Evaluation of prognostic scores and factors affecting survival in patients with malignant pleural effusion

ABSTRACT BACKGROUND: Malignant pleural effusion (MPE) occurs in approximately 15% of cancer patients and is associated with poor prognosis, with a median survival of 3–12 months. Expected survival is a key factor in treatment decision-making. This study aimed to identify clinical and laboratory parameters affecting survival in patients with MPE and to evaluate the prognostic performance of the LENT, PROMISE, AL, and Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scores in predicting mortality. METHODS: This retrospective study included 161 patients pathologically diagnosed with MPE at a tertiary care center between January 2010 and December 2024. Overall survival was defined as the time from MPE diagnosis to death. LENT, PROMISE, AL, and ECOG-PS scores were calculated at diagnosis. Three-month mortality was the primary endpoint. RESULTS: The median overall survival was 93 days, and the 3-month survival rate was 50.1%. Univariate analysis showed that body mass index ≥25 kg/m 2 , gastrointestinal tract malignancies, presence of extrapleural metastases, elevated leukocyte, neutrophil, and platelet counts, an increased neutrophil-to-lymphocyte ratio, and higher pleural fluid lactate dehydrogenase levels were significantly associated with mortality. ECOG-PS, LENT, and PROMISE scores were significant predictors of both 3-month and overall mortality. In multivariate analysis, ECOG-PS was the strongest independent predictor of 3-month mortality (hazard ratio [HR]: 46.63; 95% confidence interval [CI]: 14.23–152.83), followed by LENT (HR: 4.66; 95% CI: 2.77–7.85) and PROMISE (HR: 2.39; 95% CI: 1.41–4.03). ECOG-PS also remained the strongest predictor of overall mortality. CONCLUSION: ECOG-PS, together with LENT and PROMISE scores, are effective and clinically applicable tools for predicting early and overall mortality in patients with MPE.