Scientific Letter
LENT Score: Predicting the Survival of Malignant Pleural Effusion – A Prospective Study of Three Years
Score LENT: prediciendo la supervivencia del derrame pleural maligno – un estudio prospectivo de tres años
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Several variables have been tested for the prediction of survival of MPE, namely pleural fluid pH,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a> glucose,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> LDH<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3–5</span></a> and protein,<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">4,6,7</span></a> serum neutrophil to lymphocyte ratio (NLR)<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">6,7</span></a> serum albumin,<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> histology of primary tumour,<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">2,4,6,7</span></a> Eastern Cooperative Oncology Group performance status (ECOG PS)<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">6,7,9</span></a> and Karnofsky index (KI),<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3,10</span></a> among others, with variable performances in prediction of survival across studies.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In 2014, Clive et al.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> created and validated the first score to predict the survival of MPE patients, the LENT score, which is calculated based on pleural fluid LDH (L), ECOG PS (E), serum NLR (N) and tumour type (T). Each of the prognostic indicators has a numeric value associated. Based on the calculated score, patients are stratified in risk groups: low (score 0–1), moderate (score 2–4) and high-risk (score 5–7), with median survival of 319, 130 and 44 days respectively, performing better than ECOG PS alone in the prediction of survival.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In 2018, Abisheganaden<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> showed that LENT score underestimated survival in EGFR mutated lung adenocarcinoma (LA) patients and probably would need some adjustment in this subgroup.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We aimed at evaluating the performance of LENT score in predicting MPE survival in clinical practice and specifically in patients with MPE secondary to EGFR mutated LA.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We prospectively selected adult patients with a new and first diagnosis of MPE from January 2016 to December 2018 followed at our institution, regardless if the neoplasm was previously diagnosed or diagnosed simultaneously with MPE. Every pleural fluid sample sent for histopathologic examination was signalized. If the presence of malignant cells was confirmed the patient would be included in the study.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Besides LENT's variables, the following data was collected through consultation of medical records: sex, age at diagnosis of MPE, KI, timing of diagnosis of primary tumour, pleural effusion size and laterality, MPE time of diagnosis, pleural fluid differential cell count, pH, glucose, protein, treatment performed and time of death.</p><p id="par0035" class="elsevierStylePara elsevierViewall">We used Kaplan–Meier with log-rank method to estimate survival in each group and to search for factors with impact in this outcome. All reported p values are two-tailed, with a p value of 0.05 indicating statistical significance. Statistical analysis was performed using the IBM SPSS Statistics for Windows, version 25.</p><p id="par0040" class="elsevierStylePara elsevierViewall">We included 69 patients with a slight predominance of females (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>36; 52.2%) and a mean age of 70.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12.8 years. Mean KI was 64.26<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>26.50% and mean ECOG PS was 1.84<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.31.</p><p id="par0045" class="elsevierStylePara elsevierViewall">MPE was the first manifestation of malignancy in 73.9% of patients (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>51). Seventeen patients (24.6%) already had a previous diagnosis of cancer. In one patient it wasn’t possible to establish if MPE was secondary to a previous neoplasm or the newly diagnosed one.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The most frequent primary neoplasm observed was lung cancer (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>41; 59.4%), with LA accounting for the majority of cases (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>38; 92.7%), followed by hematologic malignancies (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>10; 14.5%), gastric cancer (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4; 5.8%), breast cancer (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3; 4.3%) and pleural mesothelioma (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3; 4.3%).</p><p id="par0055" class="elsevierStylePara elsevierViewall">All the pleural effusions were exudative and most showed a predominance of lymphocytes (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>58; 84.1%). Median pleural fluid LDH was 641.6 IQR (Interquartile Range) 366<span class="elsevierStyleHsp" style=""></span>U/L, median protein was 42 IQR 11<span class="elsevierStyleHsp" style=""></span>g/L and mean pH was 7.34<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.1.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Thirty-two patients (46.4%) showed a large effusion (occupation of more than 75% of the hemithorax) and there was a slight predominance of right-sided effusions (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>38; 55.1%).</p><p id="par0065" class="elsevierStylePara elsevierViewall">In the majority of cases the diagnosis of MPE was made through cytology of pleural fluid (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>49; 71.0%), followed by pleural biopsy (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>15; 21.7%), medical thoracoscopy (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4; 5.8%) and percutaneous transthoracic biopsy (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1; 1.4%).</p><p id="par0070" class="elsevierStylePara elsevierViewall">Most patients underwent treatment for MPE (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>62; 89.9%), 68.1% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>47) with placement of chest tube, with 16 of these (23.2%) submitted to pleurodesis, and 21.7% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>15) submitted to aspiration thoracentesis.</p><p id="par0075" class="elsevierStylePara elsevierViewall">LENT score appropriately stratified patients according to their life expectancy (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), with 75% of patients alive at 6 months in the low-risk group, 60.9% in the moderate-risk group and 5.3% in the high-risk group.