BLESS models: Improving Survival Prediction in Patients with Malignant Pleural Effusion and Metastasis

Chest. 2021 Apr 11:S0012-3692(21)00676-0. doi: 10.1016/j.chest.2021.03.059. Online ahead of print.ABSTRACTBACKGROUND: Evidence-based guidelines recommend management strategies for malignant pleural effusions (MPE) based on life expectancy. Existent risk-prediction rules do not provide precise individualized survival estimates.RESEARCH QUESTION: Can a newly developed continuous risk-prediction survival model for patients with MPE and known metastatic disease provide precise survival estimates?STUDY DESIGN AND METHODS: Single-center retrospective cohort study of patients with proven malignancy, pleural effusion, and known metastatic disease undergoing thoracentesis from 2014-2017. The outcome was time from thoracentesis to death. Risk factors were identified using Cox-proportional hazards models. Effect-measure modification (EMM) was tested using the Mantel-Cox test and addressed by using disease-specific models (DSMs) or interaction terms. Three DSMs and a combined model using interactions were generated. Discrimination was evaluated using Harrell's C-statistic. Calibration was assessed by observed-minus-predicted probability graphs at specific time-points. Models were validated using patients from 2010-2013. Using LENT variables, we generated both discrete (LENT-D) and continuous (LENT-C) models, assessing discrete vs. continuous predictors' performance.RESULTS: The development and validation cohort included 562 and 727 patients respectively. Mantel-Cox test demonstrated inte...
Source: Chest - Category: Respiratory Medicine Authors: Source Type: research