Background/Objectives: Inverted sinonasal papilloma (IP) is a benign epithelial proliferation that can recur and undergo malignant transformation. We performed a systematic review and meta-analysis to answer the following question: what are the risk factors for malignant transformation in IP?Methods: A search was performed in PubMed and Embase databases. Numbers of affected individuals in exposed versus non-exposed individuals, or odds ratio values, were compared for each specific risk factor examined. The Newcastle–Ottawa Scale (NOS) was used to assess the risk of bias. To assess the overall quality of evidence, we used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Meta-analyses were conducted using the fixed-effects and the random effects models. Heterogeneity of the results was assessed by I2statistic output. Meta-analyses and forest plots were obtained using Review Manager (RevMan) software version 5.4.Results: After examining 1875 results (942 from PubMed; 933 from Embase), 26 articles were selected. Among the 26 selected articles, the number of cases examined ranged from 14 to 162. All studies examined a population of 1271 IPs, with a carcinoma incidence of 230/1271 (18.1%). Three meta-analyses were performed for the following risk factors: smoking, alcohol, and HPV. Using the fixed-effects model, significant values were obtained for smoking (p= 0.002) and HPV (p< 0.001), with moderate and low quality of evidence, respectively. Alcohol did not reach statistical significance (p= 0.95).Conclusions: This study demonstrates that both smoking and HPV are risk factors for IP malignant transformation. Possible interventions include smoking cessation and HPV vaccination in individuals affected by IP.
背景/目的：内翻性乳头状瘤是一种可复发并发生恶性转化的良性上皮增生性病变。本研究通过系统综述与荟萃分析探讨以下问题：内翻性乳头状瘤发生恶性转化的危险因素有哪些？ 方法：系统检索PubMed和Embase数据库。针对每个特定危险因素，比较暴露组与非暴露组的患病人数或比值比。采用纽卡斯尔-渥太华量表评估偏倚风险，使用推荐分级的评估、制定与评价方法评估证据总体质量。分别采用固定效应模型和随机效应模型进行荟萃分析，通过I²统计量评估结果异质性，使用Review Manager 5.4软件进行荟萃分析并生成森林图。 结果：通过对1875项检索结果（PubMed 942项，Embase 933项）的筛选，最终纳入26篇文献。纳入研究样本量范围为14-162例，共包含1271例内翻性乳头状瘤患者，其中230例发生癌变（18.1%）。针对吸烟、饮酒及人乳头瘤病毒感染三项危险因素进行荟萃分析。固定效应模型分析显示：吸烟（p=0.002）与人乳头瘤病毒感染（p<0.001）具有统计学显著性，证据质量分别为中等级别与低级别；饮酒因素未达统计学显著性（p=0.95）。 结论：本研究证实吸烟与人乳头瘤病毒感染均为内翻性乳头状瘤恶性转化的危险因素。针对内翻性乳头状瘤患者的潜在干预措施包括戒烟与人乳头瘤病毒疫苗接种。
肿瘤(癌症)患者之家