Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, 39 Jabotinski St, Petah Tikva, 49100, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Eur Arch Otorhinolaryngol. 2024 Nov;281(11):5847-5856. doi: 10.1007/s00405-024-08832-5. Epub 2024 Jul 13.
To analyze recurrence patterns of chronic sinusitis with nasal polyposis (CRSwNP) in patients who underwent complete FESS and identify predisposing factors for different patterns of recurrence.
Retrospective analysis of patients with CRSwNP who underwent complete FESS at our tertiary medical center. Recurrence patterns were classified into edema, polyp and normal endoscopy, as well as into early (within 6 months) and late recurrence. Statistical analysis to identify risk factors for recurrence included univariate, multivariate logistic regression and cox regression models.
114 patients were included with an average follow-up of 27 months. 91% were categorized as type-2 inflammation. Recurrence was observed in 65.8% of patients within a mean of 12.9 months. 46.7% had polyp recurrence while 53.3% had edema recurrence. Early recurrence was observed in 41%. Serum eosinophilia > 500 cells/uL was found to be significantly associated with recurrence (RR = 1.62, p-value = 0.046), and particularly with polyp recurrence (RR = 3.9, p-value = 0.001). No predictive factors for early recurrence were identified. Edema recurrence was managed with intranasal corticosteroids while polyp recurrence required systemic therapy including biologic therapy.
In this study, two thirds of patients experienced post operative recurrence, either mucosal edema or nasal polyps, with similar frequency during an average follow up of over 2 years. Early recurrence was noted in 41% of recurrent cases. Serum eosinophils > 500 cells/uL was the only risk factor for recurrence on multivariate analysis, more accurate markers are needed for improved treatment allocation to CRSwNP patients.
分析接受完全功能性内镜鼻窦手术（FESS）的慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）患者的复发模式，并确定不同复发模式的诱发因素。
对在我们的三级医疗中心接受完全 FESS 的 CRSwNP 患者进行回顾性分析。复发模式分为水肿、息肉和正常内镜，以及早期（6 个月内）和晚期复发。识别复发风险因素的统计分析包括单变量、多变量逻辑回归和 Cox 回归模型。
共纳入 114 例患者，平均随访 27 个月。91%的患者被归类为 2 型炎症。平均 12.9 个月后，65.8%的患者出现复发。46.7%的患者出现息肉复发，53.3%的患者出现水肿复发。早期复发占 41%。血清嗜酸粒细胞 > 500 细胞/μL 与复发显著相关（RR = 1.62，p 值 = 0.046），特别是与息肉复发相关（RR = 3.9，p 值 = 0.001）。未发现早期复发的预测因素。水肿复发采用鼻内皮质类固醇治疗，而息肉复发需要全身治疗，包括生物治疗。
在这项研究中，三分之二的患者在平均超过 2 年的随访中经历了术后复发，无论是黏膜水肿还是鼻息肉，复发频率相似。在复发病例中，早期复发占 41%。在多变量分析中，血清嗜酸粒细胞 > 500 细胞/μL 是唯一的复发危险因素，需要更准确的标志物来改善对 CRSwNP 患者的治疗分配。
