{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T08:54:07Z","timestamp":1784710447977,"version":"3.55.0"},"reference-count":38,"publisher":"European Respiratory Society (ERS)","issue":"3","license":[{"start":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T00:00:00Z","timestamp":1736294400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["ERJ Open Res"],"accepted":{"date-parts":[[2024,11,8]]},"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Accurate survival estimation in malignant pleural effusion is essential to guide clinical management strategies and inform patient discussion. The LENT and PROMISE scores were developed to aid prognostication in malignant pleural effusion; however their uptake in practice has been limited. We aimed to conduct a detailed external validation of the LENT and PROMISE scores to develop recommendations regarding clinical utility, and to highlight factors limiting performance.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Medical records of patients diagnosed with malignant pleural effusion between 2015\u20132023 at Oxford University Hospitals were retrospectively reviewed to determine length of survival and the LENT and PROMISE scores at diagnosis. Performance of the scores in predicting overall survival and chance of survival at 3, 6 and 12\u2005months was assessed using measures of discrimination, calibration and overall model performance. Kaplan\u2013Meier analysis and Cox models were utilised to further investigate individual score variables.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>773 patients with malignant pleural effusion were included. Both scores showed predictive ability for overall survival; however median survival estimates lacked precision. Score performance in predicting survival at 3, 6 and 12\u2005months was stronger, with C-indices around 0.8 for both at each time point, and the models appearing well calibrated. Limited stratification of tumour types and lack of consideration of sensitising mutations were demonstrated to be potential factors restricting performance.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Both scores have the ability to prognosticate in malignant pleural effusion, and greater use in practice should be considered. However, areas to improve score performance were also highlighted, and these may aid future model development.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1183\/23120541.01019-2024","type":"journal-article","created":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T20:20:25Z","timestamp":1736367625000},"page":"01019-2024","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["External validation of the LENT and PROMISE prognostic scores for malignant pleural effusion"],"prefix":"10.1183","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5293-4786","authenticated-orcid":false,"given":"Craig A.","family":"Mounsey","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0065-2282","authenticated-orcid":false,"given":"Nikolaos I.","family":"Kanellakis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinesh N.","family":"Addala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie A.","family":"Mawhinney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Freemantle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najib M.","family":"Rahman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2025,1,8]]},"reference":[{"key":"2025071809300708000_11.3.01019-2024.1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00349-2018"},{"key":"2025071809300708000_11.3.01019-2024.2","doi-asserted-by":"crossref","first-page":"325","DOI":"10.4103\/lungindia.lungindia_633_21","article-title":"The role of LENT and PROMISE scores in predicting survival in malignant pleural effusion","volume":"39","author":"Ermin","year":"2022","journal-title":"Lung India"},{"key":"2025071809300708000_11.3.01019-2024.3","doi-asserted-by":"crossref","first-page":"230145","DOI":"10.1183\/20734735.0145-2023","article-title":"Malignant pleural disease","volume":"19","author":"Piggott","year":"2023","journal-title":"Breathe (Sheff)"},{"key":"2025071809300708000_11.3.01019-2024.4","doi-asserted-by":"crossref","unstructured":"Bodtger U , Hallifax RJ . Epidemiology: why is pleural disease becoming more common? In: Maskell NA, Laursen CB, Lee YCG, eds. Pleural Disease (ERS Monograph). Sheffield, European Respiratory Society, 2020; pp. 