LENT Prognostic Score for Malignant Pleural Effusion

Why did you develop the LENT Score? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?

We were aware from our own clinical practice that the prognosis of patients presenting with malignant pleural effusions was very variable: some patients survive only a few weeks, whereas others live for years after diagnosis.  A number of studies had looked at individual prognostic factors, but a validated prognostic tool was not available.  We were keen to develop a tool that could be used in research studies to balance the randomization groups better.  As the management of malignant pleural effusions had become more complex,  with a number of variably invasive strategies available, we also felt that having an estimate of a patient’s prognosis may help to inform clinical decision-making.

What pearls, pitfalls and/or tips do you have for users of the LENT Score? Do you know of cases when it has been applied, interpreted, or used inappropriately?

The LENT Score underwent external validation as part of the initial study, but its impact on clinical decision making or clinical outcomes has not been formally evaluated. It should therefore not be used in isolation to guide decision making about treatment of individual patients. It’s also really important to take into account the patient in front of you—the score certainly doesn’t replace clinical judgment or negate the need for careful discussion with patients about their preferences when making management decisions.

What recommendations do you have for doctors once they have applied the LENT Score? Are there any adjustments or updates you would make to the score based on new data or practice changes?

Patients with lung cancer had a poor prognosis in the LENT cohorts; however, we suspect certain subgroups may do better than the LENT Score predicts (such as those with specific mutations like EGFR, which may be amenable to specific tyrosine kinase inhibitors).

How do you use the LENT Score in your own clinical practice? Can you give an example of a scenario in which you use it?

We hope the LENT Score will become a useful tool for clinical trials in malignant pleural effusion to help stratify randomization groups and ensure the patients entered into studies have sufficient survival to meet the trial’s endpoints. From a clinical perspective, further work is needed to assess its clinical utility.  However, personally, I find it useful to identify the subgroup of patients with a particularly poor prognosis in whom potentially painful interventions or a hospital admission may not confer sufficient benefit to them given their very limited lifespan.  

Amelia O. Clive, PhD, MBBS, BSc, works in the Academic Respiratory Unit at the University of Bristol in the United Kingdom. Dr. Clive's research interests include infection and malignant pleural effusion.