Ceyda ANAR, Mine GAYAF, Filiz GÜLDAVAL, Ahmet Emin ERBAYCU, Mustafa CANBAZ

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LENT prognostik skoru (LDH, ECOG performans skoru, kan nötrofil/lenfosit oranı, tümör tipi) malign plevral efüzyonda klinik yaklaşımı değiştirebilir mi?

Giriş: Bu çalışmanın amacı güncel bir prognostik skor olan LENT (plevral mayide LDH, Eastern Cooperative Oncology Group [ECOG] performans durumu, serumda nötrofil-lenfosit oranı ve tümör tipi) skorunun MPE’li hastalarda, sağkalıma etkisinin ve klinik karar vermedeki durumunun prediktif gücünü değerlendirmektir. Ayrıca LENT skorunu konvansiyonel ancak subjectif skor olan ECOG ile karşılaştırmaktır. Materyal ve Metod: 2008-2018 yılları arasında MPE (malign plevral efüzyon) için tedavi edilen hastaların tıbbi kayıtları gözden geçirilerek geriye dönük gözlemsel bir çalışma yapıldı. Hastalarda LENT prognostik skoru hesaplandı.Aynı hastalar için hesaplanan ECOG skoru mortalite açısından karşılaştırıldı. Bulgular: Çalışmaya 118 erkek (%61,7) ve 73 kadın (%38,2) olmak üzere toplam 191 malign plevral efüzyonlu hasta dahil edildi. Genel sağkalımı belirlemek için duyarlılık, özgüllük, pozitif prediktif değeri (PPV) ve negatif prediktif değeri (NPV) LENT skoru >4’te sırasıyla %69,8, % 00,%100 ve %18,8 idi (p= 0,000. ECOG PS >2’de, genel sağkalımı tanımlamak için duyarlılık, özgüllük, PPV, NPV, LENT skoru >4 ile aynıydı.Tüm hastalarda, LENT skoruna göre genel medyan sağkalım, düşük/orta/yüksek risk gruplarında sırasıyla 662/119/33 gündü. Cox regresyon analizi, LENT skorunun orta (p= 0,004, OR: 2,21, CI: 1,29-%3,78) ve yüksek düzeyde olmasının (p= 0,000, OR: 4, 50 CI: 2,57-%7,89) MPE tüm hastalarda genel sağkalımı öngörmekteydi. ROC analizinde 1., 6. ve 12. aylarda hem LENT hem de ECOG açısından mortalitede fark yoktu. Sonuç: LENT erken mortaliteyi öngörmede ECOG’dan daha iyi bir skorlama sistemi iken, her ikisi de ECOG ve LENT mortaliteyi tahmin etmede hemen hemen aynı güce sahiptir. Ancak LENT biraz daha objektiftir ancak laboratuvar bulgularını içerdiğinden hesaplanması daha zordur. Bu nedenle, her iki skorlama sistemi de malign plevral efüzyonlu hastalarda mortaliteyi tahmin etmek için kullanılabilir. Hiçbirinin birbirine üstünlüğü yoktur

Can LENT Prognostic score (LDH, ECOG performance score, blood neutrophil/ lymphocyte ratio, tumor type) change the clinical approach in malignant pleural effusion?

