Department of Otolaryngology, School of Medicine, The University of North Carolina, Chapel Hill, North Carolina, USA.
Marsico Lung Institute, School of Medicine, At the University of North Carolina, Chapel Hill, North Carolina, USA.
Int Forum Allergy Rhinol. 2021 Oct;11(10):1461-1471. doi: 10.1002/alr.22810. Epub 2021 May 6.
To date, there is still a significant debate on the role of human papilloma virus (HPV) infection in transformation of inverted papillomas (IPs) to squamous cell carcinoma (SCC). This study was designed to determine if the presence of HPV in a sinonasal IP increases the risk of malignant transformation to IPSCC.
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 19 high-quality case-control and cohort studies with tissue-diagnosed IP or IPSCC and HPV diagnosis were analyzed. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the Mantel-Haenszel method with correction for random effects. Subgroup, publication bias and a sensitivity analyses were also performed.
Nineteen studies with minimal bias met the inclusion criteria for quality and identified HPV infection in an IP. The pooled data revealed a strong association with progression to malignancy with an unweighted, pooled OR of 2.38 (CI 1.47 to 3.83) and a weighted OR of 2.80 (CI 1.42 to 5.51). Sensitivity analysis revealed that no single study contributed significantly to our pooled OR calculations (ORs 2.52 to 3.57). Subgroup analyses stratified by publication date, nucleic acid target, HPV detection method and type, sample size, and region all demonstrated a positive association of HPV with IPSCC.
There appears to be a significant association between HPV infection and malignant transformation of IPs. While HPV testing is not currently the standard of care for IPs, these data suggest a link between the two and suggest further studies should be performed to identify a link between the virus and malignant transformation.
迄今为止，人乳头瘤病毒（HPV）感染在鼻内翻性乳头状瘤（IP）向鳞状细胞癌（SCC）转化中的作用仍存在较大争议。本研究旨在确定鼻窦 IP 中 HPV 的存在是否会增加向 IPSCC 恶性转化的风险。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，分析了 19 项高质量的病例对照和队列研究，这些研究均有组织学诊断的 IP 或 IPSCC 以及 HPV 诊断。使用 Mantel-Haenszel 方法计算比值比（OR）和 95%置信区间（CI），并进行随机效应校正。还进行了亚组分析、发表偏倚和敏感性分析。
19 项偏倚较小的研究符合纳入标准，确定了 IP 中的 HPV 感染。汇总数据显示，HPV 感染与恶性转化密切相关，未加权汇总 OR 为 2.38（95%CI 1.47 至 3.83），加权 OR 为 2.80（95%CI 1.42 至 5.51）。敏感性分析表明，没有单个研究对我们的汇总 OR 计算有显著贡献（OR 为 2.52 至 3.57）。按发表日期、核酸靶标、HPV 检测方法和类型、样本量和地区进行的亚组分析均显示 HPV 与 IPSCC 之间存在正相关。
HPV 感染与 IP 的恶性转化之间似乎存在显著关联。虽然 HPV 检测目前不是 IP 的标准治疗方法，但这些数据表明两者之间存在联系，并表明应进一步研究以确定病毒与恶性转化之间的联系。
