The Tissue Lymphocyte-to-Eosinophil Ratio Predicted Long-Term Recurrence of Eosinophilic CRSwNP

BACKGROUND: Eosinophilic chronic rhinosinusitis with nasal polyps (Eos-CRSwNP) remains a recalcitrant disease with a high recurrence rate. OBJECTIVE: This study aimed to identify a predictor of long-term recurrence in patients with Eos-CRSwNP. METHODS: A total of 39 Eos-CRSwNP patients who had their initial and recurrent nasal polyps surgically removed were retrospectively included in this study, with 49 Eos-CRSwNP patients without recurrence and 32 patients with non-Eos-CRSwNP matched by randomly chosen. Clinical characteristics were compared among or between groups. Spearman correlation analyses and a backward stepwise multivariate logistic regression analysis were performed to find factors associated with the recurrence and recurrence time of Eos-CRSwNP. Furthermore, a receiver operating characteristic (ROC) curve was used to determine the predictor of long-term Eos-CRSwNP recurrence. RESULTS: The number and ratio of tissue eosinophils were highest in Eos-CRSwNP with recurrence and lowest in non-Eos-CRSwNP. The ratio of tissue lymphocytes was highest in non-Eos-CRSwNP and lowest in Eos-CRSwNP with recurrence, with the number of tissue lymphocytes higher in Eos-CRSwNP without recurrence than the other two groups. The numbers of tissue lymphocytes in the initial nasal polyps were lower and the numbers of tissue eosinophils were higher in the group of recurrent nasal polyps that recurred at >5 years after surgery than in the nasal polyps that recurred at <5 years after surgery. The tissue lymphocyte-to-eosinophil ratio (LER) showed a significant negative correlation with the recurrence and the recurrence time of Eos-CRSwNP. A ROC curve revealed that a tissue LER value < 0.67 predicted long-term Eos-CRSwNP recurrence with 72.73% sensitivity and 82.35% specificity (area under the curve = 0.789). CONCLUSION: Tissue LER is strongly associated with Eos-CRSwNP recurrence and may play a key role in predicting long-term Eos-CRSwNP recurrence.