1\u201312. doi:10.1183\/2312508X.10022819","DOI":"10.1183\/2312508X.10022819"},{"key":"2025071809300708000_11.3.01019-2024.5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2023-076962"},{"key":"2025071809300708000_11.3.01019-2024.6","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2010.136994"},{"key":"2025071809300708000_11.3.01019-2024.7","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s12890-015-0025-z","article-title":"Important prognostic factors for survival in patients with malignant pleural effusion","volume":"15","author":"Zamboni","year":"2015","journal-title":"BMC Pulm Med"},{"key":"2025071809300708000_11.3.01019-2024.8","doi-asserted-by":"crossref","first-page":"3304","DOI":"10.1111\/1759-7714.14202","article-title":"Prediction modeling using routine clinical parameters to stratify survival in malignant pleural mesothelioma patients complicated with malignant pleural effusion","volume":"12","author":"Zhang","year":"2021","journal-title":"Thorac Cancer"},{"key":"2025071809300708000_11.3.01019-2024.9","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1016\/j.chest.2021.04.042","article-title":"Personalized prognostication in malignant pleural effusion: the next step?","volume":"160","author":"Addala","year":"2021","journal-title":"Chest"},{"key":"2025071809300708000_11.3.01019-2024.10","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201807-1415ST"},{"key":"2025071809300708000_11.3.01019-2024.11","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1089\/jpm.2017.0285","article-title":"Distress due to prognostic uncertainty in palliative care: frequency, distribution, and outcomes among hospitalized patients with advanced cancer","volume":"21","author":"Gramling","year":"2018","journal-title":"J Palliat Med"},{"key":"2025071809300708000_11.3.01019-2024.12","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.5535"},{"key":"2025071809300708000_11.3.01019-2024.13","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2014-205285"},{"key":"2025071809300708000_11.3.01019-2024.14","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1016\/S1470-2045(18)30294-8","article-title":"Development and validation of response markers to predict survival and pleurodesis success in patients with malignant pleural effusion (PROMISE): a multicohort analysis","volume":"19","author":"Psallidas","year":"2018","journal-title":"Lancet Oncol"},{"key":"2025071809300708000_11.3.01019-2024.15","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.16840"},{"key":"2025071809300708000_11.3.01019-2024.16","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1164\/rccm.201704-0809OC","article-title":"Randomized controlled trial of urokinase versus placebo for nondraining malignant pleural effusion","volume":"197","author":"Mishra","year":"2018","journal-title":"Am J Respir Crit Care Med"},{"key":"2025071809300708000_11.3.01019-2024.17","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1016\/j.chest.2021.03.059","article-title":"Breast and lung effusion survival score models improving survival prediction in patients with malignant pleural effusion and metastasis","volume":"160","author":"Molina","year":"2021","journal-title":"Chest"},{"key":"2025071809300708000_11.3.01019-2024.18","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1111\/crj.13700","article-title":"Development and validation of the CAIL prognostic score in non-small cell lung cancer patients with malignant pleural effusion","volume":"17","author":"Li","year":"2023","journal-title":"Clin Respir J"},{"key":"2025071809300708000_11.3.01019-2024.19","doi-asserted-by":"crossref","first-page":"1083524.","DOI":"10.3389\/fonc.2022.1083524","article-title":"Editorial: Impact of immunotherapy in lung cancer","volume":"12","author":"Ferreira","year":"2022","journal-title":"Front Oncol"},{"key":"2025071809300708000_11.3.01019-2024.20","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)32714-8"},{"key":"2025071809300708000_11.3.01019-2024.21","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1111\/resp.13837","article-title":"Malignant pleural effusion survival prognostication in an Asian population","volume":"25","author":"Quek","year":"2020","journal-title":"Respirology"},{"key":"2025071809300708000_11.3.01019-2024.22","doi-asserted-by":"crossref","unstructured":"Collins GS , Reitsma JB , Altman DG , et al. