# MMP11 as a Prognostic Indicator for Inverted Papilloma Histologic Grade and Recurrence

## TL;DR

This study shows that higher MMP11 levels in inverted papilloma tumors are linked to more severe disease and a greater risk of recurrence, suggesting it could help identify high-risk patients.

## Contribution

The study identifies MMP11 as a novel prognostic biomarker for predicting recurrence and severity in inverted papilloma.

## Key findings

- MMP11 expression was significantly higher in severe dysplasia and SCC compared to mild dysplasia.
- Patients with high MMP11 expression had a shorter time to recurrence, independent of histologic grade.
- Elevated MMP11 in initial resection specimens was associated with a higher recurrence risk.

## Abstract

Inverted papilloma (IP) is a benign, but locally aggressive sinonasal tumor with a high recurrence rate and potential for malignant transformation into squamous cell carcinoma ex‐IP (SCC). Currently, no reliable biomarkers exist to predict recurrence or severity. Matrix metalloproteinase‐11 (MMP11) has been implicated in tumor progression and extracellular matrix remodeling in various malignancies and has been shown to be progressively upregulated in IP transformation. This study investigates the relationship between MMP11 expression and IP histologic severity and recurrence risk.

Patient demographics and tumor characteristics were collected retrospectively at a tertiary care center from 2008 to 2023. Patient specimens were categorized into normal sinus tissue (NST), IP without dysplasia (IPND), IP with severe dysplasia (IPSD), and SCC. Immunohistochemical staining for MMP11 was performed, and quantitative analysis was conducted using DAB‐Quant software.

A total of 52 patients were included, with a mean follow‐up of 68.8 months. MMP11 expression was significantly elevated in IPSD and SCC compared to IPND (36.7% and 36.5% vs. 21.1%, p = 0.02 and p = 0.01). Patients with recurrence exhibited higher MMP11 expression in their initial resection specimens compared to non‐recurrent cases (31.1% vs. 18.1%, p < 0.01). High MMP11 expression (> 50%) was associated with a shorter time to recurrence (17.5 vs. 32 months, p = 0.03), independent of histologic grade.

MMP11 expression correlates with increased IP histologic grade, risk of recurrence, and shorter time to recurrence. Elevated MMP11 expression may identify patients at higher risk for recurrence, allowing for targeted surveillance strategies and treatment options.

3.

Matrix metalloproteinase‐11 (MMP11) expression increases with inverted papilloma (IP) histologic grade and is significantly higher in patients who develop recurrence. Quantitative immunohistochemistry revealed that elevated MMP11 predicts both increased recurrence risk and shorter time to recurrence, independent of dysplasia. These findings highlight MMP11 as a promising prognostic biomarker to guide personalized surveillance strategies in IP.