The relationship between clinical pathology and prognosis of chronic rhinosinusitis

Abstract

Objective:To explore the pathological type, clinical features and their relationship with prognosis of chronic rhinosinusitis（CRS）. Methods:A retrospective study of 135 patients with CRS who underwent surgical treatment in the Affiliated Jiangning Hospital of Nanjing Medical University from January 2017 to December 2018. Review the pathological slices retrospectively and divide the CRS into 4 types, eosinophilic type（eCRS）, lymphocyte or（and） plasma cell type, neutrophil type and mixed type, the latter three are collectively referred to as "non-eosinophil type（non-eCRS）". Follow-up was conducted between January and February 2021 to analyze the distribution, clinical features, and differences in prognosis of the different endotypes. Results:①Among the 135 CRS patients, 42 cases（31.1%） were eCRS and 93 cases（68.9%） were non-eCRS（76 cases[56.3%] of lymphocyte or plasma cell type, 4 cases[3.0%] of neutrophil type and 13 cases[9.6%] of mixed type）. The difference in composition ratio between the groups was statistically significant（n=135, P<0.001）. ②The absolute value and percentage of preoperative peripheral blood eosinophils（EOS） in eCRS patients were higher than those of non-eCRS patients, and the difference was statistically significant（n=125, P（absolute value）=0.030, P（percentage）=0.033）. The results of receiver operating characteristic curve showed that both absolute value and percentage have predictive value, and cut-off value was 0.325×10⁹/L（absolute value） or 2.750%（percentage）. There was no statistically significant difference in preoperative peripheral blood procalcitonin among the groups（n=69, P=0.647）. ③The ratio（E/M value） of the bilateral ethmoid sinus scores and bilateral maxillary sinus scores of the preoperative paranasal sinus CT in eCRS patients was 2.03±1.23, while the non-eCRS patients was 1.47±0.96, and the difference was statistically significant（n=112, P=0.009）. ④In total, 101 cases were effectively followed up, including 34 cases of eCRS（7 cases[20.6%] of control, 18 cases[52.9%] of partial control）, 9 cases[26.5%] of non-control and 67 cases of non-eCRS（32 cases[47.8%] of control, 26 cases[38.8%] were partially controlled, 9 cases[13.4%] were not controlled）, and the efficacy of the non-eCRS group was significantly better than that of the eCRS group（χ²=7.499, P=0.024）. Conclusion:When the absolute value of EOS in the preoperative blood examination is greater than 0.325×10⁹/L or the percentage is greater than 2.750%, eCRS can be predicted, but the accuracy is low. CT of patients with eCRS is mostly characterized by inflammation of the ethmoid sinus and usually E/M>2. The efficacy of eCRS group is worse than that of the non-eCRS group 2-4 years after surgery.