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Identifying High-Risk Patients for Recurrence in Eosinophilic Nasal Polyposis: A Multicenter Cohort Study
Jae Yoon Lee1, Hye Bin Kim1, Radeif Shamakhi2
1Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Summary
Asthma, high IgE, and reduced lung function predict nasal polyp recurrence after surgery. A risk score combining these factors can guide patient monitoring and treatment for eosinophilic nasal polyps.
Area of Science:
- Otolaryngology
- Allergy and Immunology
- Pulmonology
Background:
- Tissue eosinophil counts predict nasal polyp recurrence.
- Factors influencing recurrence in eosinophilic polyp populations are not fully understood.
Purpose of the Study:
- Identify clinical and laboratory predictors of postoperative recurrence in patients with eosinophilic nasal polyps.
- Develop a risk score to stratify patients based on recurrence likelihood.
Main Methods:
- Analysis of 1236 patients with eosinophilic polyps (≥10 eosinophils/HPF) undergoing endoscopic sinus surgery.
- Kaplan-Meier and multivariate Cox proportional hazards models used to assess predictors.
- A composite score of comorbid asthma, serum total IgE, and predicted FEV₁ was validated.
Main Results:
- Comorbid asthma (HR, 1.37), serum IgE >100 IU/mL (HR, 1.62), and predicted FEV₁ ≤80% (HR, 2.22) independently predicted recurrence.
- Blood eosinophil counts did not predict recurrence.
- A high-risk score (3-4 points) was associated with significantly higher recurrence rates (56.8% vs 23.7%).
Conclusions:
- Comorbid asthma, elevated IgE, and reduced FEV₁ are independent predictors of recurrence in eosinophilic chronic rhinosinusitis with nasal polyps (CRSwNP).
- A practical risk score incorporating these factors can guide postoperative surveillance.
- The findings support earlier application of type 2-targeted therapies for high-risk patients.
