROMISE scores in predicting survival in malignant pleural effusion.

Background:Malignant pleural effusion (MPE) is a condition, that can be seen in 15% of patients diagnosed with cancer. Because of the short overall survival, it is important to identify the appropriate treatment. In addition to the palliation of secondary symptoms due to MPE, it should also be decided in which cases a more aggressive treatment is to be followed. The purpose of the study was to evaluate the performance of LENT and clinical PROMISE scores in predicting survival in patients with MPEMethods:Age, sex, smoking history, Eastern Cooperative Oncology Group (ECOG) score, cancer type, history of chemotherapy/radiotherapy, laboratory values, and pleural fluid lactate dehydrogenase were recorded. The LENT and the PROMISE scores were calculated and risk categories were determined. During the follow-up, blood tests and tomography controls were performed on the patients as routine. The overall survival was calculated as the period from the date of diagnosis of MPE to death or until December 31, 2019Results:A total of 169 patients were included. The median age was 65 (26–86). In the single-variable analysis, there was a significant increase in mortality risk in the poor performance score and if the LENT risk group progressed from the low-to medium-/high-risk group or PROMISE categories A to B, A to C or A to D. In multivariate analysis, mortality risk in 1, 3, 6, and 12 months increased significantly in poor performance score, in PROMISE category B, C, and D. In high LENT risk-group, an increased mortality risk was shown in only 12 months of survivalConclusions:Our data show that poor performance score (ECOG 3-4), PROMISE category B, C, and D significantly increase mortality risk and the LENT score is inadequate in predicting survival.

20 years managing malignant pleural mesothelioma: a review of our experience and the quest for the optimal prognostic marker

Introduction: Malignant pleural mesothelioma (MPM) is a rare, but aggressive incurable cancer. A variety of prognostic tools have been developed to guide clinicians and patients in the management of MPM regarding the most appropriate therapy and survival time. Objectives: To evaluate the usefulness of the Brims’ decision tree analysis, the EORTC prognostic score, the CALGB prognostic groups, the modified Glasgow Prognostic Score (mGPS), and the LENT prognostic score in our MPM patients. Methods: Local retrospective database analysis of patients with MPM diagnosed between 2000 and 2020. The different prognostic scores were applied and MPM group risks’ evolution was analyzed. Statistical analysis was performed with IBM® SPSS® Statistics 25. Results: A total of 67 patients were evaluated (55 males, 82.1%). Epithelioid MPM was the commonest histological type (51 patients, 76.1%). Median overall survival (OS) was 11 months (IQR 23) and median progression free-survival (PFS) was 7 months (IQR 12.5). Survival distributions were statistically significantly different for the Brims’ and the mGPS’ groups (respectively, χ2 = 7.188, p = .027, and χ2 = 6.46, p = .04). For EORTC, CALGB and LENT score, there were not statistically significant differences in survival distributions (respectively, χ2 =.57, p = .811; χ2 = 7.978, p = .157; and χ2 = 1.23, p = .267). Brims’ model and mGPS statistically significantly predicted OS (respectively, F(1,57) = 11.1, p &lt; 0.01, and F(1,32) = 6.846, p = .01). EORTC, CALGB and LENT failed to statistically significantly predict OS (respectively, F(1,44) = .003, p = .955; F(1.43) = .722, p = 0.4; and F(1,14) = 1.193, p = .293). Conclusion: The small number of patients included and missing data for some parameters are limitations of our analysis. However, to our knowledge, this was the first study and the largest cohort to address MPM prognostic scores in our country. In our cohort, the Brims’ model and mGPS were useful in predicting survival. Both are simple tools with easily accessible parameters and should be considered for clinical practice.

LENT score in prognostic assessment of malignant pleural effusion – the impact of target therapy

