The Impact of Neutrophil-Lymphocyte Ratio and LENT Score on Prognosis in Malignant Pleural Effusions

Year 2025, Volume: 22 Issue: 2, 245 - 250, 27.06.2025

Suzan Temiz Bekce

https://doi.org/10.35440/hutfd.1585523

Abstract

Background: This study aims to investigate the clinical impact of serum neutrophil-to-lymphocyte ratio (NLR), Eastern Coope-rative Oncology Group (ECOG) performance status, and LENT risk score (which includes serum lactate dehydrogenase (LDH), ECOG performance status, blood neutrophil-to-lymphocyte ratio (NLR), and tumor type (T)) on mortality and prognosis in patients with malignant pleural effusion.
Materials and Methods: This retrospective, observational, single-center study evaluated the outcomes of 73 patients who were followed between October 2022 and July 2024 due to malignant pleural effusion (MPE) and paramalignant pleural effu-sion (PMPE).
Results: The mean age of the included patients was 66.493 ± 13.988 years. A statistically significant relationship was found between survival time and the presence of comorbidities (p=0.017), metastatic disease (p=0.045), and the side of pleural effusion (p=0.032). In the analysis of treatment modalities, a statistically significant correlation was observed between survival time and patients who underwent thoracentesis (p=0.033).
Evaluating NLR results revealed significantly higher values in patients requiring intensive care monitoring (p=0.006) and in the mortality group (p=0.014). In the ECOG performance status analysis, a statistically significant association was found in patients monitored in the intensive care unit (p=<0.001), while no significant relationship was observed in mortality analysis (p=0.203).
According to the LENT risk score results, a statistically significant correlation was found in patients requiring intensive care follow-up (p=<0.001) and in the mortality analysis (p=0.003).
Conclusions: Observing a statistically significant relationship between thoracentesis, as the least invasive method, and the number of survival days in patients suggests the importance of determining the prognosis when selecting a treatment appro-ach. In cases of pleural effusion observed in patients with malignancy, whether or not they have a diagnosis of MPE, it can be suggested that the NLR may be used for rapid prognosis assessment when calculating the LENT score is deemed unsuitable. Its affordability and ease of calculation present significant advantages.

Keywords

ECOG Performance Status , LENT Score , Malignant Pleural Effusion , Neutrophil-to-Lymphocyte Ratio , Paramalignant Pleural Effusion

Nötrofil-Lenfosit Oranı ve LENT Skorunun Malign Plevral Efüzyonlarda Prognoza Etkisi

Abstract

Amaç: Bu çalışmanın amacı; malign plevral efüzyon ile izlenen hastaların serum nötrofil/lenfosit oranı, Doğu Kooperatif Onkoloji (ECOG) performans skoru ve LENT (serum laktat dehidrogenaz (LDH), ECOG performans skoru, Kan Nötrofil/Lenfosit Oranı (NLO), Tümör tipi (T)) risk skorunun mortalite ve prognoz üzerindeki klinik etkisini araştırmaktır.
Materyal ve metod: Retrospektif, gözlemsel ve tek merkezli olan bu çalışmada Ekim 2022 ile Temmuz 2024 tarihleri arasında malign plevral efüzyon (MPE) ve paramalign plevral efüzyon (PMPE) nedeniyle takip edilen 73 hastanın sonuçları değerlendi-rilmiştir.
Bulgular: Çalışmaya dahil edilen hastaların yaş ortalamasının 66.493 ± 13.988 yıl olduğu tespit edildi. Eşlik eden komorbiditeler (p=0.017), metastatik hastalık varlığı (p=0.045) ve plevral mayinin görüldüğü taraf (p=0.032) ile sağkalım süresi arasında istatistiksel olarak anlamlı bir ilişki bulundu. Uygulanan tedavi yöntemleri açısından yapılan değerlendirmede, torasentez uygulanan hastalar ile sağkalım süresi arasında istatistiksel açıdan anlamlı ilişki tespit edildi (p=0.033).
NLO sonuçları değerlendirildiğinde, yoğun bakım takibi yapılan hastalarda (p=0.006) ve mortalite grubunda (p=0.014) istatistik-sel olarak anlamlı derecede yüksek olduğu görüldü.
ECOG performans skoru analizinde, yoğun bakımda izlenen olgularda (p=<0.001) istatistiksel olarak anlamlı bir ilişki bulunur-ken, mortalite analizi (p=0.203) açısından değerlendirildiğinde anlamlı bir ilişki saptanmadı.
LENT risk skor sonuçlarına göre, yoğun bakımda takip edilen olgularda (p=<0.001) ve mortalite analizinde (p=0.003) istatistiksel olarak anlamlı ilişki olduğu görüldü.
Sonuç: Çalışmamızda; minimal invaziv girişimlerden biri olan torasentez uygulanan hastalar ile sağkalım süresi arasındaki istatistiksel olarak anlamlı ilişki, hastaya yönelik tedavi yönteminin seçiminde prognozun belirlenmesinin önemli olduğunu ortaya koymaktadır.
Malignite nedeniyle takip edilen hastalarda plevral mayi tespit edildiğinde, LENT skorlamasının uygun olmadığı durumlarda prognozun hızlı değerlendirilmesi açısından NLO değerinin kullanılabileceği düşünülmektedir. NLO’nun düşük maliyetli ve kolay hesaplanabilir olması, klinik karar sürecinde avantaj sağlayabilecek bir parametre olduğunu göstermektedir.

