Prognostic Model for Malignant Pleural Effusion


Key Points

  • The PROMISE score includes hemoglobin, C-reactive protein, white blood cell count, performance status, cancer type, pleural fluid TIMP1 concentrations, and previous chemotherapy or radiotherapy.
  • In external validation, the C-statistic for survival was 0.89. 

As reported in The Lancet Oncology, Psallidas et al developed a model that is predictive of 3-month survival in patients with malignant pleural effusion.

Study Details

The PROMISE study involved an analysis of 5 independent data sets from randomized trials to discover, validate, and prospectively assess biomarkers of survival and pleurodesis response in malignant pleural effusion and derive a score that predicts 3-month survival. Overall, 17 biomarker candidates of survival and 7 for pleurodesis response were identified in the discovery data set.

In the biomarker validation phase (3 data sets, n = 502), none of the 7 pleurodesis biomarkers were predictive of response. Of the 17 survival markers, gelsolin, macrophage migration inhibitory factor, versican, and tissue inhibitor of metalloproteinases 1 (TIMP1) were predictive of survival.

Development of PROMISE Score

Overall, 8 variables, consisting of hemoglobin, C-reactive protein, white blood cell count, Eastern Cooperative Oncology Group performance status, cancer type, pleural fluid TIMP1 concentrations, and previous chemotherapy or radiotherapy, were validated and included in development of a PROMISE survival score. Good discrimination of the score for 3-month survival was observed with internal validation using bootstrap resampling (C statistic = 0.78, 95% confidence interval [CI] = 0.72–0.83) and with external validation among 162 patients from two independent data sets (C statistic = 0.89, 95% CI = 0.84–0.93).

The investigators concluded, “To our knowledge, the PROMISE score is the first prospectively validated prognostic model for malignant pleural effusion that combines biological and clinical parameters to accurately estimate 3-month mortality. It is a robust, clinically relevant prognostic score that can be applied immediately, provide important information on patient prognosis, and guide the selection of appropriate management strategies.”

The study was funded by the European Respiratory Society, Medical Research Funding-University of Oxford, Slater & Gordon Research Fund, and Oxfordshire Health Services Research Committee research grants.

Ioannis Psallidas, PhD, of Oxford University Hospitals NHS Foundation Trust, is the corresponding author for The Lancet Oncology article. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.