{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T02:48:20Z","timestamp":1788922100612,"version":"build-2803163510"},"reference-count":31,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Sinonasal inverted papillomas (IPs) are rare benign tumors with ~15% postoperative recurrence and a ~8% risk of malignant transformation, with human papillomavirus (HPV) reported as a risk factor in IP malignant transformation. To evaluate clinical, molecular and immunohistochemical factors associated with recurrence and malignant transformation in IPs. We retrospectively analyzed 73 patients with histologically confirmed IPs that were treated at three tertiary ENT centers, including radiologic data, HPV DNA detection and p16 immunohistochemistry. Univariate analysis was used to identify factors associated with recurrence and malignant transformation, and restricted exploratory multivariable logistic regression models were used to assess recurrence while minimizing overfitting. Fourteen recurrences (19%) were associated with longer symptom duration (p = 0.003), smoking (p = 0.03), advanced Krouse stage (III\u2013IV) (p &lt; 0.001), frontal sinus origin (p = 0.02), HPV+ DNA (50% vs. 22%, p = 0.048), and p16 loss\/reduced expression (p = 0.006). Nine recurrences transformed into carcinoma (12%) and were associated with smoking (p = 0.01). HPV+ was not associated with malignancy (p = 1.00). Recurrence was associated with the advanced stage of the IP, tobacco use, longer symptom duration, frontal sinus origin, HPV+, and p16 loss\/reduced expression.<\/jats:p>","DOI":"10.3390\/life16030442","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T13:27:18Z","timestamp":1773062838000},"page":"442","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Sinonasal Inverted Papillomas: Predictors of Recurrence and Malignant Transformation"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4475-7737","authenticated-orcid":false,"given":"Ionut","family":"Tanase","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mircea-Sorin","family":"Ciolofan","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Codrut-Caius","family":"Sarafoleanu","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3426-6478","authenticated-orcid":false,"given":"Carmen Aurelia","family":"Mogoant\u0103","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0296-8141","authenticated-orcid":false,"given":"Florentina-Carmen","family":"Badea","sequence":"additional","affiliation":[{"name":"ENT Department, Medicover Hospital, 020331 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constantin-Ioan","family":"Busuioc","sequence":"additional","affiliation":[{"name":"Department of Pathology, Sfanta Maria Hospital, 011172 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5966-3314","authenticated-orcid":false,"given":"Shirley","family":"Tarabichi","sequence":"additional","affiliation":[{"name":"Doctoral School, Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Milea","sequence":"additional","affiliation":[{"name":"Doctoral School, Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilona Mihaela","family":"Liliac","sequence":"additional","affiliation":[{"name":"Department of Histology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Iovanescu","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300113 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gheorghe","family":"Iovanescu","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300113 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6731-3341","authenticated-orcid":false,"given":"Gabriela-Cornelia","family":"Musat","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1001\/jamaoto.2020.5261","article-title":"Survival Outcomes of De Novo vs. Inverted Papilloma-Associated Sinonasal Squamous Cell Carcinoma: A Systematic Review and Meta-analysis","volume":"147","author":"Lee","year":"2021","journal-title":"JAMA Otolaryngol.\u2014Head Neck Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1186\/s43163-022-00371-2","article-title":"Diagnostic strategy and therapeutic management of sinonasal inverted papilloma: Our experience with review of literature","volume":"38","author":"Bouatay","year":"2022","journal-title":"Egypt. 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