TY - JOUR
T1 - Morphologic, intraoperative, and histologic risk factors for sinonasal inverted papilloma recurrence
AU - Lee, Jake J.
AU - Roland, Lauren T.
AU - Licata, Jordan J.
AU - Orlowski, Hilary L.P.
AU - Jiramongkolchai, Pawina
AU - Piccirillo, Jay F.
AU - Kallogjeri, Dorina
AU - Klatt-Cromwell, Cristine N.
AU - Chernock, Rebecca D.
AU - Schneider, John S.
N1 - Funding Information:
Research reported in this publication was supported by the National Institutes of Health (NIH) (5T32DC000022-30) and by the National Center for Advancing Translational Sciences (NCATS) of the NIH (UL1TR002345).
Publisher Copyright:
© 2019 The American Laryngological, Rhinological and Otological Society, Inc.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Objective: 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. Methods: 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. Results: 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. Conclusion: 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. Level of Evidence: 3. Laryngoscope, 130:590–596, 2020.
AB - Objective: 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. Methods: 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. Results: 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. Conclusion: 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. Level of Evidence: 3. Laryngoscope, 130:590–596, 2020.
KW - Inverted papilloma
KW - dysplasia
KW - frontal sinus
KW - paranasal sinus
KW - recurrence
UR - http://www.scopus.com/inward/record.url?scp=85066142213&partnerID=8YFLogxK
U2 - 10.1002/lary.28078
DO - 10.1002/lary.28078
M3 - Article
C2 - 31112326
AN - SCOPUS:85066142213
SN - 0023-852X
VL - 130
SP - 590
EP - 596
JO - Laryngoscope
JF - Laryngoscope
IS - 3
ER -