Risk Factors for Malignant Transformation in Inverted Sinonasal Papilloma: A Systematic Review and Meta-Analysis
Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Guidelines and PICO
- Participants: patients with IP malignant transformation;
- Intervention/Index: risk factor exposure;
- Comparison: IP without malignant transformation;
- Outcome: number of malignant transformations in exposed vs. non-exposed individuals.
2.2. Protocol Registration
2.3. Search Strategy
- sinonasal inverted papilloma;
- malignant transformation.
- 1.
- PubMed
- 2.
- Embase
2.4. Selection of Articles
2.5. Eligibility Criteria
- Observational and interventional studies, cohort studies, in English, with any publication date, from any country.
- Patients above 18 years of age presenting with a histologically proven diagnosis of sinonasal inverted papilloma and malignant transformation, either synchronous (present at the time of initial diagnosis) or metachronous (during follow-up).
- Documented exposure to risk factors with at least one of the following:
- Smoking
- Alcohol
- Infectious agents (i.e., viruses)
- Professional exposure (i.e., exposure to chemicals or substances specifically related to a determined occupational activity, such as dusts or solvents).
- Comparison of the incidence of malignant transformation between exposed and non-exposed individuals. The comparison may be documented either by the number of individuals affected by malignancy compared to those who did not have malignancy or by odds ratio. Odds ratio values had to be clearly expressed in the main text, tables, figures, or Supplementary Tables/Materials.
- Studies reporting case series with fewer than 5 participants.
- Only malignant transformed cases with no comparison with non-transformed (benign) cases.
- No adequate comparisons with non-exposed individuals.
- Studies with unclear diagnostic methods.
- Selected populations (i.e., only geriatric cases or only cases from a specific topography)
- Studies including non-consecutive cases, but only selected cases (possible selection biases).
- Foreign language (not English).
- Discussion papers (i.e., reviews, both narrative and systematic), with no new cases described.
- Cases including only carcinoma in situ with no invasive component in the evaluation of malignant transformation.
2.6. Risk of Bias Assessment
- Selection (four items with a maximum of four stars).
- Is the case definition adequate?
- Representativeness of the cases
- Selection of controls
- Definition of controls
- Comparability (one item with a maximum of two stars)
- Comparability of cases and controls on the basis of the design or analysis
- Exposure (three items with a maximum of three stars)
- Ascertainment of exposure
- Same method of ascertainment for cases and controls
- Non-response rate
2.7. Statistical Analysis
2.8. Quality of Evidence
3. Results
3.1. Article Selection
3.2. Risk of Bias Assessment
3.3. Population Examined
3.4. Meta-Analysis Results
- The evidence for HPV as a significant risk factor is robust, with the lack of heterogeneity further strengthening confidence in its oncogenic role.
- Smoking is confirmed as a significant risk factor, although the moderate degree of variability warrants careful consideration, especially given the limited number of studies.
- Alcohol consumption is not a relevant risk factor in this context.
3.5. Quality of Evidence
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
IP | Inverted Papilloma |
C-IP | Carcinoma in Inverted Papilloma |
HPV | Human Papillomavirus |
EBV | Epstein-Barr Virus |
PRISMA | Preferred Reporting Items for Systematic Reviews and Meta-Analyses |
NOS | Newcastle–Ottawa Scale |
GRADE | Grading of Recommendations, Assessment, Development, and Evaluation |
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Author | 1. Selection | 2. Comparability | 3. Exposure | Total Score |
---|---|---|---|---|
Archang [23] | 4 | 1 | 3 | 8 |
Bernauer [24] | 4 | 1 | 2 | 7 |
Buchwald [25] | 4 | 1 | 3 | 8 |
Cabal [26] | 4 | 1 | 2 | 7 |
Caruana [27] | 4 | 1 | 2 | 7 |
Franzmann [28] | 4 | 1 | 3 | 8 |
Gaffey [29] | 4 | 1 | 2 | 7 |
Holm [30] | 4 | 1 | 2 | 7 |
Hong [31] | 4 | 1 | 3 | 8 |
Hwang [32] | 4 | 1 | 2 | 7 |
Jalilvand [33] | 4 | 1 | 2 | 7 |
Jenko [34] | 4 | 1 | 2 | 7 |
