Sex differences in CRSwNP: focus on histopathological endotypes and recurrence

Chronic rhinosinusitis with nasal polyps (CRSwNP) exhibits sex-specific differences in prevalence and clinical presentation. However, the underlying histopathological characteristics and recurrence remain underexplored.

A retrospective cohort of 410 CRSwNP patients (287 males, 123 females) undergoing endoscopic sinus surgery between January 2021 and June 2024 was analyzed. Histological evaluation was employed by H&E staining and features of inflammatory profile were identified by immunohistochemistry. Multivariate logistic regression and receiver operating characteristic analyses were performed to assess predictors of recurrence.

Males exhibited higher body mass index (BMI) and greater allergic rhinitis prevalence, while females had more asthma comorbidity and higher SNOT-22 scores. While no significant sex differences were observed in histopathological endotypes, elevated BMI was more likely to exacerbate inflammation in males than females. Additionally, males showed a higher recurrence rate, with male sex being identified as an independent risk factor. However, females who experienced recurrence exhibited more severe eosinophilic and T2 inflammation compared to their male counterparts. Therefore, higher threshold values for tissue eosinophil counts and Charcot-Leyden crystals were required to predict recurrence in female patients.

These findings underscore the necessity for sex tailored therapeutic strategies, particularly emphasizing weight control in male patients and intensified anti-T2 inflammation management in female patients with recurrent CRSwNP. Further research is needed to investigate the underlying causes and to offer evidence-based treatment guidelines.