title: Sinonasal Tract Inflammation as a Precursor to Nasopharyngeal Carcinoma: A Systematic Review and Meta-Analysis.
abstract: Chronic inflammation has been described as a precursor to the development of malignancy in several disease states. However, the relationship of sinonasal tract inflammation to nasopharyngeal carcinoma (NPC) remains poorly defined.
  
  
  
  Systematic review of primary studies identified through PubMed, EMBASE, MEDLINE, and Cochrane.
  
  
  
  Systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. MEDLINE, EMBASE, and Cochrane databases were queried for English-language studies published between 1980 and 2015. Studies were excluded that did not provide quantitative data on sinonasal tract inflammation such as chronic rhinosinusitis (CRS), allergic rhinitis (AR), or human papillomavirus (HPV) status and NPC. An itemized assessment of the risk of bias was conducted for each included study.
  
  
  
  Of the 325 studies identified during systematic review, 5 met the criteria for analysis. The level of evidence of those studies was generally low. There was an increased risk of NPC in patients with a previous diagnosis of CRS or AR. Meta-analysis demonstrated an odds ratio (95% confidence interval [CI]) of 2.35 (2.00-2.76) for all studies. Subgroup analysis of patients with sinonasal inflammation had an odds ratio of 2.39 (95% CI, 2.20-2.60). Patients with AR had an odds ratio of 2.29 (95% CI, 2.06-2.54), while those with CRS had an odds ratio of 2.70 (95% CI, 1.98-3.70).
  
  
  
  This systematic review and meta-analysis suggests an association between previous sinonasal inflammatory disease and subsequent NPC. Prospective studies are needed to further examine this relationship.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Riley
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Marino
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Hawkey
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
authors.forename: Claire M
authors.initials: CM
authors.lastname: Lawlor
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana, USA emccoul@gmail.com.
authors.forename: Edward D
authors.initials: ED
authors.lastname: McCoul
mesh_terms: D002277:Carcinoma / Q000209:etiology*; D002908:Chronic Disease; D006801:Humans; D007249:Inflammation / Q000150:complications; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000209:etiology*; D011230:Precancerous Conditions; D012852:Sinusitis / Q000150:complications*
keywords: meta-analysis; nasopharyngeal carcinoma; sinonasal inflammation; systematic review