Introduction: The aim of this study was to evaluate the predictive power of LENT (LDH in pleural fluid, Eastern Cooperative Oncology Group [ECOG] performance status, neutrophil–lymphocyte ratio in the serum, and tumor type) score which is a current prognostic score in patients with MPE and to determine its effect on survival and its status in clinical decision making. In addition, it was aimed to compare LENT score with the conventional but subjective score ECOG. Materials and Methods: A retrospective observational study was conducted reviewing the medical records of patients managed for MPE (malign pleural effusion) between 2008 and 2018. LENT prognostic score was calculated in the patients. The ECOG score calculated for the same patients was compared in terms of mortality. Results: A total of 191 patients with malignant pleural effusion, 118 males (61.7%) and 73 females (38.2%), were included in the study. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for identifying overall survival were 69.8 %, 100%, 100% and 18.8%, respectively at the LENT score > 4 (p= 0.000). At ECOG PS >2, the sensitivity, specificity, PPV, NPV were as the same as the LENT score >4 for identifying overall survival. In all patients, overall median survival according to the LENT score was 662/119/33 days in low/moderate/high risk groups, respectively. Cox regression analysis indicated that having a moderate LENT score (p= 0.004, OR: 2.21, CI: 1.29 -3.78%) and high LENT score (p= 0.000, OR: 4, 50 CI: 2.57-7.89%) were predictors for overall survival in all patients due to MPE. In ROC analysis, there was no difference in mortality in terms of both LENT and ECOG at 1st, 6th and 12th months. Conclusion: LENT is a better scoring system than ECOG in predicting early mortality, while both ECOG and LENT have almost the same power in predicting mortality. However, LENT is slightly more objective but more difficult to calculate because it contains laboratory findings. Thus, both scoring systems can be used to predict mortality in patients with malignant pleural effusions. Neither of them has superiority to each other.
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  • 1. Kasapoglu U, Arınç S, Gungor S, Irmak I, Guney P, Aksoy, et al. Prognostic factors affecting survival in non-small cell lung carcinoma patients with malignant pleural effusions. Clin Respir J 2015; 10: 791-9.
  • 2. Clive AO, Kahan BC, Hooper CE, Bhatnagar R, Morley AJ, Evans NZ, et al. Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score. Thorax 2014; 69(12): 1098-104.
  • 3. Anevlavis S, Kouliatsis G, Sotiriou I, Koukourakis MI, Archontogeorgis K, Karpathiou G, et al. Prognostic factors in patients presenting with pleural effusion revealing malignancy. Respiration 2014; 87(4): 311-6.
  • 4. Bibby AC, Dorn P, Psallidas I, Porcel JM, Janssen J, Froudokıs M, et al. ERS/EACTS statement on the management of malignant pleural effusions. Eur J Cardiothorac Surg 2019; 55(1): 116-32.
  • 5. Roberts ME, Neville E, Berrisford RG, Antunes G, Ali JN. Management of a malignant pleural effusion: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010; 65(Suppl 2): ii32-40.
  • 6. Tan C, Sedrakyan A, Browne JS, Swift S, Treasure T. The evidence on the effectiveness of management for malignant pleural effusion: a systematic review. Eur J Cardiothorac Surg 2006; 29(5): 829-38.
  • 7. Abisheganaden J, Verma A, Dagaonkar RS, Light RW. An observational study evaluating the performance of LENT score in the selected population of malignant pleural effusion from lung adenocarcinoma in Singapore. Respiration 2018; 96(4): 308-13.
  • 8. Ozyurtkan MO, Balci AE, Cakmak M. Predictors of mortality within three months in the patients with malignant pleural effusion. Eur J Intern Med 2010; 21(1): 30-4.
  • 9. Bielsa S, Salud A, Martinez M, Esquardo A, Martin A, Panadore FR, et al. Prognostic significance of pleural fluid data in patients with malignant effusion. Eur J Intern Med 2008; 19(5): 334-9.
  • 10. Pilling JE, Dusmet ME, Ladas G, Goldstraw P. Prognostic factors for survival after surgical palliation of malignant pleural effusion. J Thorac Oncol 2010; 5(10): 1544-50.
  • 11. Burrows CM, Mathews WC, Colt HG. Predicting survival in patients with recurrent symptomatic malignant pleural effusions: an assessment of the prognostic values of hysiologic, morphologic, and quality of life measures of extent of disease. Chest 2000; 117(1): 73-8.
  • 12. Zamboni MM, da Silva CT Jr, Baretta R, Cunha ET, Cardoso GP. Important prognostic factors for survival in patients with malignant pleural effusion. BMC Pulm Med 2015; 15: 29.
  • 13. Heffner JE, Nietert PJ, Barbieri C. Pleural fluid pH as a predictor of survival for patients with malignant pleural effusions. Chest 2000; 117(1): 79-86.
  • 14. Pinato DJ, Mauri FA, Ramakrishnan R, Wahap L, Lyold T, Sharma R. Inflammation-based prognostic indices in malignant pleural mesothelioma. J Thorac Oncol 2012; 7(3): 587-94.
  • 15. Proctor MJ, Morrison DS, Talwar D, Balmer SM, Fletcher CD, O’Reilly SD, et al. A comparison of inflammationbased prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study. Eur J Cancer 2011; 47(17): 2633-41.
  • 16. Su J, Barbera L, Sutradhar R. Do repeated assessments of performance status improve predictions for risk of death among patients with cancer? A population-based cohort study. Palliat Med 2015; 29(6): 547-53.
  • 17. Nishikawa H, Kita R, Kimura T, Ohara Y, Sakamoto A, Saito S, et al. Clinical implication of performance status in patients with hepatocellular carcinoma complicating with cirrhosis. J Cancer 2015; 6(4): 394-402.
  • 18. Martinez-Moragon E, Aparicio J, Sanchis J, Menendez R, Rogado MC, Sanchis F. Malignant pleural effusion: prognostic factors for survival and response to chemical pleurodesis in a series of 120 cases. Respiration 1998; 65(2): 108-13.
  • 19. Paramanathan A, Saxena A, Morris DL. A systematic review and metaanalysis on the impact of pre-operative neutrophil lymphocyte ratio on long term outcomes after curative intent resection of solid tumours. Surg Oncol 2014; 23(1): 31-9.
  • 20. Guthrie GJ, Charles KA, Roxburgh CS, Horgan PG, McMillan DC, Clarke SJ. The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Hematol 2013; 88(1): 218-30.
  • 21. Lee YS, Nam HS, Lim JH, Kim JS, Moon Y, Cho JH, et al. Prognostic impact of a new score using neutrophil-tolymphocyte ratios in the serum and malignant pleural effusion in lung cancer patients. BMC Cancer 2017; 17(1): 557.
  • 22. Yang J, Lee OJ, Son SM, Woo CG, Jeong Y, Yang Y, et al. EGFR mutation status in lung adenocarcinoma-associated malignant pleural effusion and efficacy of EGFR tyrosine kinase inhibitors. Cancer Res Treat 2018; 50(3): 908-16.
  • 23. Wu SG, Yu CJ, Tsai MF, Liao WY, Yang CH, Jan IS, et al. Survival of lung adenocarcinoma patients with malignant pleural effusion. Eur Respir J 2013; 41(6): 1409-18.
  • 24. Murray J, Turner R, Bothamley GH, Bhowmik A. A response to the LENT score. Thorax 2014; 69(12): 1144.
Tüberküloz ve Toraks-Cover
  • ISSN: 0494-1373
  • Yayın Aralığı: 4
  • Başlangıç: 1951
  • Yayıncı: Tuba Yıldırım
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