Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill.
Department of Preventive Medicine-Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, Ill.
J Allergy Clin Immunol. 2022 Aug;150(2):352-361.e7. doi: 10.1016/j.jaci.2022.02.029. Epub 2022 Mar 16.
Chronic rhinosinusitis with nasal polyps 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.
We sought to evaluate the impact of PR on measures of disease severity post-ESS and quantify the prognostic value of various clinical variables and biomarkers.
Ninety-four patients with chronic rhinosinusitis with nasal polyps and 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 and endoscopic and radiographic scoring pre- and post-ESS. Biomarkers in polyp homogenates were measured with ELISA and Luminex. Relaxed least absolute shrinkage and selection operator regression optimized predictive clinical, biomarker, and combined models. Model performance was assessed using receiver-operating characteristic curve and random forest analysis.
PR was found in 39.4% of patients, despite significant improvements in modified Lund-Mackay (MLM) radiographic and 22-item Sinonasal Outcomes Test scores (both P < .0001). PR was significantly associated with worse post-ESS MLM, modified Lund-Kennedy, and 22-item Sinonasal Outcomes Test scores. Relaxed least absolute shrinkage and selection operator identified 2 clinical predictors (area under the curve = 0.79) and 3 biomarkers (area under the curve = 0.78) that were prognostic for PR. When combined, the model incorporating these pre-ESS factors: MLM, asthma, eosinophil cationic protein, anti-double-stranded DNA IgG, and IL-5 improved PR predictive accuracy to area under the curve of 0.89. Random forest analysis identified and validated each of the 5 variables as the strongest predictors of PR.
PR had strong associations with patient-reported outcome measures, endoscopic and radiographic severity. A combined model comprised of eosinophil cationic protein, IL-5, pre-ESS MLM, asthma, and anti-double-stranded DNA IgG could accurately predict PR.
慢性鼻-鼻窦炎伴鼻息肉常采用内镜鼻窦手术（ESS）进行治疗。既往研究描述了个体临床变量和嗜酸性粒细胞密度指标可预测息肉复发（PR）。然而，这些因素的相对预后意义尚未得到广泛研究。
我们旨在评估 PR 对 ESS 后疾病严重程度评估指标的影响，并量化各种临床变量和生物标志物的预后价值。
94 例慢性鼻-鼻窦炎伴鼻息肉患者在 ESS 时前瞻性采集鼻息肉匀浆，并在 ESS 后 2 至 5 年进行随访。患者在 ESS 前后通过患者报告的结局测量、内镜和影像学评分进行评估。通过 ELISA 和 Luminex 测量息肉匀浆中的生物标志物。松弛最小绝对收缩和选择算子回归优化预测临床、生物标志物和联合模型。使用接受者操作特征曲线和随机森林分析评估模型性能。
尽管改良 Lund-Mackay（MLM）影像学和 22 项鼻-鼻窦结局测试评分均显著改善（均 P<0.0001），仍有 39.4%的患者出现 PR。PR 与 ESS 后 MLM、改良 Lund-Kennedy 和 22 项鼻-鼻窦结局测试评分较差显著相关。松弛最小绝对收缩和选择算子识别出 2 个临床预测因素（曲线下面积=0.79）和 3 个生物标志物（曲线下面积=0.78），这些因素对 PR 具有预后意义。当将这些 ESS 前因素纳入模型时，包括 MLM、哮喘、嗜酸性粒细胞阳离子蛋白、抗双链 DNA IgG 和 IL-5 的模型可提高 PR 预测准确性，曲线下面积达 0.89。随机森林分析确定并验证了这 5 个变量中的每一个均为 PR 的最强预测因子。
PR 与患者报告的结局测量、内镜和影像学严重程度具有很强的相关性。由嗜酸性粒细胞阳离子蛋白、IL-5、ESS 前 MLM、哮喘和抗双链 DNA IgG 组成的联合模型可以准确预测 PR。