Introduction: Malignant pleural effusion (MPE) is a common manifestation in patients with advanced lung cancer. The LENT score was developed as a risk stratification system to predict the survival of these patients. However, following the discovery of molecular markers and a new era of personalized therapy, prognostic estimation became a challenging exercise. The aim of this study was to evaluate the performance of LENT score in predicting MPE survival in EGFR and ALK mutated lung adenocarcinoma. Methods: A retrospective single-center study of patients with MPE from lung adenocarcinoma followed between January 2008 to December 2018. Results: Forty-two patients were included in the study (mean age 76.4 ± 12.6 years, 52% female). Of these patients, 29% exhibited EGFR gene mutation or ALK gene translocation and received tyrosine kinase inhibitor therapy (TKI), in contrast to 71% of patients without identification of mutational factors and receiving conventional chemotherapy. Based on LENT score, in the sub-group treated with conventional chemotherapy, 67% had a moderate-risk category and 33% a high-risk category, with a median overall survival (OS) of 109 (31-406) and 36 (11-77) days, respectively. In the sub-group treated with targeted therapy, 75% were in a moderate-risk category and 25% in a high-risk category with a median OS of 1033 (245-1710) and 238 (27-not available) days, respectively. Patients receiving targeted therapy had a longer survival than patients receiving conventional chemotherapy in all LENT score risk categories (p&lt;0.05). Conclusions: OS in patients with MPE due to lung adenocarcinoma was similar to that predicted by the LENT score, except for patients with EGFR mutation or ALK translocation. In this subgroup, the LENT score seems to underestimate the prognosis. Although this study has limitations regarding sample size, it does reveal, in the present time, some inaccuracy of the LENT score, demonstrating that it needs to be reviewed and revalidated in view of recent therapeutic advances.

P02.04 Pectoral Muscle Area Correlates with LENT Score in Non-Small Cell Lung Cancer Associated Pleural Effusion Survival Prediction

P02.04 Pectoral Muscle Area Correlates with LENT Score in Non-Small Cell Lung Cancer Associated Pleural Effusion Survival Prediction

Etiology and prognostic evaluation of malignant pleural effusion

Background: Malignant pleural effusion is a common medical problem in patients with cancer. The survival of patients with malignant pleural effusion is generally poor. The objectives of our study were to reveal possible prognostic factors of malignant pleural effusion.Methods: Fifty-three consecutive patients, 34 male and 19 female patients of malignant pleural effusion diagnosed by pleural fluid positive for malignant cytology and/or pleural tissue positive for malignancy by thoracoscopy biopsy. Performance status by the Eastern Cooperative Oncology Group (ECOG) score and LENT score was calculated at the time of diagnosis. Median survival time was calculated using Kaplan-Meier analysis curve. Survival time was defined as the time from diagnosis to death or the last follow-up.Results: Most common cause of malignant pleural effusion was lung carcinoma 46 (86.79%). Adenocarcinoma was the most common 31 (58.5%) followed by NSCLC 10 (18.0%). Low, moderate and high-risk LENT score was found in 3 (5.7%), 35 (66%) and 15 (28.3%) respectively. The median survival time of pleural fluid sugar less than 20 were 3 months. The median survival time of LENT low, medium and high risk was 12 months, 5.2 months and 2.5 months respectively. The median survival time of patients with ECOG score of 1 and 4 was 6.5 months and 1 month respectively. Patients with bilateral pleural fluid had a mean survival time of 2 months.Conclusions: Adenocarcinoma lung is the most common etiology of malignant pleural effusion. The median overall survival time was 4 months. Higher ECOG score and LENT score are associated with shorter survival time.

ERS/EACTS statement on the management of malignant pleural effusions.

Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeons alike. In recent years, several well-designed randomized clinical trials have been published that have changed the landscape of MPE management. The European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS) established a multidisciplinary collaboration of clinicians with expertise in the management of MPE with the aim of producing a comprehensive review of the scientific literature. Six areas of interest were identified, including the optimum management of symptomatic MPE, management of trapped lung in MPE, management of loculated MPE, prognostic factors in MPE, whether there is a role for oncological therapies prior to intervention for MPE and whether a histological diagnosis is always required in MPE. The literature revealed that talc pleurodesis and indwelling pleural catheters effectively manage the symptoms of MPE. There was limited evidence regarding the management of trapped lung or loculated MPE. The LENT score was identified as a validated tool for predicting survival in MPE, with Brims' prognostic score demonstrating utility in mesothelioma prognostication. There was no evidence to support the use of oncological therapies as an alternative to MPE drainage, and the literature supported the use of tissue biopsy as the gold standard for diagnosis and treatment planning.Management options for malignant pleural effusions have advanced over the past decade, with high-quality randomized trial evidence informing practice in many areas. However, uncertainties remain and further research is required http://ow.ly/rNt730jOxOS.

