慢性鼻窦炎伴鼻息肉患者功能性内镜鼻窦手术后复发预后列线图的开发与内部验证
Development and internal validation of a prognostic nomogram for recurrence in chronic rhinosinusitis with nasal polyps after functional endoscopic sinus surgery.
文献信息
| PMID | 42724079 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Yang Yang |
| 作者单位 | Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China. |
| 期刊 | Frontiers in medicine |
| SCI 分区 | Q1 |
| IF | 3.7 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
目的： 慢性鼻窦炎伴鼻息肉（CRSwNP）在功能性内镜鼻窦手术（FESS）后经常复发。本研究旨在开发并内部验证一个预后列线图，用于预测CRSwNP患者FESS术后两年无复发生存率（RFR）。
方法： 回顾性纳入404例接受FESS的CRSwNP患者，并随机分为训练队列（n = 303）和内部验证队列（n = 101）。复发定义为术后2年内通过鼻内镜检查首次发现鼻息肉。使用LASSO Cox回归筛选候选预测因子，并进一步通过多因素Cox回归进行评估。构建列线图以预测两年RFR。
结果： 在两年随访期间，148例患者出现复发。最终模型纳入五个独立预测因子：既往鼻腔手术次数、嗅裂息肉、Lund-Mackay评分、外周血嗜酸性粒细胞百分比和组织嗜酸性粒细胞百分比。该列线图显示出良好的区分度，训练队列的C指数为0.751（95% CI，0.707-0.795），内部验证队列为0.707（95% CI，0.625-0.789）。校准曲线显示预测的两年RFR与观察到的两年RFR之间具有良好的一致性。基于列线图评分的风险分层将患者分为低、中、高风险组，各组的RFR差异显著。
结论： 我们开发并内部验证了一个用于估计CRSwNP患者FESS术后两年无复发生存率的列线图。该列线图将有助于识别复发高风险患者，并协助制定CRSwNP患者的个体化治疗方案。此外，我们发现嗅裂息肉是CRSwNP术后复发的一个新的独立危险因素。
英文摘要
OBJECTIVES: Chronic rhinosinusitis with nasal polyps (CRSwNP) frequently recurs after functional endoscopic sinus surgery (FESS). This study aimed to develop and internally validate a prognostic nomogram for predicting the two-year recurrence-free rate (RFR) in patients with CRSwNP after FESS.
METHODS: A total of 404 patients with CRSwNP who underwent FESS were retrospectively enrolled and randomly divided into a training cohort (n = 303) and an internal validation cohort (n = 101). Recurrence was defined as the first postoperative detection of nasal polyps by nasal endoscopy within 2 years. Candidate predictors were selected using LASSO Cox regression and further evaluated using multivariate Cox regression. A nomogram was constructed to predict the two-year RFR.
RESULTS: During the two-year follow-up, 148 patients experienced recurrence. Five independent predictors were included in the final model: number of previous nasal surgeries, olfactory cleft polyp, Lund-Mackay score, peripheral blood eosinophil percentage, and tissue eosinophil percentage. The nomogram showed good discrimination, with C-indices of 0.751 (95% CI, 0.707-0.795) in the training cohort and 0.707 (95% CI, 0.625-0.789) in the internal validation cohort. Calibration curves demonstrated good agreement between predicted and observed two-year RFR. Risk stratification based on the nomogram score separated patients into low-, intermediate-, and high-risk groups with significantly different RFRs.
CONCLUSION: We developed and internally validated a nomogram for estimating two-year recurrence-free rate in patients with CRSwNP after FESS. The nomogram will help identify patients at high risk of recurrence and assist in the development of individualized treatment plans for patients with CRSwNP. Furthermore, we found that olfactory cleft polyps were a new independent risk factor for the postoperative recurrence of CRSwNP.