A nomogram for predicting sclerotherapy response for treatment of lymphatic malformations in children
Zhiping Wu1, Yun Zou1, Ronghua Fu1
1Department of Plastic Surgery, Jiangxi Provincial Children's Hospital, Nanchang, China.
Insights
Polidocanol foam and pingyangmycin sclerotherapy effectively treats pediatric lymphatic malformations (LMs), achieving high response rates with minimal complications. A predictive nomogram aids in anticipating treatment outcomes for LMs.
Area of Science:
- Pediatric Surgery
- Vascular Anomalies
- Interventional Radiology
Background:
- Lymphatic malformations (LMs) are congenital vascular anomalies requiring effective treatment.
- Sclerotherapy is a common treatment modality for pediatric LMs.
- Identifying prognostic factors can optimize sclerotherapy outcomes.
Purpose of the Study:
- To identify prognostic factors for treating pediatric lymphatic malformations (LMs) using polidocanol foam and pingyangmycin.
- To develop a nomogram for predicting sclerotherapy response in pediatric LMs.
Main Methods:
- Retrospective analysis of 77 children with LMs treated with polidocanol foam and pingyangmycin.
- Clinical response graded as excellent (≥90%), good (≥50% to <90%), and poor (<50%).
- Prognostic factors identified using statistical tests; a nomogram was constructed and validated.
Main Results:
- High acceptable response rate (88.3%) and excellent response rate (75.3%) were observed.
- Clinical disfigurement, skin discoloration, morphological subtype, and lesion extent correlated with response.
- The developed nomogram demonstrated good calibration and discrimination for predicting sclerotherapy response.
Conclusions:
- Polidocanol foam and pingyangmycin sclerotherapy is effective for pediatric LMs with low complication rates.
- The constructed nomogram accurately predicts sclerotherapy response in pediatric LMs.
- Prognostic factors identified can guide treatment strategies for lymphatic malformations.
Purpose:
In this manuscript, we purposed to identify the prognostic factors for treatment of lymphatic malformations in children using polidocanol foam combined with pingyangmycin and to construct nomogram for predicting sclerotherapy response.
Methods:
A retrospective analysis of 77 children having LMs who underwent sclerotherapy using polidocanol foam combined with pingyangmycin under ultrasound display from January 2017 to April 2020 was done. The clinical response was graded as excellent (≥ 90%), good (≥ 50%, < 90%), and poor (< 50%). More than 50% was considered as acceptable response. Prognostic factors were identified by Pearson's Chi-square or Fisher's exact test and multivariable logistic regression model was used to construct a nomogram to predict sclerotherapy response. The discrimination and calibration of nomogram were verified through the receiver operating characteristic cure and calibration plots.
Results:
The mean number of treatment sessions was 3.1 (range, 1-6). Among 77 patients, 58 patients (75.3%) had excellent response to treatment (≥ 90%) and 68 patients (88.3%) had an acceptable response (≥ 50%, < 90%). Clinical disfigurement (P = 0.014), skin discoloration (P = 0.040), morphological subtype (P < 0.001) and extent of the lesion (P < 0.001) correlated with clinical response to sclerotherapy in LMs. Sclerotherapy response was predicted through nomogram constructed in this study, which shows good calibration and discrimination. Also, focal lesion and macrocystic or mixed morphological subtype lesion were seen more often in lower number of treatment sessions among the patients with excellent response.
Conclusions:
An acceptable response to sclerotherapy using polidocanol foam combined with pingyangmycin was achieved in majority of LMs in children with extremely low complication rates. Nomogram based on the prognostic factors of sclerotherapy response for LMs in children was shown to possess an excellent performance to predict the probability of LMs sclerotherapy response.
