Several Postsurgery Prognostic Factors Linked With Nasal Polyp Recurrence

Polyp recurrence occurred in more than 1 in 3 patients with chronic rhinosinusitis with nasal polyps who underwent endoscopic sinus surgery, with several prognostic factors linked with recurrence.

Several outcome measures and clinical features were associated with polyp recurrence after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Findings were reported at the 2022 American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting and are published in The Journal of Allergy and Clinical Immunology.

Recommended for patients with CRSwNP who are unresponsive to standard of care intranasal and systemic corticosteroids, ESS has been linked with significant improvement in symptom burden. However, polyp recurrence is common after ESS, with approximately 60% to 70% of patients experiencing relapse after 18 months.

Findings of a recent study investigating risk of relapse in patients with CRSwNP who underwent ESS identified nonsteroidal anti-inflammatory drug (NSAID)–exacerbated respiratory disease (NERD), higher preoperative total score, and frontal sinus CT score as potential prognostic factors, but these results were not confirmed by an additional multivariable analysis.

“Metrics are needed by which we can predict the outcomes of ESS for CRSwNP,” noted the investigators of the current study. “Prior studies described elevated type 2 inflammation and clinical features in polyp recurrence, but the prognostic significance of these features has not been investigated.”

They recruited 94 patients with CRSwNP in the 2 to 5 years post ESS who had biobanked polyp homogenates. Participants were evaluated via patient-reported outcome measures (PROMs) and endoscopic and radiographic scores pre- and post ESS, including the modified Lund-Mackay (MLM), modified Lund-Kennedy (MLK), and 22-item Sinonasal Outcomes Test (SNOT-22) scales.

“Pre-ESS biomarkers were assayed with ELISA and Luminex. Relaxed LASSO regression was applied to compare predictive biomarker-, clinical-, and combined models. Model performance was assessed using ROC and random forest (RF) analysis,” the investigators explained.

Among the study cohort, polyp recurrence was reported in 39.4% of patients despite significant improvements in MLM radiographic scores (P < .0001) and SNOT-22 scores (P < .0001).

Regarding risk factors, polyp recurrence was found to be associated with worse post-ESS MLM (P < .0001), modified Lund-Kennedy (P < .0001), and SNOT-22 (P < .01) scores. Moreover, relaxed LASSO identified 3 biomarkers (area under the curve [AUC] = 0.78) and 2 clinical predictors (AUC = 0.79) of polyp recurrence.

The combined model improved polyp recurrence predictive accuracy to an AUC of 0.89, noted researchers, and it incorporated 5 predictors: eosinophil cationic protein, anti–double-stranded DNA (anti-dsDNA) immunoglobulin G (IgG), interleukin (IL)-5, pre-ESS MLM, and asthma.

Further RF analysis quantified the prognostic value of each variable and similarly identified the 5 variables as the strongest predictors of polyp recurrence.

“Polyp recurrence was a representative indicator for CRSwNP with strong associations with PROM, endoscopic, and radiographic severity,” concluded the study authors. “The combined model comprised of ECP, IL-5, anti-dsDNA IgG, preoperative MLM, and asthma could accurately predict polyp recurrence.”

Reference

Bai J, Huang J, Price C, et al. Prognostic factors for polyp recurrence in chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol. Published online February 1, 2022. doi:10.1016/j.jaci.2021.12.485