Comprehensive evaluation of clinical outcomes in hepatic epithelioid hemangioendothelioma subsets: insights from SEER Database and departmental cohort analysis

Front Immunol. 2024 Oct 22:15:1491922. doi: 10.3389/fimmu.2024.1491922. eCollection 2024.

Abstract

Background: Epithelioid hemangioendothelioma (EHE), is an uncommon, intermediate-grade malignant vascular tumor that can manifest in diverse organs, including the liver, lungs, and bones. Given its unique malignancy profile and rarity, there lacks a consensus on a standardized treatment protocol for EHE, particularly for hepatic epithelioid hemangioendothelioma (HEHE). This study aims to elucidate factors influencing the clinical prognosis of EHE by analyzing data from the SEER database, complemented with insights from a departmental cohort of 9 HEHE cases. Through this, we hope to shed light on potential clinical outcomes and therapeutic strategies for HEHE.

Methods: Using SEER data from 22 registries, we analyzed 313 liver cancer patients with ICD-O-3 9130 and 9133 histology. Twelve variables were examined using Cox regression and mlr3 machine learning. Significant variables were identified and compared. Clinical data, imaging characteristics, and treatment methods of nine patients from our cohort were also presented.

Result: In univariate and multivariate Cox regression analyses, Age, Sex, Year of diagnosis, Surgery of primary site, Chemotherapy, and Median household income were closely related to survival outcomes. Among the ten survival-related machine learning models, CoxPH, Flexible, Mboost, and Gamboost stood out based on Area Under the Curve(AUC), Decision Curve Analysis(DCA), and Calibration Curve Metrics. In the feature importance analysis of these four selected models, Age and Surgery of primary site were consistently identified as the most critical factors influencing prognosis. Additionally, the clinical data of nine patients from our cohort not only demonstrated unique imaging characteristics of HEHE but also underscored the importance of surgical intervention.

Conclusion: For patients with resectable HEHE, surgical treatment is currently a highly important therapeutic approach.

Keywords: Cox regression analyses; SEER; general surgery; hepatic epithelioid hemangioendothelioma; machine learning.

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Female
  • Hemangioendothelioma, Epithelioid* / diagnosis
  • Hemangioendothelioma, Epithelioid* / mortality
  • Hemangioendothelioma, Epithelioid* / pathology
  • Hemangioendothelioma, Epithelioid* / therapy
  • Humans
  • Liver Neoplasms* / diagnosis
  • Liver Neoplasms* / mortality
  • Liver Neoplasms* / pathology
  • Liver Neoplasms* / therapy
  • Male
  • Middle Aged
  • Prognosis
  • SEER Program*
  • Treatment Outcome

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by the National Key Research and Development Program of China (2023YFC3403800), National Natural Science Foundation of China (82141127), CAMS Innovation Fund for Medical Sciences (CIFMS) (2021-I2M-C&T-B-057).