March 2022

ENT

PROGNOSTIC FACTORS FOR POLYP RECURRENCE IN CHRONIC RHINOSINUSITIS WITH NASAL POLYPS

Featuring: ​ Kevin C Welch, MD, Robert C Kern, MD, Atsushi Kato, PhD, Bruce K Tan, MD
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Read the full study here.


Abstract
Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is frequently managed with endoscopic sinus surgery (ESS). Prior studies describe individual clinical variables and eosinophil density measures as prognostic for polyp recurrence (PR). However, the relative prognostic significance of these have not been extensively investigated.

Objective: To evaluate the impact of PR on measures of disease severity post-ESS and quantify the prognostic value of various clinical variables and biomarkers.

Methods: Ninety-four CRSwNP patients with prospectively biobanked polyp homogenates at the time of ESS were recruited 2 to 5 years post-ESS. Patients were evaluated with patient-reported outcome measures (PROMs) and endoscopic and radiographic scoring pre- and post-ESS. Biomarkers in polyp homogenates were measured with ELISA and Luminex. Relaxed LASSO regression optimized predictive clinical, biomarker, and combined models. Model performance was assessed using receiver operating characteristic curve (ROC) and random forest (RF) analysis.

Results: PR was found in 39.4% patients, despite significant improvements in modified Lund-Mackay (MLM) radiographic and 22-item Sinonasal Outcomes Test (SNOT-22) scores (both p < 0.0001). PR was significantly associated with worse post-ESS MLM, modified Lund-Kennedy (MLK), and SNOT-22 scores. Relaxed LASSO identified 2 clinical predictors (AUC=0.79) and 3 biomarkers (AUC=0.78) that were prognostic for PR. When combined, the model incorporating these pre-ESS factors: MLM, asthma, ECP, anti-dsDNA IgG, and IL-5 improved PR predictive accuracy to AUC of 0.89. RF analysis identified and validated each of the five variables as the strongest predictors of PR.
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Conclusions: PR had strong associations with PROMs, endoscopic and radiographic severity. A combined model comprised of ECP, IL-5, pre-ESS MLM, asthma, and anti-dsDNA IgG could accurately predict PR.



This abstract was originally published in the Journal of Allergy and Clinical Immunology on March 16, 2022. ​
Kevin C Welch, MD, professor of Otolaryngology - Head and Neck Surgery.
Robert C Kern, MD, chair of the department of Otolaryngology - Head and Neck Surgery, George A. Sisson, MD, and professor of Otolaryngology - Head and Neck Surgery and Allergy and Immunology in the Department of Medicine.
Atsushi Kato, PhD, assistant professor of Allergy and Immunology in the Department of Medicine and Otolaryngology - Head and Neck Surgery. ​
Bruce K Tan, MD, associate professor of Otolaryngology - Head and Neck Surgery and Allergy and Immunology in the Department of Medicine.

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