Development of RECLS score to predict survival in lung cancer patients with malignant pleural effusion

BACKGROUND: Malignant pleural effusion (MPE) is usually caused by lung cancer, and the prognostic factors are poorly understood. We aimed to develop models to predict the survival of lung cancer patients and lung adenocarcinoma patients with MPE. METHODS: We enrolled lung cancer patients with MPE in Nanjing Jinling Hospital from January 2008 to June 2018 into our study. We selected risk factors using multivariable Cox proportional-hazards analysis in the development cohort. The risk models were created according to the risk ratio (RR) value. The participants were categorized into low-risk, moderate-risk, and high-risk groups according to the sum of every risk factor. RESULTS: A total of 367 lung cancer patients were included in the development cohort. The scoring systems RECLS (relapse or not, ECOG PS, CRP, pleural LDH, and TNM stage) and RECLSAM (relapse or not, ECOG PS, CRP, pleural LDH, TNM stage, albumin-globulin ratio, and activating gene mutation) were created for lung cancer patients with MPE and lung adenocarcinoma patients with MPE. The area under the curve (AUC) values for the RECLS model were 0.911, 0.845, and 0.754, respectively, at 1 month, 6 months, and 12 months. CONCLUSIONS: This study developed prognostic models for lung cancer patients with MPE. The RECLS and RECLSAM scores are practical, clinically applicable models to help guide the selection of optimal treatment strategies.