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Concerning EGFR status: 8 of the 38 patients with LA carried the mutation, all of them classified as LENT moderate-risk. Nonetheless, they showed significantly longer survival (265 days CI [0–558] VS median not reached – mean of 506 days CI [343–668]; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.04) than patients with the same tumour and risk group without EGFR mutation.</p><p id="par0085" class="elsevierStylePara elsevierViewall">We also found that patients with serum albumin of 3.5<span class="elsevierStyleHsp" style=""></span>g/dl or lower and those with lower ECOG PS and higher KI had worse survival (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><p id="par0090" class="elsevierStylePara elsevierViewall">In summary, MPE has a dismal prognosis and life expectancy should guide therapy, so that patients are offered treatment options that maximize the control of symptoms and quality of life in their last weeks or months.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Several variables influenced survival. Firstly the performance scores, ECOG PS and KI, matching other studies,<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3,6,9</span></a> an aspect already evaluated in LENT. Secondly, serum albumin, probably a surrogate for nutritional status, as it was also demonstrated in other publications<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> and probably important to take into consideration when evaluating these patients, as it's not included in LENT.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Finally, LENT is a valuable tool in this setting but needs to be used with caution in MPE patients with LA carrying EGFR mutations, as it seems to underestimate their survival, even though these patients seem to have worse outcomes under tirosine kinase inhibitor therapy compared with patients with the same diagnosis but without MPE.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">13,14</span></a> Nevertheless, it seems clear they still have a better prognosis than LA patients with MPE with wild-type EGFR.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Although EGFR mutations appear only in a small subset of LA, this is frequently the most common malignancy causing MPE and, furthermore, there is data suggesting that the rate of EGFR mutation is higher in LA patients with MPE.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> These data highlight the importance of seeking tools to accurately predict survival in these patients.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Median survival (days) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Global median survival</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81 CI [28–134] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">LENT risk groups</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="4" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Low risk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NR<a class="elsevierStyleCrossRef" href="#tblfn0010">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderate risk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">161 CI [51–271] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>High risk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 CI [17–43] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">ECOG PS</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>0–2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">173 CI [0–369] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3–4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 CI [28–44] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">KI</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="5" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><30% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 CI [0–82] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>40–50% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 CI [32–46] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>60–70% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 CI [4–120] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>>80% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">376 CI [223–529] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Serum albumin</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.005</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>≤3.5<span class="elsevierStyleHsp" style=""></span>g/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 CI [10-76] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>>3.5<span class="elsevierStyleHsp" style=""></span>g/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">246 CI [0-246] \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2345438.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">CI: confidence interval; ECOG PS: Eastern Cooperative Oncology Group Performance Status Score; KI: Karnofsky index; LENT: Lactate dehydrogenase, ECOG PS, Neutrophil to lymphocyte ratio, Tumour type; MPE: Malignant pleural effusion; NR: Not reached.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Mean 720 CI [336–1104].</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Global survival of MPE and survival according to LENT groups, ECOG PS, KI and serum albumin.<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interventions for the management of malignant pleural effusions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Clive" 1 => "R. Bhatnagar" 2 => "N.J. Preston" 3 => "H.E. Jones" 4 => "N. Maskell" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2013" "paginaInicial" => "2013" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0085" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pleural fluid ph as a predictor of survival for patients with malignant pleural effusions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.E. Heffner" 1 => "P.J. Nietert" 2 => "C. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 52 | 2 | 54 |
| 2024 October | 399 | 41 | 440 |
| 2024 September | 389 | 23 | 412 |
| 2024 August | 315 | 60 | 375 |
| 2024 July | 292 | 26 | 318 |
| 2024 June | 223 | 25 | 248 |
| 2024 May | 301 | 38 | 339 |
| 2024 April | 182 | 35 | 217 |
| 2024 March | 220 | 30 | 250 |
| 2024 February | 141 | 31 | 172 |
| 2024 January | 1 | 1 | 2 |
| 2023 December | 1 | 0 | 1 |
| 2023 November | 2 | 2 | 4 |
| 2023 October | 1 | 4 | 5 |
| 2023 September | 3 | 1 | 4 |
| 2023 June | 3 | 2 | 5 |
| 2023 May | 2 | 0 | 2 |
| 2023 March | 46 | 3 | 49 |
| 2023 February | 198 | 37 | 235 |
| 2023 January | 174 | 52 | 226 |
| 2022 December | 170 | 51 | 221 |
| 2022 November | 203 | 51 | 254 |
| 2022 October | 207 | 48 | 255 |
| 2022 September | 248 | 50 | 298 |
| 2022 August | 189 | 60 | 249 |
| 2022 July | 126 | 60 | 186 |
| 2022 June | 113 | 51 | 164 |
| 2022 May | 122 | 46 | 168 |
| 2022 April | 114 | 31 | 145 |
| 2022 March | 113 | 41 | 154 |
| 2022 February | 74 | 21 | 95 |
| 2022 January | 3 | 2 | 5 |
| 2021 December | 1 | 2 | 3 |
| 2021 November | 1 | 0 | 1 |
| 2021 October | 4 | 4 | 8 |
| 2021 September | 1 | 1 | 2 |
| 2021 June | 1 | 0 | 1 |
| 2021 April | 7 | 4 | 11 |
| 2021 March | 69 | 2 | 71 |
| 2020 November | 10 | 9 | 19 |
| 2020 October | 0 | 2 | 2 |
| 2020 September | 0 | 2 | 2 |
| 2020 August | 7 | 5 | 12 |
| 2020 July | 42 | 26 | 68 |
| 2020 June | 1 | 0 | 1 |
| 2020 April | 9 | 5 | 14 |
| 2020 March | 2 | 3 | 5 |
| 2020 February | 3 | 5 | 8 |
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