Nasopharyngeal carcinoma (NPC) is a relatively uncommon diagnosis in the West but is prevalent in Southeast Asia. Several factors have been established to be associated with a higher risk of developing NPC, including salted fish consumption, smoking, alcohol, and Epstein Barr virus infection. Chronic inflammation is associated with a risk of developing malignancy in sites including the oral cavity and cervix. This systematic review sought to evaluate the relationship between chronic inflammation of the sinonasal tract and the risk of developing NPC. Eight studies involving 1,044,332 patients (8245 NPC; 1,036,087 non-NPC) were included in the meta-analysis. Four of the studies were case-control and four cohort. The overall odds ratio (OR) of patients being diagnosed with NPC after reporting sinonasal inflammation was 1.81 (95% CI 1.73–1.89). Chronic rhinosinusitis (CRS) was more closely associated with an increased risk of NPC (OR of 1.78 (95%-CI: 1.68–1.90)) than allergic rhinitis (OR of 1.60 (95%-CI: 1.52–1.68)). The authors acknowledge a number of limitations of the studies included in their systematic review, including the potential for recall and confounding bias. Nevertheless, the results do suggest a significant association between sinonasal inflammation and a subsequent diagnosis of NPC. This is considered biologically plausible given that inflammatory cells and the signalling molecules they generate are recognised to facilitate neoplastic processes by promoting the proliferation, survival and migration of tumour cells. As such, this paper arguably provides further evidence in support of offering appropriate interventions – including surgery where indicated – for the treatment of chronic rhinosinusitis in particular.
Chronic rhinosinusitis – a pre-malignant condition?
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