Prognostic factors of mortality and recurrence of malignant pleural effusion in high-risk tumors according to the LENT Score.

e21666 Background: The aim of this study was to identify predictors of overall survival (OS) and recurrence after palliative pleural procedures in patients with malignant pleural effusion (MPE) and high-risk tumors according to the LENT Score. Methods: Data was collected from our database between January 2013 and December 2015 of patients with MPE and high-risk tumors according to the LENT Score. All patients were followed-up for at least 30 days after the pleural procedure. We evaluated radiological aspects, biochemical and hematologic parameters as well as clinical features. For OS analysis, patients were divided into two groups. Group I included OS &lt; 30 days and group II included OS &gt; 30 days. Prognostic factors for pleural recurrence and OS were identified by univariate analysis, using Fisher's exact and Student's t-test. Subsequently, significant variables were entered into a multivariate logistic regression analysis ( p &lt; 0.05). Results: A total of 134 patients were included. Median follow-up time for surviving patients was 56 (range: 2-623) days. High-risk primary tumors included lung (66.4%), gastrointestinal (24.6%) , sarcoma (3.7%), urologic (3.7%) and others (1.5%). Forty-four patients in Group I had OS &lt; 30 days while 22 patients had MPE recurrence. Factors affecting OS in univariate analysis were: type of procedure, ECOG, albumin, leukocytes, neutrophil to lymphocyte ratio( NRL) and hemoglobin. Factors affecting recurrence were: type of procedure, chemotherapy line (CT), albumin and platelets. In multivariate analysis for Group I, type of procedure (therapeutic pleural aspiration – TPA) ( p= 0.011), ECOG 3/4 ( p= 0.004), NLR &gt; 5 ( p= 0.037) and leukocytes &gt; 8000 ( p= 0.042) were identified as independent predictors of OS. In terms of recurrence, only CT beyond first line ( p = 0.042) was identified as an independent prognostic factor. Conclusions: Patients with MPE who underwent TPA, had ECOG 3/4, leukocytes &gt; 8000, and NLR &gt; 5 were significantly associated with shorter OS,. CT beyond first line was associated with recurrence. The identification of these prognostic factors may assist physicians in choosing the optimal palliative technique.

S117 Survival In Patients With Malignant Pleural Effusions Who Developed Pleural Infection: A Retrospective Case Review From 6 Uk Centres

Background The incidence of malignant pleural effusions (MPE) is increasing and overall prognosis remains poor. In-dwelling pleural catheters (IPCs) relieve symptoms, but increase the risk of pleural infection. We reviewed survival times of cases of pleural infection in patients with IPCs for MPE from 6 UK centres. Methods Baseline data were collected for all IPC insertions from 1/1/05 to 31/1/14. Survival times were analysed by underlying tumour. Results were compared with national data, and with data from a cohort of 789 patients with MPE (the LENT cohort). LENT scores were used to calculate individual predicted life expectancy, which was compared with actual survival. Results Of 672 IPCs inserted across 6 centres during the study period, 25 patients (3.6%) experienced pleural infection. 19/25 were male,median age 69 (range 35–79). 12/25 had mesothelioma, 8/25 lung cancer, 3/25 breast cancer, 1/25 lymphoma and 1/25 thyroid cancer. 18/25 had a performance status of 0–1, and 19/25 received oncological treatment. Survival with MPE and pleural infection compared favourably with the LENT cohort (see figure 1). Median survival with mesothelioma and pleural infection was 753 days (95% confidence interval 446–1089) compared with 339 days in the LENT cohort (95% CI 267–442) and less than 365 days in nationally reported data. Patients with lung cancer and pleural infection also outlived their LENT counterparts; median survival of 138 days (95% CI 62–479) versus 74 days (95% CI 60–90). Patients with breast cancer had similar survival times (167 vs 192 days). LENT scores were calculated where possible. 9/13 (69%) outlived their predicted life expectancy. 16/25 (64%) developed infection within 90 days of IPC insertion. There was no difference in survival times between patients with early and late infection (p = 0.6). Discussion In this series of patients with IPCs, pleural infection was associated with longer survival with mesothelioma and lung cancer, but not breast cancer. Most patients experienced early infection, suggesting this result isn’t simply a result of higher infection rates in patients who survive longer with an IPC in situ . We propose that pleural infection stimulates a local immune response, which acts against tumour. Further studies are planned to investigate this hypothesis further.

