B Wei1, F Liu1, J Zhang2, Y Liu1, J Du1, S Liu1, N Zhang3, C Bachert3, J Meng1. 1. ENT Department, West China Hospital, Sichuan University, Chengdu, China. 2. The Upper Airway Research Laboratory, West China Hospital, Sichuan University, Chengdu, China. 3. Upper Airways Research Laboratory and Department of Oto-Rhino-Laryngology, Ghent University and Ghent University Hospital, Belgium.
Abstract
BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) remains a challenging clinical problem due to its propensity for recurrence. However, data on the frequency of CRSwNP recurrence after surgery in China are rare. METHODS: 78 CRSwNP patients undergoing functional endoscopic sinus surgery were followed-up for 8 years and classified into recurrent and non-recurrent groups. A cluster analysis of the CRSwNP based on inflammatory endotypes was performed, and the endotypes were secondarily matched with clinical phenotypes. RESULTS: The recurrence rate of CRSwNP in Southwest China was 21.8% over 8 years post-surgery. The CRSwNP was classified into 4 clusters: cluster 1 (higher expression of IL-5, IgE, and ECP and high positivity rate for SE-IgE); cluster 2 (higher concentrations of IL-6, IL-8 and MPO); cluster 3 (higher concentrations of TNF-alpha; and IFN-gamma); and cluster 4 (higher expression of IL-17). Cluster 1 (type-2 inflammation) exhibited the highest recurrence rate, co-morbid asthma and atopy. Notably, the ECP/MPO ratio increased significantly in patients with non-type-2 recurrent CRSwNP 8 years after the first surgery. CONCLUSION: Different inflammatory endotypes of CRSwNP exhibited clearly different prognoses. The type-2 subgroup had high recurrence and co-morbid asthma rates comparable to the rates reported in Western countries.
BACKGROUND:Chronic rhinosinusitis with nasal polyps (CRSwNP) remains a challenging clinical problem due to its propensity for recurrence. However, data on the frequency of CRSwNP recurrence after surgery in China are rare. METHODS: 78 CRSwNP patients undergoing functional endoscopic sinus surgery were followed-up for 8 years and classified into recurrent and non-recurrent groups. A cluster analysis of the CRSwNP based on inflammatory endotypes was performed, and the endotypes were secondarily matched with clinical phenotypes. RESULTS: The recurrence rate of CRSwNP in Southwest China was 21.8% over 8 years post-surgery. The CRSwNP was classified into 4 clusters: cluster 1 (higher expression of IL-5, IgE, and ECP and high positivity rate for SE-IgE); cluster 2 (higher concentrations of IL-6, IL-8 and MPO); cluster 3 (higher concentrations of TNF-alpha; and IFN-gamma); and cluster 4 (higher expression of IL-17). Cluster 1 (type-2 inflammation) exhibited the highest recurrence rate, co-morbid asthma and atopy. Notably, the ECP/MPO ratio increased significantly in patients with non-type-2 recurrent CRSwNP 8 years after the first surgery. CONCLUSION: Different inflammatory endotypes of CRSwNP exhibited clearly different prognoses. The type-2 subgroup had high recurrence and co-morbid asthma rates comparable to the rates reported in Western countries.
Authors: Wytske J Fokkens; Valerie Lund; Claus Bachert; Joaquim Mullol; Leif Bjermer; Jean Bousquet; Giorgio W Canonica; Lauren Deneyer; Martin Desrosiers; Zuzana Diamant; Joseph Han; Enrico Heffler; Claire Hopkins; Roger Jankowski; Guy Joos; Andrew Knill; Jivianne Lee; Stella E Lee; Gert Mariën; Benoit Pugin; Brent Senior; Sven F Seys; Peter W Hellings Journal: Allergy Date: 2019-07-15 Impact factor: 13.146
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