OBJECTIVES The goal was to evaluate the accuracy of preoperative histological assessment and the factors affecting the accuracy and the subsequent effect on postoperative survival after surgical treatment for malignant pleural mesothelioma (MPM). METHODS We analysed the perioperative course of patients who underwent surgery for MPM in a single institution over a 5-year period. The primary end point was to evaluate the proportion of histological discordance between preoperative assessment and postoperative histological diagnosis. The secondary end point was to evaluate its prognostic effect on postoperative survival after surgical treatment. RESULTS One-hundred and twenty-nine patients were included in this study. Histological discordance between preoperative assessment and postoperative histological diagnosis was found in 27 of 129 patients (20.9%): epithelial to biphasic/sarcomatoid (negative discordance) in 24 and biphasic to epithelial (positive discordance) in 3 (P-value < 0.001). All 24 patients who exhibited epithelial-to-mesenchymal transition (EMT) had received neoadjuvant chemotherapy (P-value: 0.006). In the 34 patients who underwent upfront surgery, only 1 case (2.9%) of EMT was identified (P-value: 0.127). EMT was not associated with a less invasive method of biopsy (P-value: 0.058) or with the volume or maximum diameter of the biopsy (P-value: 0.358 and 0.518, respectively), but it was significantly associated with the receipt of neoadjuvant chemotherapy (P-value: 0.006). At a median follow-up of 17 months (IQR: 11.0-28.0), 50 (39%) patients are still alive. Overall survival was significantly reduced in those patients who received neoadjuvant chemotherapy and who exhibited discordance (EMT) compared to those who did not: 11 (95% CI: 6.2-15.8) months versus 19 (95% CI: 14.2-23.8) months (P-value < 0.001). In addition, there was no difference in overall survival between those who received neoadjuvant chemotherapy and those who had upfront surgery: 16 (95% CI: 2.5-19.5) months versus 30 (95% CI: 11.6-48.4) months (P-value: 0.203). CONCLUSIONS The association of neoadjuvant chemotherapy with perioperative histological discordance can be explained by EMT, which leads to worse survival. Therefore, there is an argument for the preferential use of upfront surgery in the treatment of otherwise resectable MPM.

中文翻译：

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胸膜切除/去皮质后围手术期间皮瘤细胞类型不一致——新辅助化疗由于上皮向间质转化可能产生不利影响？

目的 评估术前组织学评估的准确性、影响准确性的因素以及对恶性胸膜间皮瘤（MPM）手术治疗后术后生存的影响。方法 我们分析了 5 年期间在单一机构接受 MPM 手术的患者的围手术期过程。主要终点是评估术前评估和术后组织学诊断之间组织学不一致的比例。次要终点是评估其对手术治疗后术后生存的预后影响。结果 本研究纳入 129 名患者。129 例患者中，有 27 例 (20.9%) 发现术前评估与术后组织学诊断之间存在组织学不一致：24 例为上皮性至双相/肉瘤样（阴性不一致），3 例为双相至上皮（阳性不一致）（P 值 < 0.001）。所有 24 名出现上皮间质转化 (EMT) 的患者均接受了新辅助化疗（P 值：0.006）。在 34 名接受前期手术的患者中，仅 1 例 (2.9%) 发生了 EMT（P 值：0.127）。EMT 与微创活检方法（P 值：0.058）或活检的体积或最大直径（P 值分别：0.358 和 0.518）无关，但与接受新辅助治疗显着相关化疗（P 值：0.006）。中位随访时间为 17 个月（IQR：11.0-28.0），50 名患者（39%）仍然活着。与未接受新辅助化疗且表现出不一致 (EMT) 的患者相比，接受新辅助化疗且表现出不一致 (EMT) 的患者的总生存期显着降低：11 (95% CI: 6.2-15.8) 个月与 19 (95% CI: 14.2-23.8) 个月相比。 P 值 < 0.001)。此外，接受新辅助化疗的患者和接受前期手术的患者的总生存期没有差异：16 (95% CI: 2.5-19.5) 个月 vs 30 (95% CI: 11.6-48.4) 个月（P 值） ：0.203）。结论 新辅助化疗与围手术期组织学不一致的相关性可以通过 EMT 来解释，从而导致生存率较差。因此，对于在其他可切除的 MPM 的治疗中优先使用前期手术存在争议。