Serum Index for Malignant Pleural Effusion (SIMPLE): A non-invasive, blood-based prognostic score for patients with newly diagnosed and relapsing MPE.

Authors

Pedro Magalhães Ferreira, David Coelho, Cláudia Freitas, Francisco Machado, Natália Melo, Maria Gabriela O Fernandes, Adriana Magalhães, Hélder Novais Bastos

Published in

Pulmonology. Volume 32. Issue 1. Pages 2704379. Epub Jul 21, 2026.

Abstract

Accurate prognostication of malignant pleural effusion (MPE) is essential to guide management decisions and provide patients with meaningful survival estimates. LENT and PROMISE scores are widely recognised MPE-specific prognostic tools, although with limited uptake in clinical practice. More objective, serum-based indices such as the Prognostic Index for Cancer Outcomes (PICO) and Modified Glasgow Prognostic Score (mGPS) have shown robust prognostic value in oncology and may offer advantages by allowing reproducible, treatment-responsive reassessment.
Retrospective cohort study including patients with MPE, defined by cytological and/or histopathological confirmation, between 2012-2022 at a Portuguese tertiary hospital. Demographic, clinical and biochemical data were extracted from medical records, enabling calculation of LENT, PROMISE, mGPS and PICO scores, as well as a novel serum-based index (SIMPLE).
678 patients were included in the cohort. LENT and PROMISE prognostic scoring models underperformed when compared with their serum-based counterparts. PROMISE showed the lowest area under the curve [AUC = 0.735 (95% CI 0.675-0.794)], followed by LENT [AUC = 0.758 (95% CI 0.710-0.808)], PICO [AUC = 0.781 (95% CI 0.725-0.837)] and mGPS [AUC = 0.819 (95% CI 0.745-0.893)]. The most significant serum-based factors (albumin, white blood cell counts and C-reactive protein) were selected for a new prognostic model. SIMPLE showed the highest numerical discriminatory performance [AUC = 0.852 (95% CI 0.782-0.921)], statistically outperforming MPE-specific scores, while demonstrating comparable discrimination to general oncology scores.
SIMPLE is a promising, accessible prognostic tool for patients with MPE, demonstrating strong discriminatory performance and outperforming LENT and PROMISE in our sample. External validation is required before routine clinical implementation.

PMID:
42480101
Bibliographic data and abstract were imported from PubMed on 22 Jul 2026.

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