Prognostication in malignant pleural effusion: One size does not fit all

Our plain-English summary of Prognostication in malignant pleural effusion: One size does not fit all, by A. Dipper, N. Maskell (Respirology, 2020).

The study

• Authors: A. Dipper, N. Maskell
• Journal: Respirology
• Published: 2020;25(12):1229-1230
• Type of article: Editorial, Comment
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This is an editorial, not an original study. The authors, from the University of Bristol, UK, commented on a study by Quek and colleagues, published in the same journal, about predicting survival in people with malignant pleural effusion (fluid around the lung caused by cancer). As the editorial described it, Quek and colleagues used a single-centre pleuroscopy database in an Asian population to test three existing prognostic scores: LENT, modified LENT and the clinical PROMISE score. They found that none predicted survival strongly in their patients. They then built a new score, SELECT, which includes EGFR mutation status. In a comparison in 52 patients, SELECT performed better than LENT and PROMISE but not better than modified LENT. The editorial authors noted that the Quek study was retrospective and single-centre, that 81% of its patients had an ECOG performance status of 0 or 1, and that few patients fell into high-risk groups. They said SELECT needs external prospective validation before clinical use. The authors concluded that no score yet estimates survival accurately enough to decide an individual patient's treatment.

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 another published study (Quek et al., Respirology 2020); the editorial authors collected no new data
• Who was studied: The editorial authors studied no population. The study they discussed (Quek et al.) used patients with malignant pleural effusion from a pleuroscopy database in an Asian population. LENT and modified LENT scores could be calculated for 130 participants and the clinical PROMISE score for 57. SELECT was developed in 147 patients and compared with the other scores in 52.
• Main results:
  • According to the editorial, Quek et al. evaluated the LENT, modified LENT and clinical PROMISE scores. As measured by C-statistics, none of these scores was strong at predicting survival in their patient population.
  • According to the editorial, Quek et al. had data to calculate LENT and modified LENT scores in 130 participants and the clinical PROMISE score in 57.
  • According to the editorial, the SELECT model developed by Quek et al. uses sex, ECOG performance status, leucocyte count, EGFR mutation, chemotherapy and primary tumour type. It sorts patients into low-risk (predicted 90-day mortality of 10% or less) and high-risk (more than 10%) groups.
  • According to the editorial, in a logistic regression comparison in 52 patients, SELECT performed better than the LENT and PROMISE scores but not better than modified LENT.
  • The editorial reported that 56% of lung adenocarcinoma patients in the Asian population studied by Quek et al. had an EGFR-positive mutation. This was about four times the 12–15% in the UK, Australian and Netherlands based LENT population.
• The authors' conclusion: The editorial authors concluded that SELECT needs external prospective validation in an unselected cohort before it is used in clinical practice. They also concluded that no prognostic score yet gives a survival estimate accurate enough to determine an individualized treatment strategy.
• Limitations the authors state:
  • The editorial authors stated that a significant limitation of the Quek et al. study was its retrospective design and single-centre evaluation.
  • The editorial authors stated that more dependent patients were under-represented in the Quek et al. study: 81% of the pleuroscopy patients had an ECOG status of 0 or 1.
  • The editorial authors stated that few patients in the Quek et al. study fell into higher-risk categories: 10 of 130 participants were high risk by LENT criteria, and 0 of 57 were in PROMISE Group D.
  • The editorial authors stated that the real-world usefulness of SELECT's 'high-risk' classification (more than 10% 90-day mortality risk) has yet to be determined.

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 Effusion.

Related studies

• Personalized Prognostication in Malignant Pleural Effusion: The Next Step? — D.N. Addala, N.M. Rahman, et al. (2021)
• Prognostic factors in patients presenting with pleural effusion revealing malignancy — S. Anevlavis, G. Kouliatsis, et al. (2014)
• Current controversies in the management of malignant pleural effusions — M. Azzopardi, J.M. Porcel, et al. (2014)
• Videothoracoscopy in the diagnosis and treatment of malignant pleural mesothelioma with associated pleural effusions — A. Cantó, R. Guijarro, et al. (1997)
• Positive pleural cytology is an indicator for visceral pleural invasion in metastatic pleural effusions — M.E. Froudarakis, J. Plojoux, et al. (2018)
• Clinically important associations of pleurodesis success in malignant pleural effusion: Analysis of the TIME1 data set — R.M. Mercer, J. Macready, et al. (2020)

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