Personalized Prognostication in Malignant Pleural Effusion: The Next Step?

Our plain-English summary of Personalized Prognostication in Malignant Pleural Effusion: The Next Step?, by D.N. Addala, N.M. Rahman, F. Maldonado (Chest, 2021).

The study

• Authors: D.N. Addala, N.M. Rahman, F. Maldonado
• Journal: Chest
• Published: 2021;160(3):805-806
• Type of article: Editorial, Comment
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This article was an editorial, not a research study. Its authors commented on a separate study by Molina and colleagues, published in the same issue of CHEST, that built and tested scores to predict survival in people with malignant pleural effusion, a buildup of fluid around the lungs caused by cancer. The editorial did not mention asbestos or mesothelioma. As the editorial described it, Molina and colleagues used records of 562 patients to build the models and 727 later patients from the same institution to test them. Only the lung and breast cancer models were validated. The model for blood cancers was not. The lung and breast models had C-statistics (a measure of predictive accuracy) of 0.72 and 0.70, compared with 0.6 for an existing score called LENT. The editorial's authors noted three concerns. The models still need testing in other patient groups. Treatment choices depend heavily on patient preference and local resources. Changing cancer treatments can erode a score's accuracy over time. The authors concluded that, if further validated, the scores may help give patients more personalized survival estimates.

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: Editorial commenting on a separate study (Molina et al.) published in the same journal issue; no new data were collected
• Who was studied: No population of its own. The editorial describes the Molina et al. study: 562 patients used to develop the models and 727 later patients from the same institution used to validate them, all with malignant pleural effusion
• Exposure: Not applicable. The editorial concerns survival prediction scores in malignant pleural effusion and does not discuss asbestos or any fiber exposure
• Main results:
  • As reported by the editorial about Molina et al.: the disease-specific models outperformed general models, including LENT and a modified LENT
  • As reported by the editorial about Molina et al.: only the lung and breast models were validated
  • As reported by the editorial about Molina et al.: the C-statistic was 0.72 for the lung model and 0.70 for the breast model, compared with 0.6 for LENT
  • As reported by the editorial about Molina et al.: the models give a percentage probability of survival at 30-day intervals from 0 to 180 days
• The authors' conclusion: The editorial's authors concluded that, if further validated, the BLESS scores may be an essential step toward giving patients more personalized survival information
• Limitations the authors state:
  • The editorial's authors said the internally validated models still need prospective, external validation in other, possibly more representative, cohorts
  • The editorial's authors said clinical decisions are heavily influenced by patient choice, local expertise and infrastructure, not only by expected survival
  • The editorial's authors said the reasons the hematologic model failed validation are unclear
  • The editorial's authors said rapidly changing cancer treatments can make a prognostic score less valid over time

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Pleural Effusion.

Related studies

• Pleural effusions and pneumothorax: Beyond simple plumbing: Expert opinions on knowledge gaps and essential next steps — R. Thomas, N.M. Rahman, et al. (2020)
• Personalized Oncolytic Therapy: The Next Step Toward the Successful Clinical Application of Vaccine-Strain Measles Viruses for Cancer Therapy? — T. Peikert (2020)
• Prognostication in malignant pleural effusion: One size does not fit all — A. Dipper, N. Maskell (2020)
• Calretinin. A selective marker of normal and neoplastic mesothelial cells in serous effusions — M.C. Barberis, M. Faleri, et al. (1997)
• Diagnostic usefulness of tumour marker levels in pleural effusions of malignant and benign origin — F. Kuralay, Z. Tokgöz, et al. (2000)
• Profile of soluble factors in pleural effusions predict prognosis in mesothelioma — I.M. Dick, Y.C.G. Lee, et al. (2022)

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