Analysis On The Difference Of Efficacy Of Pingyangmycin Combined With Dexamethasone In The Treatment Of Infantile Hemangioma And Establishment Of The Prognostic Prediction Model

Objective:To investigate factors affecting the efficacy of pingyangmycin combined with dexamethasone in the treatment of infantile hemangioma and establish the prognostic prediction model.Methods:Clinical data of infantile hemangioma treated with pingyangmycin combined with dexamethasone in the Department of Vascular Surgery of the Affiliated Hospital of North Sichuan Medical College from January 2016 to December 2020 were analyzed retrospectively.According to the efficacy,the patients were divided into a cure group and a non-cure group.The clinical data from the two groups were compared with the univariate Log-rank test and multivariate Cox regression analysis,and independent risk factors affecting the efficacy of pingyangmycin combined with dexamethasone in the treatment of infantile hemangioma were analyzed.All of the variables were included in the Lasson regression,and the optimal penalty coefficient λ was determined according to the internal cross-validation to screen predictors which re-fitted the C ox risk regression model to establish a prognosis prediction model.Bootstrap was used for the internal verification,C index was calculated to judge the differentiation of the prediction model,and then the model calibration was tested.Results:A total of 450 cases were included in the cure group(n=386)and the non-cure group(n=64)according to the efficacy.Parameters with statistical significance as shown with the multivariate Cox regression analysis included:gestational ages(premature)[odds ratio(OR)=0.677;95%confidence interval(95%CI),0.484-0.947;P=0.023],lesion types(mixed hemangioma)(OR=0.677;95%CI,0.538-0.853;P=0.001)and lesion sizes[4.1-8cm:(OR=0.340;95%CI,0.232-0.497;P<0.001);>8cm:(OR=0.089;95%CI,0.022-0.362;P=0.001)].Five predictive factors including the treatment ages,lesion locations,lesion types,lesion sizes and gestational ages were selected according to the Lasson regression,and prediction models for the 6 months and 12 months cure rates were established using the above variables.Model verification:when the observation times were 6 and 12 months,the C-index and Brier Score of the prediction model were C-index=0.821(0.772-0.871),Brier=0.118(0.097-0.139)and C-index=0.965(0.941-0.988),Brier=0.057(0.033-0.080),respectively.For the internal verification,when the observation times were 6 and 12 months,the C-index and Brier Score of the prediction model were C-index=0.807(0.724-0.881),Brier=0.123(0.093-0.154)and C-index=0.960(0.929-0.994),Brier=0.064(0.033-0.095),respectively.Conclusion:Gestational ages(premature),lesion types(mixed hemangioma)and lesion sizes(4.1-8cm,>8cm)were independent risk factors affecting the efficacy of pingyangmycin combined with dexamethasone in the treatment of infantile hemangioma.The prognostic prediction model could well distinguish the cure infantile patients from the non-cure infantile patients,thus conducive to individualized treatment plans for the patients with poor prognosis.