A nomogram to predict Hemoporfin-mediated photodynamic therapy response in children with port-wine stains under general anesthesia

Hemoporfin-mediated photodynamic therapy (Hemoporfin-PDT) was authorized for the treatment of port-wine stain (PWS) in China in 2017. This study aims to identify the prognostic factors influencing the effectiveness of Hemoporfin-PDT for treating pediatric PWS under general anesthesia. Additionally, the study seeks to develop a nomogram to predict treatment response. A retrospective analysis was performed on clinical data from 209 pediatric PWS patients who underwent PDT under general anesthesia between January 2021 and June 2024. Clinical responses were categorized as excellent (76–100%), good (51–75%), fair (26–50%), or poor (0–25%), with a response rate above 50% considered effective. Prognostic factors were identified using Pearson’s chi-squared test or Fisher’s exact test, and a multivariable logistic regression model was employed to develop the predictive nomogram. The nomogram's discriminative ability and calibration were evaluated through receiver operating characteristic (ROC) curves and calibration plots. This study analyzed 209 pediatric PWS patients who underwent an average of 3.6 PDT sessions (range: 1–9) under general anesthesia. Of these, 158 patients (75.6%) demonstrated an effective response (≥ 50%), while 51 patients (24.4%) exhibited an ineffective response (0–50%). Significant associations with clinical outcomes were found for age (P = 0.009), lesion distribution (P = 0.012), PWS type (P = 0.009), lesion size (P = 0.037), and history of pulsed dye laser (PDL) treatment (P < 0.001). The nomogram developed in this study accurately predicted PDT response, demonstrating both good calibration and discrimination. Furthermore, our observations revealed that patients aged 6 years or younger, with peripheral facial and neck lesions, pink or red PWS types, lesion sizes smaller than 25 cm2, and no history of PDL treatment, required significantly fewer treatment sessions. The majority of pediatric PWS patients exhibited an effective response to PDT under general anesthesia, with a very low complication rate. The nomogram, constructed based on prognostic factors, performed exceptionally well in predicting the likelihood of an effective response.