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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.
Background:
Although tissue eosinophil count predicts nasal polyp recurrence, the factors determining recurrence within eosinophilic polyp populations remain unclear.
Objective:
To determine the clinical and laboratory predictors of postoperative recurrence in eosinophilic nasal polyps.
Methods:
We analyzed 1236 patients with eosinophilic polyps (≥10 eosinophils per high-power field) who underwent endoscopic sinus surgery at 8 centers (2008-2023). Recurrence was defined as endoscopically detectable nasal polyps during postoperative follow-up. Predictors were assessed using Kaplan-Meier and multivariate Cox proportional hazards models. A composite score derived from comorbid asthma, serum total IgE, and predicted forced expiratory volume in 1 second (FEV₁) was tested in an independent validation cohort.
Results:
Comorbid asthma (hazard ratio [HR], 1.37; 95% CI, 1.07-1.77; P = .014), serum IgE greater than 100 IU/mL (HR, 1.62; 95% CI, 1.13-2.32; P = .009), and predicted FEV₁ less than or equal to 80% (HR, 2.22; 95% CI, 1.17-4.23; P = .015) independently predicted recurrence, whereas blood eosinophil count and percentage did not. High-risk patients (3-4 points) had a higher recurrence rate than low-risk patients (56.8% vs 23.7%; HR, 2.62; 95% CI, 1.49-4.62; P < .001). Recurrence rose steeply within 2 months and stabilized after 6 months. In the validation, the high-risk group retained the direction of effect (HR, 1.82; 95% CI, 0.63-5.31; P = .264).
Conclusion:
Within eosinophilic CRSwNP, comorbid asthma, elevated IgE, and reduced FEV₁ independently predict recurrence and combine into a practical risk score to guide postoperative surveillance and earlier type 2-targeted therapies.