Keywords

ECOG Performans Skalası , LENT Skoru , Malign Plevral Efüzyon , Nötrofil-Lenfosit Oranı , Paramalign Plevral Efüzyon

References

• 1. Yan G, Li H, Bhetuwal A, McClure MA, Li Y, Yang G, et al. Pleu-ral effusion volume in patients with acute pancreatitis: a ret-rospective study from three acute pancreatitis centers. Ann Med. 2021;53(1):2003-2018.
• 2. Chopra A, Highland KB, Kilb E, Huggins JT. The Relationship of Pleural and Pericardial Effusion With Pulmonary Hemodyna-mics in Patients With Pulmonary Hypertension. Am J Med Sci. 2021;361(6):731-735.
• 3. Hung TH, Tseng CW, Tsai CC, Tsai CC, Tseng KC, Hsieh YH. The long-term outcomes of cirrhotic patients with pleural effusion. Saudi J Gastroenterol. 2018;24(1):46-51.
• 4. McDill H, Maskell N. Setting up a Pleural Disease Service. Clin Chest Med 2021;42(4):611-623.
• 5. Akkurt B, Parmaksız ET, Doğan C, Doğan C, Sagmen SB, Kıral N, et al. The Role of PET-CT in the differential diagnosis of malig-nant-paramalignant pleural effusion. South. Clin. Ist. Euras. 2019;30(4):315-319.
• 6. Hudson JL, Puri V. Malignant pleural effusions. In: LoCicero J, Feins RH, Colson YL, Rocco G, editors. General thoracic sur-gery. Philadelphia: Wolters Kluwer; 2019; 8242-366.
• 7. Asciak R, Rahman NM. Malignant pleural effusion: from diag-nostics to therapeutics. Clin Chest Med. 2018;39(1):181–93.
• 8. Thomas R, Kalomenidis I, Jett J, Gary Lee YC. Effusion from malignant causes. In: Light RW, Gary Lee YC, editors. Textbook of pleural diseases. New York: Taylor & Francis Group, LLC; 2016; 278-94.
• 9. Clive AO, Kahan BC, Hooper CE, Bhatnagar R, Morley AJ, Zahan-Evans N, et al. Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score. Thorax. 2014;69(12):1098-110.
• 10. Clive AO, Bhatnagar R, Psallidas I, Maskell NA. Individualised management of malignant pleural effusion. Lancet Respir Med 2015;3(7):505-506.
• 11. Rodriguez-Panadero F, Borderas Naranjo F, Lopez-Mejias J. Pleural metastatic tumours and effusions: frequency and pat-hogenic mechanisms in a post-mortem series. Eur Respir J 1989;(2):366-369.
• 12. Metintaş S, Demir AU. Plevra Hastalıklarının Epidemiyolojisi. Metintaş M, editör. Göğüs hastalıkları uzmanları için plevra hastalıkları tanı ve tedavi rehberi. TTD ve TÜSAD Yayını. Anka-ra, 2016:1-3.
• 13. Deniz S, Gülce Z, Çeldir Emre J, Aydemir Y, Alizoroğlu D, Erbay-cu AE. May Biochemical Variables and Pleural Fluid Cell Count Be Used in the Benign-Malign Differentiation of Pleural Effusi-ons Associated with Lung Cancer? Bezmialem Science 2019;7(1):18-22.
• 14. Haberal MA, Sengoren Dıkıs O, Akar E. Evaluation of pleural effusions: Malignant and paramalignant. Akd Med J 2020;2:203-8.
• 15. Akbıyık AG, Şencan TB, Koçak D, Doğan C, Eren TŞ. Retrospecti-ve analysis of patients with paramalignant and malignant pleu-ral effusion. J Surg Arts 2025;18(1):14-19.
• 16. Roberts ME, Neville E, Berrisford RG, Antunes G, Ali NJ. Mana-gement of a malignant pleural effusion: British Thoracic Soci-ety pleural disease guideline 2010. Thorax 2010;65:32-40.
• 17. Yu Y, Qian L, Cui J. Value of neutrophil-to-lymphocyte ratio for predicting lung cancer prognosis: A meta-analysis of 7,219 pa-tients. Mol Clin Oncol 2017;7:498–506.
• 18. Kishi Y, Kopetz S, Chun YS, Palavecino M, Abdalla EK, Vauthey JN. Blood neutrophil-to-lymphocyte ratio predicts survival in patients with colorectal liver metastases treated with syste-mic chemotherapy. Ann Surg Oncol 2009;16:614–22.
• 19. Lee YS, Nam HS, Lim JH, Kim JS, Moon Y, Cho JH, et al. Prog-nostic impact of a new score using neutrophil-to-lymphocyte ratios in the serum and malignant pleural effusion in lung can-cer patients. BMC Cancer 2017;17(1):557.
• 20. Otoshi T, Kataoka Y, Kaku S, Iki R, Hirabayashi M. Prognostic impact of inflammation-related biomarkers on overall survival of patients with inoperable malignant pleural mesothelioma. In Vivo 2018; 32(2): 445-50.
