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Validation of a risk predictor score for early polyp recurrence in CRSwNP
Junqin Bai1, Lutfiyya N Muhammad2, Aditi Agarwal3
1Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Ill.
Background:
Polyp recurrence (PR) can occur in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) following endoscopic sinus surgery (ESS). We previously constructed a PR prediction model incorporating tissue biomarkers, including eosinophil cationic protein (ECP), IL-5, and anti-double-stranded DNA IgG, as well as clinical variables including the pre-ESS modified Lund-Mackay radiographic score and asthma status.
Objective:
Our aim was to develop the model into a risk predictor score (RPS), validate it by using an independent set of patients, and test its ability to stratify patients by time to PR.
Methods:
Two prospective cohorts of patients with CRSwNP (training and validation), were evaluated for PR for 2 to 5 years after ESS. Baseline demographics, pre-ESS radiographic and endoscopic assessments, and biomarker levels (using the ELISA and Luminex assays) were collected. The RPS was generated by using the prediction model coefficients as weights. Predictive accuracy was evaluated by using receiver operating characteristic analysis. The combined cohort was stratified into low-, intermediate-, and high-risk groups based on RPS tertiles, and Cox regression was used to analyze associations with time to PR.
Results:
The model combining ECP level, IL-5 level, level of anti-double-stranded DNA IgG, asthma status, and pre-ESS modified Lund-Mackay radiographic score reliably predicted PR in the validation set (area under the curve = 0.76), which was comparable to the value found for the training set (area under the curve = 0.89) (DeLong P = .19). Cox regression analysis showed significant differences in recurrence time across RPS tertiles. Patients with a high RPS had a median PR time of 38 months, which was significantly shorter than the PR time in the intermediate group (54 months) and that in the group with the lowest RPS (60 months) (both P values < .01).
Conclusions:
This study validated the RPS as a predictor for post-ESS PR in an independent cohort of patients with CRSwNP and demonstrated its effectiveness in identifying high-risk patients with significantly shorter times to recurrence.
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