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- Title
Morphologic, intraoperative, and histologic risk factors for sinonasal inverted papilloma recurrence.
- Authors
Lee, Jake J.; Roland, Lauren T.; Licata, Jordan J.; Orlowski, Hilary L.P.; Jiramongkolchai, Pawina; Piccirillo, Jay F.; Kallogjeri, Dorina; Klatt‐Cromwell, Cristine N.; Chernock, Rebecca D.; Schneider, John S.; Klatt-Cromwell, Cristine N
- Abstract
<bold>Objective: </bold>Sinonasal inverted papillomas (IP) are benign neoplasms with a propensity for local recurrence. Many risk factors are reported, with little consistency between studies. This study aimed to comprehensively assess for demographic, imaging, histopathologic, and intraoperative risk factors for recurrence.<bold>Methods: </bold>We performed a single-center retrospective cohort study of patients with pathologically diagnosed IP without malignancy who underwent surgical resection between 1997 and 2018. Eligible patients were identified through a database maintained by the Department of Pathology. Logistic regression identified variables associated with recurrence, and conjunctive consolidation was performed to create a predictive model.<bold>Results: </bold>Of 76 subjects, 37% (n = 28) had recurrence. Median follow-up and time to recurrence were 2.9 (range 0.5-21.1) and 1.7 (range 0.2-13.0) years, respectively. Confirmed negative margins on histology were protective (odds ratio [OR] 0.25, 95% confidence interval [CI] 0.08-0.85). Frontal sinus involvement (adjusted odds ratio [aOR] 5.83, 95% CI 1.20-28.37), incomplete resection (aOR 9.67, 95% CI 2.24-41.72), and presence of dysplasia (aOR 4.38, 95% CI 1.01-19.10) were significantly associated with recurrence on multivariable analysis. A three-level composite recurrence risk staging system was created by consolidating the above three variables. The recurrence risks of composite stage I, II, and III disease were 20%, 38%, and 100%, respectively. No demographic, imaging, staging, or surgical approach variables were associated with recurrence.<bold>Conclusion: </bold>Frontal sinus involvement, incomplete resection, and dysplasia were significant risk factors for IP recurrence, whereas confirmed negative margins were protective. Creation of a composite staging system using the above variables may allow for risk stratification and a patient-specific approach to postoperative IP management.<bold>Level Of Evidence: </bold>3 Laryngoscope, 130:590-596, 2020.
- Subjects
PAPILLOMA; FRONTAL sinus; SURGICAL excision; BENIGN tumors; MAXILLECTOMY; ODDS ratio; LOGISTIC regression analysis; SURGICAL therapeutics; CANCER relapse; PARANASAL sinus cancer; RETROSPECTIVE studies; RESEARCH funding; ENDOSCOPY
- Publication
Laryngoscope, 2020, Vol 130, Issue 3, p590
- ISSN
0023-852X
- Publication type
journal article
- DOI
10.1002/lary.28078