Smoking Increases Risk of Inverted Papilloma Recurrence

What clinical and environmental factors can predict recurrence or malignant transformation of sinonasal inverted papilloma (IP)?

Background: IP is a benign neoplasm that is locally aggressive, with a less than 10 percent recurrence rate and potential for malignant transformation. Few studies have reported the effects of environmental factors, especially cigarette smoking, on recurrence rates of IP.

Study design: Retrospective study of patients who had primary surgery for IP at a single university

Setting: Seoul National University Hospital, Seoul, South Korea

Synopsis: The study included 132 patients with IP over a 22-year period. Recurrence rates were significantly higher in patients with a smoking history and for those patients with Krouse stage IV tumors (extranasal/extrasinus extension). Average time to recurrence was 48.3 months. Recurrence rates were not affected by a history of diabetes mellitus, hypertension or allergic rhinitis. Malignant transformation was more likely in Krouse stage III (5/72, 6.9 percent) and especially stage IV tumors (3/3, 100 percent).

Because this is a retrospective study, there are limitations on smoking data acquisition. Smoking history was identified but could not be quantified as to extent of smoking history (i.e., pack years) and whether patients smoked at the time of resection or recurrence. All three patients with stage IV tumors had malignant transformation, but this is a small number.

Bottom line: A history of smoking increased the risk of recurrence of IP. Also, tumors at a more advanced stage were more likely to undergo malignant transformation. Because the average time to recurrence was 48.3 months, long-term postoperative follow-up is necessary for patients after IP resection.

Citation: Moon IJ, Lee DY, Suh MW, et al. Cigarette smoking increases risk of recurrence for sinonasal inverted papilloma. Am J Rhinol Allergy. 2010;24(5):325-329.

—Reviewed by John Del Gaudio, MD