Inverted papilloma with multifocal attachment is associated with increased recurrence.

BACKGROUND: Inverted papilloma (IP) is a benign sinonasal tumor with a well-known propensity to recur, especially at its bony attachment site. Anecdotal evidence suggests lower rate of recurrence in primary resection. We also aimed to evaluate the effect of multifocal vs single focus of attachment in disease control. METHODS: This work is a retrospective review of 535 IP resections performed during the period from 2006 to 2016 at a tertiary-care center. Demographic data, tumor location and attachment sites, and follow-up duration data were obtained. RESULTS: Two hundred ten patients were eligible for analysis. The mean age was 57 years, with an average postoperative surveillance of 36.4 months. Patients who had a previous procedure at an outside institution have a recurrence rate of 22.3%, compared with 12.4% for patients who had primary surgery at our institution. The most common site of attachment was maxillary sinus (47.6%), followed by ethmoid sinus (39%). Individual tumor review showed 50% of the patients to have multifocal attachment disease, of which there is a higher prevalence in secondary cases when compared with primary cases (53.7% vs 44.9%). Multiple tumor attachment sites had a significant effect on recurrence (odds ratio, 3.5; 95% confidence interval, 1.6-7.6; p = 0.002). CONCLUSION: Primary resection and single-focus attachment of inverted papilloma are associated with lower recurrence rates at 3-year follow-up.

Clinical outcomes of sinonasal squamous cell carcinomas based on tumor etiology.

BACKGROUND: Squamous cell carcinoma (SCC) of the sinonasal cavity is a rare entity that arises as either de-novo tumors or from inverted papillomas (IPs). In this study we evaluate and compare oncologic outcomes of sinonasal SCCs based on their etiology and treatment strategy. METHODS: This investigation was a single-center, retrospective review comparing de-novo SCCs (n = 28) and those associated with IPs (n = 38) resected during the period from 2000 to 2015. Demographic and tumor data, surgical approach, recurrence, and clinical outcomes were analyzed. RESULTS: There was no statistical difference when comparing age, smoking history, tumor origin, or tumor stage of our patients with de-novo sinonasal SCC (DN-SCC) vs IP-transformed SCC (IP-SCC). IP-SCC tumors demonstrated better overall survival (p = 0.065) and disease-specific survival (p = 0.041) compared with DN-SCC. Early T-stage IP-SCC tumors had better disease-free survival compared with early T-stage DN-SCC tumors (p = 0.002). Distant metastasis was an independent prognostic factor of worse disease-specific survival (p = 0.002). SCC disease-specific survival was not affected by surgical resection technique. CONCLUSION: SCC tumors arising from IPs appear to have improved disease-specific survival compared with de-novo sinonasal SCC tumors. The oncologic differences between the 2 groups are found primarily among the early-stage tumors.