Prediction modeling using routine clinical parameters to stratify survival in malignant pleural mesothelioma patients complicated with malignant pleural effusion

Our plain-English summary of Prediction modeling using routine clinical parameters to stratify survival in malignant pleural mesothelioma patients complicated with malignant pleural effusion, by S. Zhang, Y. Zhang, W. Feng, et al (Thoracic Cancer, 2021).

The study

• Authors: S. Zhang, Y. Zhang, W. Feng, Z. Shi, H. Shi, Y. Zhang
• Journal: Thoracic Cancer
• Published: 2021;12(24):3304-3309
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural effusion (MPE) is common in malignant pleural mesothelioma (MPM). The survival of patients with MPM and MPE is heterogeneous. The LENT and BRIMS scores using routine clinical parameters were developed to predict the survival of patients with unselected MPE and MPM, respectively. This study aimed to stratify the survival of selected MPM patients with MPE.

Methods: Data were collected from subjects diagnosed with MPM and MPE. The LENT and BRIMS scores were applied using a combination of clinical variables to stratify subjects and compare survival characteristics.

Results: In total, 101 patients with MPM complicated by MPE were included in the study. The median follow-up time was 71 months (interquartile range: 24-121 months). Overall median survival was 24 (interquartile range: 12-52 months). Based on the LENT score, the low-, moderate-, and high-risk groups accounted for 65.3% (66 cases), 34.7% (35 cases), and 0%, respectively. The cumulative survival rates of the two groups were statistically significant (p = 0.031). The area under the curve (AUC) of the LENT score was 0.662. Based on the BRIMS score, the first, second, third, and fourth risk groups accounted for 1.0% (1 case), 42.9% (35 cases), 28.7% (29 cases), and 19.4% (36 cases), respectively. Survival was significantly higher in patients in the risk groups 1 and 2 than in patients in the risk groups 3 and 4 (p = 0.037). The AUC of the BRIMS score was 0.605.

Conclusions: Using routinely available clinical variables, both LENT and BRIMS scores could stratify selected MPM and MPE patients into risk groups with statistically different survival.

© 2021 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

In plain English

This single-center, retrospective study looked at 101 consecutive patients at Beijing Chaoyang Hospital in China. All were diagnosed between June 2010 and July 2021 with malignant pleural mesothelioma and malignant pleural effusion (a buildup of fluid around the lung caused by the cancer), and all were treated without surgery. The authors tested two existing survival scores, LENT and BRIMS, which are built from routine clinical measurements. Of the 101 patients, 26 had a history of asbestos exposure. Overall median survival was 24 months. On the LENT score, 66 patients were low-risk (median survival 37 months) and 35 were moderate-risk (22 months). No patient was high-risk. On the BRIMS score, the 36 patients in groups 1 and 2 had a median survival of 35 months, against 24 months for the 65 patients in groups 3 and 4. The authors concluded that both scores could help sort these patients by survival risk with fair-to-good performance. They called for prospective studies and noted their single-center, retrospective design.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Single-center retrospective observational study of consecutive patients, using medical records
• Who was studied: 101 consecutive patients newly diagnosed with malignant pleural mesothelioma (MPM) with malignant pleural effusion (MPE), confirmed by tissue examination and treated without surgery, at Beijing Chaoyang Hospital (Capital Medical University), China, June 1, 2010 to July 1, 2021. Median age 63.7 years; 53 (52.5%) male. Histology: epithelioid 63, sarcomatoid 6, biphasic 4, not defined 28. 93 (92.1%) received chemotherapy, alone or with antiangiogenesis therapy; 8 (7.9%) received best supportive care.
• Exposure: The study did not examine asbestos exposure as a cause. It recorded asbestos exposure history: 26 of 101 patients (25.7%) had a history of asbestos exposure. No fiber types, products or jobs were reported. The factors studied were two prognostic scores. LENT uses pleural fluid LDH, performance status, blood neutrophil-to-lymphocyte ratio and tumor type. BRIMS uses weight loss, performance status, hemoglobin, albumin and histology.
• Main results:
  • All 101 patients: median follow-up was 71 months (interquartile range 24 to 121) and median survival was 24 months (interquartile range 12 to 52)
  • LENT score: 66 patients (65.3%) were low-risk, with a median survival of 37 months (interquartile range 10 to 72). 35 patients (34.7%) were moderate-risk, with a median survival of 22 months (interquartile range 12 to 30). No patient fell in the high-risk group.
  • LENT score: the moderate-risk group (35 patients) had a hazard ratio of 1.687 (95% CI 1.036 to 2.746), p = 0.034, compared with the low-risk group (66 patients)
  • LENT score: the survival curves of the low- and moderate-risk groups differed significantly (log-rank p = 0.031)
  • LENT score: area under the ROC curve was 0.662 (95% CI 0.554 to 0.771)
  • BRIMS score: 1 patient (1.0%) was in risk group 1, 35 (34.7%) in group 2, 29 (28.7%) in group 3 and 36 (35.6%) in group 4
  • BRIMS score: groups 1 and 2 (36 patients) had a median survival of 35 months (interquartile range 12 to 98). Groups 3 and 4 (65 patients) had a median survival of 24 months (interquartile range 12 to 52), with a hazard ratio of 1.763 (95% CI 1.022 to 3.040), p = 0.039, compared with groups 1 and 2.
  • BRIMS score: the survival curves of groups 1 and 2 versus groups 3 and 4 differed significantly (log-rank p = 0.037)
  • BRIMS score: area under the ROC curve was 0.605 (95% CI 0.484 to 0.726)
• The authors' conclusion: The authors concluded that both the LENT and BRIMS scores could help stratify the survival risk of patients with MPM complicated by MPE, with fair-to-good performance. They also concluded that more effective predictive models should be built in adequately designed prospective studies.
• Limitations the authors state:
  • Single-center, retrospective observational design
  • The selected mesothelioma population differs from the unselected ('all-comers') population in which the LENT score was developed, which may affect the evaluation
  • The suggestion that both scores predict better after 18 months of follow-up still needs to be checked prospectively in a larger cohort

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Pleural Effusion, Median Overall Survival.

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