Survival Outcome Of Squamous Cell Carcinoma Arising From Sinonasal Inverted Papilloma

Objective:To analyze the factors affecting prognosis of the carcinoma arising from nasal and sinonasal inverted papilloma. To analyze the relation between the prognosis of patients with squamous cell carcinoma arising from sinonasal inverted papilloma(IP/SCC) and human papillomavirus (HPV) infection.Methods:In the first part,87 patients from our institution from 1970 to 2012 were analyzed.Of the cases,13 were at stage Ⅰ or Ⅱ;30 stage Ⅲ;44 stage Ⅳ. Twenty-nine patients were treated with surgery alone,58 with combination of surgery and radiation therapy.Kaplan-Merier and Log-rank were used in the analyses.In the second part,55 patients with IP/SCC of the 87 cases who met the enrollment criteria during the period from Janaury 1997 to Janaury 2012 were restrospectively reviewed. A "sandwich " technique was used to cut paraffinsections for hematoxylin and eosin (H&E) staining and for HPV-DNA analysis.Overall survival (OS) and disease specific survival (DSS) for HPV-positive and HPV-negative patients were estimated by SPSS 19.0. Log-rank and Cox regression model was used.Results:In the first part,the overall 5-years survival rate was 39.6%,the 5-years survival rate was 64.2% in stage Ⅰ or Ⅱ,59.7% in stage Ⅲ,19.0% in stage Ⅳ (P< 0.05). The 5-years survival rate was 65.7% in patients who had no surgical history, 29.7% in patients who had (P<0.05). The 5-years survival rate was 47.5% in the patients who had the involvement of cranial base and (or) orbit,it was 26.9% in the patients whose cranial base and (or) orbit were clean (P<0.05).Of the patients with same stage (Ⅲ-Ⅳ),the cases who were treated with surgery only was 30.7%, that with combination treatment was 39.9%(P=0.849). The distant metastasis was main causes of death.In the second part,HPV-DNA was detected in 11 (20%) of the tumor specimens, 5(45.5%) of which were of the HPV-16 subtype,3(27.3%) were of the HPV-6 subtype. The other three types included HPV-39, HPV-18/39and HPV-33/52/54. The estimated 5-year OS was 35.6%, in these, HPV positive patients were 18.7% HPV negative patients were 38.9%. The estimated 5-year DSS was 35.6%,in these, HPV positive pat-ients were 18.7% HPV negative patients were 49.2%. Patients with HPV positive tumors compared with that of patients with HPV negative tumors have lower outcomes, but have no statistically significant difference (p=0.915, p=0.773).Conclusion:Age, clinical stageand surgical history are the main factors affecting the prognosis of the patients. Otherwise, the history of recurrent and the involvement of cranial base or orbit play a important role. The distant metastasis was main causes of death in the patients of the carcinoma arising from nasal and sinonasal inverted papilloma.HPV-DNA was detected in 20% of the patients with IP/SCC.It has no prognostic predictors for human papil-lomavirus in IP/SCC.