• 21. Templeton AJ, McNamara MG, Šeruga B, Vera-Badillo FE, Aneja P, Ocaña A, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014 May 29;106(6):124.
• 22. Anevlavis S, Kouliatsis G, Sotiriou I, Koukourakis MI, Archonto-georgis K, Karpathiou G, et al. Prognostic factors in patients presenting with pleural effusion revealing malignancy. Respi-ration. 2014;87(4):311–316.
• 23. Kao SC, Pavlakis N, Harvie R, Vardy JL, Boyer MJ, van Zandwijk N, et al. High blood neutrophil-to-lymphocyte ratio is an indi-cator of poor prognosis in malignant mesothelioma patients undergoing systemic therapy. Clin Cancer Res. 2010;16(23):5805–13.
• 24. Pinato DJ, Mauri FA, Ramakrishnan R, Wahab L, Lloyd T, Shar-ma R. Inflammation-based prognostic indices in malignant ple-ural mesothelioma. J Thorac Oncol. 2012;7(3):587–94.
• 25. Jafri SH, Shi R, Mills G. Advance lung cancer inflammation index (ALI) at diagnosis is a prognostic marker in patients with metastatic non-small cell lung cancer (NSCLC): a retrospective review. BMC Cancer. 2013;13:158.
• 26. Cedres S, Torrejon D, Martinez A, Martinez P, Navarro A, Za-mora E, et al. Neutrophil to lymphocyte ratio (NLR) as an indi-cator of poor prognosis in stage IV non-small cell lung cancer. Clin Transl Oncol. 2012;14(11):864–9.
• 27. Lee JG, Ko MK, Kay EP. Endothelial mesenchymal transforma-tion mediated by IL-1beta-induced FGF-2 in corneal endothe-lial cells. Exp Eye Res. 2012;95(1):35–9.
• 28. Noh H, Eomm M, Han A. Usefulness of pretreatment neutrop-hil to lymphocyte ratio in predicting disease-specific survival in breast cancer patients. J Breast Cancer. 2013;16(1):55–9.
• 29. Popowicz N, Cheah HM, Gregory C, Miranda A, Dick IM, Lee YCG, Creaney J. Neutrophil-to-lymphocyte ratio in malignant pleural fluid: Prognostic significance. PLoS One. 2021;26;16(4):e0250628.
• 30. Basham J, Sampang K, Singh M, Sivakumaran P, Sriram B. An elevated neutrophil lymphocyte ratio is a poor prognostic marker in all categories of pleural effusions. Eur Respir J. 2016;(60):PA5082.
• 31. Zamboni MM, da Silva CT Jr, Baretta R, Cunha ET, Cardoso GP. Important prognostic factors for survival in patients with ma-lignant pleural effusion. BMC Pulm Med. 2015 Mar 28;15:29.
• 32. McMillan DC. The systemic inflammation-based Glasgow prog-nostic score: a decade of experience in patients with cancer. Cancer Treat Rev. 2013;39(5):534-40.
• 33. Royston P, Altman DG. External validation of a Cox prognostic model: principles and methods. BMC Med Res Methodol. 2013;6(13):33-39.
• 34. Raimundo S, Loureiro AI, Vieira F, Fernandes A. LENT Score: Predicting the Survival of Malignant Pleural Effusion - A Pros-pective Study of Three Years. Arch Bronconeumol. 2020;56(7):465-466.
• 35. Abisheganaden J, Verma A, Dagaonkar RS, Light RW. An Obser-vational Study Evaluating the Performance of LENT Score in the Selected Population of Malignant Pleural Effusion from Lung Adenocarcinoma in Singapore. Respiration. 2018;96(4):308-313.
• 36. Akram MJ, Khalid U, Ashraf MB, Bakar MA, Butt FM, Khan F. Predicting the survival in patients with malignant pleural effu-sion undergoing indwelling pleural catheter insertion. Ann Thorac Med. 2020 Oct- Dec;15(4):223-229.
• 37. Gayaf M, Anar C, Canbaz M, Doğan Bİ, Erbaycu AE, Güldaval F. Can LENT Prognostic score (LDH, ECOG performance score, blood neutrophil/lymphocyte ratio, tumor type) change the clini-cal approach in malignant pleural effusion? Tuberk Toraks 2021;69(2):133-143.
• 38. Peng P, Yang Y, Du J, Zhai K, Shi HZ. Prognostic biomarkers of malignant patients with pleural effusion: a systematic review and meta-analysis, Cancer Cell Int. 2022;22(1):99.
• 39. Grendelmeier P, Rahman NM. What's the Score? Do pleural effusion clinical scoring systems help in management of disea-se? Semin Respir Crit Care Med. 2019;40(3):394–401.