Multiple Attachment Sites and Broad-Based Attachment Predict Recurrence in Sinonasal Papilloma

Background Although attachment characteristics are associated with sinonasal papilloma recurrence, the independent associations of multiple attachment sites and broad-based attachment remain incompletely defined. Objective This study evaluated clinical, histological, and surgical predictors of sinonasal papilloma recurrence, emphasizing multiple and broad-based attachment. Methods A single-center retrospective cohort study was conducted including 178 patients who underwent surgical treatment for sinonasal papilloma between January 2006 and December 2021. Demographic, clinical, and histopathological variables—such as number of surgeries, origin of attachment site, histological subtype, presence of multiple attachment sites, broad-based attachment, follow-up duration, recurrence status, and time to recurrence—were extracted from medical records, operative notes, and surgical videos. Binomial logistic regression was used to identify independent predictors of recurrence. Results The cohort included 178 patients, of whom 167 (93.8%) had inverted papilloma. The mean age was 52.2 ± 7.9 years, and 84.3% of patients were male. The median follow-up duration was 86.9 months (IQR:64.9-100.8). Thirty-one patients (17.4%) were revision cases. Recurrence occurred in 20 patients (11.2%), with a median time to recurrence of 26.4 months (IQR 10.1-45.7). No significant differences were observed between recurrence and nonrecurrence groups regarding age, sex, or histological type ( p > 0.05). However, recurrence was significantly associated with the origin of attachment site (frontal sinus), revision cases, multiple attachment sites, and broad-based attachment ( p < 0.05). In multivariate analysis, only multiple attachment sites (OR = 18.7, 95% CI:2.6-133.8, p = 0.004) and broad-based attachment (OR = 13.3, 95% CI:2.3-76.9, p = 0.004) remained independently associated with recurrence. Conclusion Multiple attachment sites and broad-based attachment significantly increase recurrence risk—approximately 19- and 13-fold, respectively—highlighting the importance of thorough intraoperative evaluation and complete resection of all tumor attachment sites.