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. BMJ 2015; 350: g7594. doi:10.1136\/BMJ.G7594","DOI":"10.1136\/bmj.g7594"},{"key":"2025071809300708000_11.3.01019-2024.23","doi-asserted-by":"crossref","first-page":"106650","DOI":"10.1016\/j.rmed.2021.106650","article-title":"Evaluation of prognostication scores and proposal for refinement in malignant pleural effusion in Asians","volume":"189","author":"Wong","year":"2021","journal-title":"Respir Med"},{"key":"2025071809300708000_11.3.01019-2024.24","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.1111\/1759-7714.13987","article-title":"Does the LENT score risk-stratify patients with malignant pleural mesothelioma? An observational study","volume":"12","author":"Chollet","year":"2021","journal-title":"Thorac Cancer"},{"key":"2025071809300708000_11.3.01019-2024.25","doi-asserted-by":"crossref","first-page":"341","DOI":"10.5578\/tt.20229605","article-title":"The clinical utility of the LENT score in patients with malignant pleural mesothelioma","volume":"70","author":"S\u00f6yler","year":"2022","journal-title":"Tuberk Toraks"},{"key":"2025071809300708000_11.3.01019-2024.26","doi-asserted-by":"crossref","unstructured":"Riley RD , Moons KG , Debray TP , et al. Prognostic model research. In: Riley RD , van der Windt D , Croft P , et al. , Eds. Prognosis Research in Health Care. Oxford, Oxford University Press, 2019; pp. 139\u2013187.","DOI":"10.1093\/med\/9780198796619.003.0008"},{"key":"2025071809300708000_11.3.01019-2024.27","unstructured":"Gould SJ. The Median isn't the Message (article). Date last accessed: 12 April 2024. www.phoenix5.org\/articles\/GouldMessage.html"},{"key":"2025071809300708000_11.3.01019-2024.28","doi-asserted-by":"crossref","unstructured":"Hosmer DW , Lemeshow S . Applied Logistic Regression. John Wiley & Sons, 2000. doi:10.1002\/0471722146","DOI":"10.1002\/0471722146"},{"key":"2025071809300708000_11.3.01019-2024.29","doi-asserted-by":"crossref","first-page":"FSO958","DOI":"10.2144\/fsoa-2023-0168","article-title":"Validating LENT score in malignant pleural effusion","volume":"10","author":"Alawneh","year":"2024","journal-title":"Future Sci OA"},{"key":"2025071809300708000_11.3.01019-2024.30","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1136\/thorax-2022-219784","article-title":"British Thoracic Society Guideline for pleural disease","volume":"78","author":"Roberts","year":"2023","journal-title":"Thorax"},{"key":"2025071809300708000_11.3.01019-2024.31","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1038\/s41565-021-01032-w","article-title":"Intrapleural nano-immunotherapy promotes innate and adaptive immune responses to enhance anti-PD-L1 therapy for malignant pleural effusion","volume":"17","author":"Liu","year":"2022","journal-title":"Nat Nanotechnol"},{"key":"2025071809300708000_11.3.01019-2024.32","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.627548"},{"key":"2025071809300708000_11.3.01019-2024.33","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-023-02825-6"},{"key":"2025071809300708000_11.3.01019-2024.34","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2008.10.010"},{"key":"2025071809300708000_11.3.01019-2024.35","doi-asserted-by":"crossref","first-page":"ezad385","DOI":"10.1093\/ejcts\/ezad385","article-title":"Statistical primer: using prognostic models to predict the future: what cardiothoracic surgery can learn from Strictly Come Dancing","volume":"64","author":"Mawhinney","year":"2023","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025071809300708000_11.3.01019-2024.36","doi-asserted-by":"publisher","DOI":"10.1038\/s41409-019-0679-x"},{"key":"2025071809300708000_11.3.01019-2024.37","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.332.7549.1080"},{"key":"2025071809300708000_11.3.01019-2024.38","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1159\/000489315","article-title":"An observational study evaluating the performance of LENT score in the selected population of malignant pleural effusion from lung adenocarcinoma in Singapore","volume":"96","author":"Abisheganaden","year":"2018","journal-title":"Respiration"}],"updated-by":[{"DOI":"10.1183\/23120541.51019-2024","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T00:00:00Z","timestamp":1753056000000}}],"container-title":["ERJ Open Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1183\/23120541.01019-2024","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T16:30:17Z","timestamp":1752856217000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.ersnet.org\/lookup\/doi\/10.1183\/23120541.01019-2024"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,8]]},"references-count":38,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,6,16]]},"published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1183\/23120541.01019-2024"],"URL":"https:\/\/doi.org\/10.1183\/23120541.01019-2024","relation":{"correction":[{"id-type":"doi","id":"10.1183\/23120541.51019-2024","asserted-by":"object"}]},"ISSN":["2312-0541"],"issn-type":[{"value":"2312-0541","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,8]]}}}