Late radiation injury of the central nervous system, recording of morbidity according to the SOMA / LENT scoring system

Late radiation injury of the central nervous system, recording of morbidity according to the SOMA / LENT scoring system

A correlation between residual radiation-induced DNA double-strand breaks in cultured fibroblasts and late radiotherapy reactions in breast cancer patients

Background and purpose: Prediction of late normal tissue reactions to radiotherapy would permit tailoring of dosage to each patient. Measurement of residual DNA double strand breaks using pulsed field gel electrophoresis (PFGE) shows promise in this field. The aim of this study was to test the predictive potential of PFGE in a group of retrospectively studied breast cancer patients.Materials and methods: Thirty nine patients, treated uniformly for breast cancer 9–15 years previously, with excision of the tumour and radiotherapy to the breast and drainage areas, were assessed clinically using the LENT SOMA scale, and a 5-mm punch biopsy taken from the buttock. Fibroblast cell strains were established and used to study residual DNA double strand breaks, using PFGE.Results: There were significant correlations between the DNA assay results and the fibrosis score (rs=0.46; P=0.003), the combined fibrosis and retraction score (rs=0.45, P=0.004) and the overall LENT score (rs=0.43; P=0.006). Using polychotomous logistic regression, the fibroblast DNA assay result was an independent prognostic factor for fibrosis severity.Conclusions: There is a relationship between residual radiation-induced DNA damage in fibroblasts and the severity of the late normal tissue damage seen in the patients from whom the cells were cultured.

Urinary Incontinence in Patients Who Have a TURP/TUIP Following Prostate Brachytherapy

Abstract Purpose: To determine urinary morbidity in patients who have transurethral resection of the prostate (TURP) after 125 I brachytherapy. Materials and Methods: A total of 109 patients with Stage T1–T2 prostatic carcinoma were treated with 125 I implantation from 1991 through 1995. Ten patients underwent TURP/transurethral incision of the prostate (TUIP) after brachytherapy to relieve urinary obstruction refractory to nonsurgical management. Results: Patients who developed refractory urinary retention had a slightly larger preimplant prostate volume than those who did not (62 vs. 54 ml; p = 0.16). Seven of the 10 patients developed some degree of permanent urinary incontinence following TURP/TUIP. Urinary incontinence was mild in three patients [Late Effects Normal Tissue Radiation Oncology Group (LENT) score = 1] and severe in four additional patients (LENT score = 3). There was no obvious relationship between the degree of incontinence and use of TURP vs. TUIP, amount of tissue resected, or time between brachytherapy and TURP/TUIP. In five patients for whom detailed urethral radiation dose information was available, the doses were higher than generally recommended. Conclusion: Permanent urinary incontinence is common in patients who require a TURP or TUIP after prostate brachytherapy. Its cause is apparently multifactorial and may include the degree of physical damage to the urinary sphincters and the radiation dose to the urethral region.

Urinary Incontinence in Patients Who Have a TURP/TUIP Following Prostate Brachytherapy

Purpose: To determine urinary morbidity in patients who have transurethral resection of the prostate (TURP) after 125I brachytherapy. Materials and Methods: A total of 109 patients with Stage T1–T2 prostatic carcinoma were treated with 125I implantation from 1991 through 1995. Ten patients underwent TURP/transurethral incision of the prostate (TUIP) after brachytherapy to relieve urinary obstruction refractory to nonsurgical management. Results: Patients who developed refractory urinary retention had a slightly larger preimplant prostate volume than those who did not (62 vs. 54 ml; p = 0.16). Seven of the 10 patients developed some degree of permanent urinary incontinence following TURP/TUIP. Urinary incontinence was mild in three patients [Late Effects Normal Tissue Radiation Oncology Group (LENT) score = 1] and severe in four additional patients (LENT score = 3). There was no obvious relationship between the degree of incontinence and use of TURP vs. TUIP, amount of tissue resected, or time between brachytherapy and TURP/TUIP. In five patients for whom detailed urethral radiation dose information was available, the doses were higher than generally recommended. Conclusion: Permanent urinary incontinence is common in patients who require a TURP or TUIP after prostate brachytherapy. Its cause is apparently multifactorial and may include the degree of physical damage to the urinary sphincters and the radiation dose to the urethral region.