Role of P53, Kİ67, human papilloma virus in sinonasal inverted papilloma and clinical outcomes

ABSTRACT Role of P53, Ki67, Human Papilloma Virus in Sinonasal Inverted Papilloma and Clinical Outcomes Objective: The aim of this study is to determine the role of tumor supressor gene p53, cell proliferation marker ki67 and human papilloma virus in patients with sinonasal inverted papilloma. Also to understand the relationship between p53 and ki67 expression with age, gender, smoking, tumor localisation, malignant transformation, recurrence, tumor Krause stage is objected. Finally it is aimed to analyse the treatment choices regarding to tumor stage and clinical outcome such as recurrence and malignant transformation. Material and Method: In this study 41 patients operated in Cukurova University Faculty of Medicine Otolaryngology Department between 2006 and 2014 were included. Patients pathological tissue and ten samples of normal nasal mucosa were evaluated. Tissue samples were studied with p53 and ki67 antibodies for immunophenotyping and polymerase chain reaction (PCR) for policlonal human papillomavirus. Patients with human papillomavirus were also searched for subtypes 16 and 18. Results: 32 patients (78%) were male and 9 patients (22%) were female. Mean age was 54,46 (32-81). The risk was 3,55 times higher for male patients. Mean follow-up time was 36,8 months (3-86). One patient had 2 recurrence and 10 patients had one recurrence (26,8%). 10 of patients with recurrence had tumor originated from maxillary sinus. Medial maxillectomy was not performed in 7 of patients with recurrence in first operation. Patients not had medial maxillectomy were shown to have higher risk for recurrence. Malignant transformation was seen in 3 patients. Human papilloma virus was shown in these 3 patients (7,3%) tissue samples with polymerase chain reaction. Two patients had HPV subtype 16 and one patient had HPV subtype 18. None of the patients without malignant transformation had HPV. Correlation between p53 expression and recurrence and malignancy was statistically significant. There were no correlation with age, gender, smoking and Krause tumor staging. Correlation between ki67 expression and malignancy was statistically significant. There were no correlation with recurrence, age, gender, smoking and Krause tumor staging. Conclusion: p53 expression was shown to be effective on recurrence and malignant transformation and ki67 on malignant transformation only. HPV was positive in all patients with malignant transformation. Human papilloma virus positivity and expression of p53 and ki67 can be valuable for clinicians for prediction of malignancy. Keywords: Inverted papilloma, p53, ki67, HPV, sinonasal