Prognostic significance of pre-operative diagnosis in sinonasal inverted papilloma: recurrence-free survival analysis.

PURPOSE: This study aimed to evaluate the clinical characteristics associated with post-operative recurrence in patients with sinonasal inverted papilloma (IP), focusing on the prognostic factors influencing recurrence-free survival (RFS).

METHODS

We retrospectively reviewed clinical records from patients who underwent surgery for IP between January 1, 2007, and August 31, 2023. RFS was analyzed using Kaplan-Meier method and Cox proportional hazard regression analyses to identify the prognostic factors for recurrence. Variables, including age, sex, symptoms, timing of diagnosis, radiological findings, Krouse staging, previous surgery history, surgical method, and tumor origin site, were analyzed.

RESULTS

Among the 315 patients with IP, 48 experienced recurrences. The survival analysis revealed 1-, 3-, and 5-year RFS rates of 88.88%, 82.84%, and 69.47%, respectively, and indicated that headache, diagnosis during or following surgery, high Krouse staging, intracranial extension, and frontal sinus origin reduce median RFS or the 5-year RFS rate. Multivariate Cox regression showed that headache, diagnoses made during or after surgery, intracranial extension, and frontal sinus origin significantly increased recurrence risk.

CONCLUSIONS

If IP is suspected, a biopsy should be performed, and an appropriate surgical approach should be planned. To select the appropriate surgical method, determining the tumor origin site using radiological imaging is crucial, particularly in cases involving the frontal sinus or intracranial extension. Additionally, vigilant monitoring is essential for identifying recurrences early in patients with significant risk factors.