Comparison of LENT, PROMISE, and RECLS scores in malignant pleural effusions

Malignant pleural effusion (MPE) is an indicator of advanced malignancy associated with poor prognosis and increased symptom burden and healthcare costs. Predicting survival in patients with MPE is important for determining appropriate palliative management and the need for pleurodesis.

The data of 211 patients diagnosed with MPE between January 2012 and January 2024 were retrospectively analyzed. Patients were categorized into three groups: lung adenocarcinoma (LAC), non-adenocarcinoma lung tumors (NALC), and non-lung malignancies (NLM). LENT, PROMISE, and modified RECLS scores were calculated for all patients. Survival analyses were performed using ROC analysis, Kaplan-Meier curves, and Cox regression methods.

All scoring systems were significantly higher in patients who died at 1, 6, and 12 months compared with those who survived. RECLS demonstrated the highest discriminative ability for overall mortality prediction, with particularly improved performance at 6 and 12 months. The LENT score was also significantly associated with survival in the overall cohort as well as in the lung adenocarcinoma and non-lung malignancy subgroups. The PROMISE score showed lower predictive accuracy and did not outperform the other scoring systems. ECOG performance status was one of the strongest prognostic variables across all time periods.

RECLS and LENT appear to be more effective than PROMISE in predicting survival in patients with MPE. In particular, RECLS may serve as a reliable tool for predicting both early and late mortality and could contribute to clinical decision-making in the management of patients with malignant pleural effusion.