Predicting Survival for Patients with Malignant Pleural Effusion: Development of the CONCH Prognostic Model

Abstract

Background

Malignant pleural effusion (MPE) is a frequent complication of advanced malignancies that leads to a poor quality of life and limits treatment options.

Objective

The objective of this study was to identify biomarkers of survival in patients with MPE, which will greatly facilitate the clinical management of this complication.

Methods

This retrospective study recruited patients who had been pathologically diagnosed with MPE, regardless of the type of primary cancer, at Beijing Chao-Yang Hospital over 158 months. Demographic, clinical, hematological, and pleural fluid data were collected and analyzed as potential predictors of survival, and a new predictive model was developed based on Cox and logistic regression analyses.

Results

In our alternative prognostic model (n = 281), four routinely detected variables, namely, carcinoembryonic antigen (CEA) level, monocyte count, N-terminal pro B-type natriuretic peptide (NT-pro-BNP) level, and pleural effusion chloride level on admission, were identified as predictors (the CONCH prognostic score). Patients were divided into three prognosis subgroups based on risk stratification, with median survival periods of 17, 11, and 5 months, respectively. In comparison with the low-risk group, patients in the medium- and high-risk groups showed significantly poorer survival (medium-risk group: hazard ratio [HR], 1.586; 95% confidence interval [CI], 1.047–2.402; P = 0.029; high-risk group: HR, 4.389; 95% CI, 2.432–7.921; P < 0.001).

Conclusion

Four routinely detected variables were used to develop the CONCH scoring system, which was confirmed to be an accurate prognostic score for patients with MPE. This system can guide the selection of interventions and management for MPE.

Keywords:

• malignant pleural effusion
• prognosis
• CEA
• monocyte
• NT-pro-BNP

Abbreviations

ADA, adenosine deaminase; ALP, alkaline phosphatase; CEA, carcinoembryonic antigen; CI, confidence interval; CRP, C reactive protein; CYFRA, Cytokeratin 19 fragment; ECOG PS, Eastern Cooperative Oncology Group performance status; ESR, erythrocyte sedimentation rate; HGB, hemoglobin; HR, hazard ratio; LDH, lactate dehydrogenase; LMR, lymphocyte-to-monocyte ratio; MPE, malignant pleural effusion; MPV, mean platelet volume; MVA, multivariate analysis; NLR, neutrophil-to-lymphocyte ratio; NSE, neuron specific enolase; NT-pro-BNP, N-terminal pro B-type natriuretic peptide; OS, overall survival; PLR, platelet-to-lymphocyte ratio; PLT, platelet; SCC, squamous cell carcinoma antigen; SCLC, small cell carcinoma; SQC, squamous cell carcinoma; UVA, Univariate analysis.

Statement of Ethics

The study was approved by the Institutional Review Board of Beijing Chao-Yang Hospital. Patients’ consent was not required because this is a retrospective study. We declare keep patients’ data confidential and comply with the Declaration of Helsinki.

Author Contributions

Huan-Zhong Shi and Feng-Shuang Yi conceived the idea, supervised the study; Xin Zhang and Feng-Shuang Yi collected data. All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors have no financial or other conflicts of interest.