Does the LENT score risk-stratify patients with malignant pleural mesothelioma? An observational study

Our plain-English summary of Does the LENT score risk-stratify patients with malignant pleural mesothelioma? An observational study, by B. Chollet, J. Guinde, S. Laroumagne, et al (Thoracic Cancer, 2021).

The study

• Authors: B. Chollet, J. Guinde, S. Laroumagne, H. Dutau, P. Astoul
• Journal: Thoracic Cancer
• Published: 2021;12(11):1752-1756
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural mesothelioma (MPM) is a rare, highly aggressive and deadly disease with a poor patient life expectancy. A few years ago, the main challenge was the histological diagnosis of this disease; at present, the search for the best therapeutic strategy is now a priority. However, an optimal therapeutic strategy is not yet clear, despite growing efforts in the treatment armamentarium and research, and at the era of tailored and individualized treatment, tools to predict patient survival are needed for therapeutic decision-making. Among them, the LENT scoring system was developed to predict prognosis in patients with malignant pleural effusion. The aim of this study was to assess the performance of the LENT score in predicting prognosis in patients with MPM.

Methods: A retrospective observational study was conducted by analyzing the prospective collected databases of patients undergoing medical thoracoscopy in a single center with a final diagnosis of MPM confirmed by the MESOPATH National Reference Center.

Results: A total of 41 patients with MPM were studied. All patients underwent platinum-based chemotherapy combined with pemetrexed ± bevacizumab. No high-risk category patients were found using the LENT scoring system in this cohort. The median (range) LENT score at the time of medical thoracoscopy was 0 (0-3) and the median survival was 15.5 (2-54) months for the entire cohort. The median survival of low-risk and moderate-risk category patients was 21.4 months (2-54, 32 patients) and 6.7 months (2-19, nine patients), respectively. A total of 27 patients with MPM of epithelial subgroup had a median LENT score of 1 (0-2) with a 26 (2-54) months median survival. The median LENT score and median survival of nonepithelial mesothelioma patients (biphasic MPM subgroup, eight patients; sarcomatoid MPM subgroup, six patients) were 0 (0-3) and 11 (2-52) months, respectively.

Conclusions: Applied to a homogenous cohort of MPM patients, the LENT score underestimated prognosis and was not useful per se for the management of this disease, as evidenced in the epithelial mesothelioma subgroup of patients in our study.

© 2021 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

In plain English

This single-center French study reviewed records of 41 patients with malignant pleural mesothelioma. All were diagnosed by thoracoscopy and given platinum-based chemotherapy plus pemetrexed, with or without bevacizumab. It tested the LENT score, a tool built to predict survival in people with cancer-related fluid around the lung. The score combines a pleural fluid test, physical functioning, a blood cell ratio and tumor type. Thirty-six patients (88%) had asbestos exposure. No patient scored as high risk. The 32 low-risk patients had a median survival of 21.4 months and the nine moderate-risk patients 6.7 months. The original LENT study had reported 10.6 and 4.3 months for these groups. Median survival was 26 months for the 27 epithelial patients and 11 months for the 14 nonepithelial patients. The authors concluded that the LENT score underestimated survival in mesothelioma. They mainly blamed how the score rates mesothelioma subtype and its failure to consider the extent of tumor in the pleura. They noted their patients were fit enough for thoracoscopy and chemotherapy, which might set them apart from the unselected patients used to build the score.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective observational study at a single center (brief report)
• Who was studied: 41 patients with malignant pleural mesothelioma at Hôpital Nord, Marseille, France. All were diagnosed by medical thoracoscopy, had the diagnosis confirmed by the MESOPATH National Reference Center, and were treated with platinum-based chemotherapy plus pemetrexed with or without bevacizumab. 33 (80%) were male and the median age was 73 (range 43–87). Study dates were not given.
• Exposure: The factor studied was the LENT prognostic score, not asbestos. Asbestos exposure was recorded for 36 of 41 patients (88%). All 33 males had occupational asbestos exposure and three females had also been exposed. No fiber types, jobs or doses were reported.
• Main results:
  • For the whole cohort of 41 patients, the median LENT score was 0 (range 0–3) and median overall survival was 15.5 months (range 2–54).
  • No patient had a high-risk LENT score. 32 patients were low risk (score 0–1) and 9 were moderate risk (score 2–4).
  • Median survival was 21.4 months (range 2–54) in the 32 low-risk patients and 6.7 months (range 2–19) in the 9 moderate-risk patients (p less than 0.001).
  • In the original study that created the LENT score (a different study), median survival was 10.6 (7.6–18.3) months for low-risk patients and 4.3 (1.6–15.6) months for moderate-risk patients.
  • Median survival was 26 months (range 2–54) for the 27 patients with epithelial mesothelioma and 11 months (range 2–52) for the 14 nonepithelial (biphasic or sarcomatoid) patients (p = 0.03). The median LENT score was 1 (0–2) in the epithelial group and 0 (0–3) in the nonepithelial group.
  • Survival did not differ significantly between the 20 patients who had talc pleural symphysis (median 21 months, range 7–45) and the 21 who did not (median 13 months, range 2–54; p = 0.3).
  • The authors suggested that nonepithelial mesothelioma should be given a tumor-type score of 2 instead of 0. This would place those patients in the medium-risk category.
• The authors' conclusion: The authors concluded that, in a uniform group of mesothelioma patients, the LENT score underestimated survival and was not useful on its own for managing the disease. They attributed this mainly to how the score rates mesothelioma subtype and to its lack of consideration for pleural tumor extent.
• Limitations the authors state:
  • The authors acknowledged that their patients were in good condition and fit enough for thoracoscopy and chemotherapy. They said one could argue this made their group different from the unselected 'all-comers' population used to build the LENT score. They did not directly compare the fitness of the two groups.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Life Expectancy, Prognosis, Pleural Effusion, Medical Thoracoscopy, Chemotherapy, Pemetrexed (Alimta), Bevacizumab.

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