Impact of Dysplasia on Inverted Papilloma Recurrence: A Systematic Review and Meta-Analysis

Sinonasal inverted papilloma (SNIP) is a benign but locally aggressive tumor that has demonstrated a propensity to recur. Multiple anatomic and surgical factors have been proposed to influence recurrence; dysplasia has recently emerged as a predictor, yet its prognostic significance remains unclear. Clarifying its role may improve postoperative risk stratification.

A systematic review and meta-analysis were performed following PRISMA guidelines and registered with PROSPERO (CRD420251140223). PubMed, Embase, Scopus, and Web of Science were queried for studies reporting recurrence outcomes stratified by dysplasia status. Studies with extractable recurrence data for dysplasia and non-dysplasia SNIP were included. Fixed-effects meta-analysis was performed using the inverse variance method to calculate pooled odds ratios (OR) with 95% confidence intervals (CIs). Heterogeneity was assessed using I² and Cochran's Q statistics.

Thirteen studies comprising 1893 patients were included. Based on reported data, mean age ranged from 48.3 to 58.0 years. The cohort was predominantly male (1172/1720; 68.1%). Of 283 patients with dysplasia, 104 experienced recurrence (36.7%), compared with 302 of 1346 patients without dysplasia (22.4%). Dysplasia was significantly associated with increased recurrence risk (pooled OR 3.42; 95% CI, 2.45-4.78; p < 0.001) with low-moderate heterogeneity (I² = 20.33%). Mean follow-up was 39.8 months. Findings were robust on leave-one-out sensitivity analysis and trim-and-fill adjustment (adjusted OR 3.05; 95% CI 2.21-4.22).

Dysplasia is a significant independent predictor of recurrence in SNIP, conferring 3.4 times increased odds of recurrence. Standardized dysplasia reporting and risk stratification protocols are needed to optimize surveillance strategies in SNIP patients.