Mounsey Craig A, Kanellakis Nikolaos I, Addala Dinesh N, Mawhinney Jamie A, Freemantle Nick, Rahman Najib M
Oxford Pleural Unit, Oxford University Hospitals, Oxford, UK.
Chinese Academy of Medical Science Oxford Institute, Nuffield Department of Medicine, Medical Sciences Division, Oxford University, Oxford, UK.
ERJ Open Res. 2025 Jun 16;11(3). doi: 10.1183/23120541.01019-2024. eCollection 2025 May.
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.
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.
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.
Both scores have the 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.
准确估计恶性胸腔积液患者的生存期对于指导临床管理策略及与患者沟通至关重要。LENT和PROMISE评分用于辅助预测恶性胸腔积液的预后；然而，它们在实际应用中的推广有限。我们旨在对LENT和PROMISE评分进行详细的外部验证，以提出关于临床实用性的建议，并指出限制其性能的因素。
回顾性分析2015年至2023年在牛津大学医院诊断为恶性胸腔积液的患者的病历，以确定生存期以及诊断时的LENT和PROMISE评分。使用区分度、校准度和整体模型性能指标评估评分在预测总生存期以及3、6和12个月生存率方面的表现。采用Kaplan-Meier分析和Cox模型进一步研究各个评分变量。
纳入773例恶性胸腔积液患者。两个评分均显示出对总生存期的预测能力；然而，中位生存期估计缺乏精确性。在预测3、6和12个月生存率方面，评分表现更强，每个时间点的C指数均约为0.8，且模型校准良好。肿瘤类型分层有限以及未考虑敏感突变被证明是限制性能的潜在因素。
两个评分均有预测恶性胸腔积液预后的能力，应考虑在实际中更多地使用。然而，也指出了需要改进评分性能的方面，这些可能有助于未来模型的开发。