Kim [35] | 4 | 1 | 2 | 7 |
Kraft [36] | 4 | 1 | 3 | 8 |
Li [37] | 4 | 1 | 2 | 7 |
McKay [38] | 4 | 1 | 2 | 7 |
Menendez [39] | 4 | 1 | 2 | 7 |
Mirza [40] | 4 | 1 | 2 | 7 |
Mohajeri [41] | 4 | 1 | 3 | 8 |
Re [42] | 4 | 1 | 2 | 7 |
Stoddard [43] | 4 | 1 | 2 | 7 |
Syrjanen [44] | 4 | 1 | 2 | 7 |
Wang [45] | 4 | 1 | 3 | 8 |
Wang [46] | 4 | 1 | 2 | 7 |
Xian [47] | 4 | 1 | 2 | 7 |
Yan [48] | 4 | 1 | 2 | 7 |
Average | 4 | 1 | 2.3 | 7.3 |
Authors | Year | N. of All IP | N. of IP Without Carcinoma | N. of C-IP | Rate of Malignancy (%) | HPV N. of Cases in IP vs. C-IP (p-Value) | Smoking Status N. of Cases in IP vs. C-IP (p-Value) | Alcohol N. of Cases in IP vs. C-IP (p-Value) | EBV N. of Cases in IP vs. C-IP (p-Value) |
---|---|---|---|---|---|---|---|---|---|
Archang [23] | 2022 | 100 | 96 | 4 | 4/100 (4%) | 39/106 vs. 5/12 (0.281) | 32/106 vs. 4/12 (0.035) | ||
Bernauer [24] | 1997 | 22 | 19 | 3 | 3/22 (13.6%) | 5/19 vs. 2/3 (NA) | |||
Buchwald [25] | 1995 | 57 | 52 | 5 | 5/57 (8.8%) | 3/52 vs. 2/5 (NA) | |||
Cabal [26] | 2020 | 55 | 41 | 14 | 14/55 (25.5%) | 4/40 vs. 2/13 (NA) | |||
Caruana [27] | 1997 | 19 | 15 | 4 | 4/19 (21.1%) | 6/15 vs. 2/4 (NA) | 3/15 vs. 2/4 (NA) | 3/15 vs. 0/4 (NA) | |
Franzmann [28] | 1998 | 17 | 12 | 5 | 5/17 (29.4%) | 0/12 vs. 3/5 (NA) | |||
Gaffey [29] | 1996 | 20 | 19 | 1 | 1/20 (5%) | 1/19 vs. 1/1 (NA) | 1/12 vs. 1/1 | ||
Holm [30] | 2020 | 53 | 50 | 3 | 3/53 (5.7%) | 2/38 vs. 1/2 (NA) | |||
Hong [31] | 2013 | 162 | 145 | 17 | 17/162 (10.5%) | 39/145 vs. 17/17 (<0.001) | |||
Hwang [32] | 1998 | 42 | 36 | 6 | 6/42 (14.3%) | 3/36 vs. 2/5 (NA) | |||
Jalivand [33] | 2016 | 40 | 37 | 3 | 3/40 (7.5%) | 7/37 vs. 3/3 (0.002) | |||
Jenko [34] | 2011 | 71 | 66 | 5 | 5/71 (7.0%) | 20/66 vs. 3/5 (NA) | |||
Kim [35] | 2007 | 57 | 50 | 7 | 7/57 (12.3%) | 7/57 vs. 0/7 (NA) | |||
Kraft [36] | 2001 | 34 | 30 | 4 | 4/34 (11.8%) | 1/29 vs. 0/4 (NA) | |||
Li [37] | 2019 | 25 | 16 | 9 | 9/25 (36.0%) | 4/12 vs. 3/6 (NA) | |||
McKay [38] | 2005 | 14 | 11 | 3 | 3/14 (21.4%) | 3/11 vs. 2/3 (NA) | |||
Menendez [39] | 2022 | 60 | 49 | 11 | 11/60 (18.3%) | 2/49 vs. 2/11 (0.034 0.006 *) | |||
Mirza [40] | 1998 | 30 | 29 | 1 | 1/30 (3.3%) | 5/29 vs. 1/1 (NA) | |||
Mohajeri [41] | 2018 | 76 | 72 | 4 | 4/76 (5.3%) | 10/76 VS. 0/4 (NA) | |||
Re [42] | 2021 | 50 | 33 | 17 | 17/50 (34.0%) | 18/33 VS. 9/17 (NA) | |||
Stoddard [43] | 2015 | 19 | 18 | 1 | 1/19 (5.3%) | 6/18 VS. 1/1 (≥5 mRNA) (NA) | |||
Syrjanen [44] | 1987 | 14 | 12 | 2 | 2/14 (14.3%) | 8/12 vs. 2/2 (NA) | |||
Wang [45] | 2019 | 25 | 17 | 8 | 8/25 (32.0%) | 4/17 vs. 2/8 (NA) | |||
Wang [46] | 2021 | 25 | 18 | 7 | 7/25 (28.0%) | 0/18 vs. 3/7 (NA) | |||
Xian [47] | 2024 | 42 | 22 | 20 | 20/42 (47.6%) | 8/22 vs. 6/20 (0.662) | |||
Yan [48] | 2019 | 142 | 76 | 66 | 66/142 (46.5%) | 7/76 vs. 8/66 (0.596) | |||
Total | 1271 | 1041 | 230 | 230/1271 (18.1%) |
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Ambrosini-Spaltro, A.; Querzoli, G.; Leucci, A.C.; Camagni, A.; Farneti, P.; D’Angelo, E.; Donini, E.; Tosoni, A.; Pasquini, E.; Galli, P.; et al. Risk Factors for Malignant Transformation in Inverted Sinonasal Papilloma: A Systematic Review and Meta-Analysis. Cancers 2025, 17, 1798. https://doi.org/10.3390/cancers17111798
Ambrosini-Spaltro A, Querzoli G, Leucci AC, Camagni A, Farneti P, D’Angelo E, Donini E, Tosoni A, Pasquini E, Galli P, et al. Risk Factors for Malignant Transformation in Inverted Sinonasal Papilloma: A Systematic Review and Meta-Analysis. Cancers. 2025; 17(11):1798. https://doi.org/10.3390/cancers17111798
Chicago/Turabian StyleAmbrosini-Spaltro, Andrea, Giulia Querzoli, Anna Caterina Leucci, Angela Camagni, Paolo Farneti, Elisa D’Angelo, Elisa Donini, Alicia Tosoni, Ernesto Pasquini, Paolo Galli, and et al. 2025. "Risk Factors for Malignant Transformation in Inverted Sinonasal Papilloma: A Systematic Review and Meta-Analysis" Cancers 17, no. 11: 1798. https://doi.org/10.3390/cancers17111798
APA StyleAmbrosini-Spaltro, A., Querzoli, G., Leucci, A. C., Camagni, A., Farneti, P., D’Angelo, E., Donini, E., Tosoni, A., Pasquini, E., Galli, P., & Foschini, M. P. (2025). Risk Factors for Malignant Transformation in Inverted Sinonasal Papilloma: A Systematic Review and Meta-Analysis. Cancers, 17(11), 1798. https://doi.org/10.3390/cancers17111798