title: Smoking, not human papilloma virus infection, is a risk factor for recurrence of sinonasal inverted papilloma.
abstract: BACKGROUND
  The recurrence rate of sinonasal inverted papillomas (SNIP) is 15-20%. However, few studies have investigated patient-dependent factors related to recurrence of SNIPs.
  
  
  OBJECTIVE
  To analyze risk factors, including human papilloma virus (HPV) infection and smoking, as well as other factors, for recurrence of SNIPs.
  
  
  METHODS
  Fifty-four patients who were diagnosed with SNIP and underwent surgery were enrolled: 39 men and 15 women, with the mean age of 54.0 years. Their mean follow-up was 40.6 months. Demographics and information about the history of smoking, previous surgery, tumor extent, follow-up, and recurrence were reviewed retrospectively. Those patients whose tumors were associated with malignant transformation were excluded in this study. HPV detection and genotyping in the tumor specimens were performed with the HPV DNA chip, a polymerase chain reaction-based DNA microarray system.
  
  
  RESULTS
  Seven patients (13.0%) had recurrence, with a mean time to recurrence of 39.8 months. Recurrence rates in T1, T2, T3, and T4 of the Krouse staging system were 0% (0/4), 8.3% (2/24), 17.4% (4/23), and 33.3% (1/3), respectively (p > 0.5). Eight patients (14.8%) were positive for HPV DNA. All of these patients belonged to the group without recurrence (p > 0.5). However, recurrence rates according to HPV DNA positivity were not statistically different (0% versus 15.2%). Three (42.9%) in the group with recurrence and four (8.5%) in the group without recurrence were smokers (p < 0.5).
  
  
  CONCLUSIONS
  Smoking was associated with recurrence of SNIP. However, HPV infection is not a recurrence of SNIP risk factor.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Hwan-Jung
authors.initials: HJ
authors.lastname: Roh
authors.forename: Sue Jean
authors.initials: SJ
authors.lastname: Mun
authors.forename: Kyu-Sup
authors.initials: KS
authors.lastname: Cho
authors.forename: Sung-Lyong
authors.initials: SL
authors.lastname: Hong
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D018308:Papilloma, Inverted / Q000453:epidemiology* / Q000601:surgery; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000453:epidemiology*; D010255:Paranasal Sinus Neoplasms / Q000453:epidemiology* / Q000601:surgery; D012189:Retrospective Studies; D012225:Rhinoplasty; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects