Assessing the clinical utility of the LENT and PROMISE scores in malignant pleural effusion

<bold>Introduction & Background:</bold> Accurate survival prediction in patients with malignant pleural effusion (MPE) is paramount, with a need to balance the aggressiveness of management against likely survival time. The LENT and PROMISE scores have both been shown to carry predictive ability for prognosis in MPE, however they have yet to be widely adopted in clinical practice. <bold>Aims & objectives:</bold> This study aimed to assess the ability of the LENT and PROMISE scores to predict survival time in patients diagnosed with MPE at Oxford University Hospitals (OUH) between 2015-2023. <bold>Methods:</bold> A cohort of patients diagnosed with MPE was generated from the OUH pleural MDT meeting database. The medical records of these patients were reviewed to calculate the length of survival from MPE diagnosis, and LENT and clinical PROMISE scores at diagnosis. <bold>Results:</bold> 775 patients with a diagnosis of MPE made between 2015-2023 were identified and included in the study. The median (IQR) length of survival for patients in the low-, moderate- and high-risk LENT groups were 521 (319-833), 131 (62-284) and 40.5 days (20-80) respectively, while in the PROMISE categories A-D they were 302 (150-665), 87 (45-202), 52 (24-98) and 28 days (10-50). Kaplan-Meier analysis demonstrated a significant difference between survival curves for both the LENT (p < 0.0001) and PROMISE (p < 0.0001) score categories. Harrell’s C-statistic was 0.68 (95% CI: 0.66 – 0.70) and 0.70 (95% CI: 0.69 – 0.72) for LENT and PROMISE categories respectively. <bold>Conclusions:</bold> Both the LENT and PROMISE scores have predictive ability for survival time in MPE patients, however their clinical utility is limited by a lack of precision in survival estimates.