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CRSwNP recurrence after surgery is linked to high eosinophils, GERD, diabetes, and asthma. A new model accurately predicts recurrence risk.

“Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common chronic inflammatory disease of the nasal cavity or nasal mucosa, with a long course and susceptibility to multiple occurrences,” researchers wrote in Frontiers in Surgery. “At present, [endoscopic sinus surgery (ESS)] is commonly performed to remove lesions, maximally preserve normal mucosa, restore nasal function, and improve nasal ventilation. However, the recurrence rate after surgery is still as high as 40%–60%, which not only reduces the patient’s willingness to undergo treatment but also increases the risk of needing a second treatment and the economic burden.”

For this retrospective analysis, investigators aimed to assess risk factors for CRSwNP recurrence following ESS and to develop a prognostic prediction model to identify novel high-risk groups and novel strategies for treatment.

Researchers enrolled adult patients with CRSwNP who had successfully undergone a first ESS. Recurrence criteria included patient complaints of nasal foreign body sensation and symptoms, such as a runny nose and nasal congestion, during the postoperative follow-up examination, as well as CT evidence of soft tissue shadows in the nasal cavity, high density in the sinuses, and increased mucosa.

Predicting Recurrence Risk in CRSwNP

The study enrolled 322 patients with CRSwNP who underwent ESS (men, n=205; women, n=117). The median age of patients was 49 years (range, 42-55). In total, 57 patients experienced postoperative recurrence of CRSwNP, representing an incidence rate of 17.7%.

Regarding comorbid conditions, patients with recurrent CRSwNP following surgery had higher rates of gastroesophageal reflux disease (GERD; 57.89% vs 25.28% [P<0.001]), diabetes (31.58% vs 11.32%; P<0.001), and bronchial asthma (40.35% vs 10.19%; P<0.001). Study investigators noted that these conditions represented independent risk factors for postoperative CRSwNP recurrence. Other risk factors for recurrence included sinusitis type, eosinophil count, neutrophil count, lymphocyte count, and total sinus score.

These eight risk factors were used to create a nomogram model for predicting recurrence risk following ESS. The researchers successfully validated the model, with the results demonstrating that the C-indices of the training set and validation set were 0.935 and 0.923, respectively. The internal validation receiver operating characteristic (ROC) curve of the area under the curve (AUC) was 0.948, and the external validation set AUC was 0.932.

“These findings indicate that the model constructed in this study has good predictive power for the risk of recurrence after ESS for [patients with CRSwNP],” study investigators wrote.