Identifying High-Risk Patients for Recurrence in Eosinophilic Nasal Polyposis: A Multicenter Cohort Study

While tissue eosinophil count predicts nasal polyp recurrence, factors determining recurrence within eosinophilic polyp populations remain unclear.

To determine clinical and laboratory predictors of postoperative recurrence in eosinophilic nasal polyps METHODS: We analyzed 1236 patients with eosinophilic polyps (≥10 eosinophils/HPF) 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 FEV₁ was tested in an independent validation cohort.

Comorbid asthma (hazard ratio [HR], 1.37; 95% CI, 1.07-1.77; P=0.014), serum IgE >100 IU/mL (HR, 1.62; 95% CI, 1.13-2.32; P=0.009), and predicted FEV₁ ≤80% (HR, 2.22; 95% CI, 1.17-4.23; P=0.015) independently predicted recurrence, whereas blood eosinophil count and percentage did not. High-risk patients (3-4 points) had higher recurrence than low-risk patients (56.8% vs 23.7%; HR, 2.62; 95% CI, 1.49-4.62; P<0.001). Recurrence rose steeply within 2 months and stabilized after 6 months. In validation, the high-risk group retained the direction of effect (HR, 1.82; 95% CI, 0.63-5.31; P=0.264).

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 therapy.