Abstract Rationale Malignant pleural effusion (MPE) is a frequent complication of advanced stage of the disease, associated with increased mortality, substantial morbidity, and impaired quality of life. The LENT and Clinical PROMISE scores are validated prognostic models used to predict survival in MPE patients. Modified LENT score was introduced later to improve predicting survival especially in Asian population. However, the performance status of these predicting tools is underexplored in South Asian population including Sri Lanka. Objective To evaluate and compare the prognostic accuracy of the LENT, Modified LENT, and Clinical PROMISE scores in predicting survival among patients with MPE in Sri Lanka. Methods A prospective observational study was conducted at three tertiary care hospitals in Sri Lanka from 2020 to 2021. Patients diagnosed with MPE were enrolled and followed up for six months. LENT, Modified LENT (adjusted for EGFR-positive adenocarcinoma), and Clinical PROMISE scores were calculated. Kaplan-Meier survival analysis, Cox regression, and receiver operating characteristic (ROC) curves were used to assess prognostic performance. Results Of 81 patients enrolled, 75 were included in survival analysis. Lung cancer (58%) and breast cancer (20%) were the most common primaries. The median overall survival was 150 days. One-, three-, and six-month survival rates were 73.3%, 58.7%, and 48%, respectively. All the prognostic tools show statistically significant performance in predicting survival. The Modified LENT score provided better risk stratification than the original LENT and Clinical PROMISE scores. Median survival by Modified LENT categories was 334 days (low risk), 151 days (moderate), and 25 days (high) (p 0.001). In multivariate analysis, only the Modified LENT score was an independent predictor of survival (p = 0.03). ROC analysis showed the Modified LENT had the highest AUC at all time points (1-month: 0.816; 3-month: 0.872; 6-month: 0.821). Conclusion The Modified LENT score outperformed both the original LENT and Clinical PROMISE scores in predicting survival among Sri Lankan MPE patients. This study supports its use for individualized prognostication and management in resource-limited settings. This abstract is funded by: None
Bandarage et al. (Fri,) studied this question.