Consensus Review: Predicting Recurrence in Chronic Rhinosinusitis With Nasal Polyps: Multidisciplinary Insights From the RELAPSE Project

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a disease with a high incidence of postoperative recurrence despite medical and surgical treatments. However, a universal definition of recurrence and its determinants is lacking. Our objective was to establish a clear definition of recurrence and reach consensus on the contributing factors. A consensus study was conducted using the Delphi method. The literature on recurrence of CRSwNP was reviewed and assessed by a multidisciplinary scientific committee. The committee designed a 2-round online Delphi questionnaire addressing recurrence in CRSwNP. As for consensus, ≥70% of panelists scored 1-3 (disagreement) or 7-9 (agreement). The survey involved 70 physicians (69 completed both rounds) with expertise in the management of CRSwNP (47 ear, nose, and throat [ENT] specialists and 22 allergists). Consensus was reached on the characteristics defining recurrence (87% overall agreement, 95% agreement among allergists, and 83% agreement among ENT specialists). Finally, a list of 10 key prognostic factors was agreed upon. The top 5 were presence of nonsteroidal anti-inflammatory drug-exacerbated respiratory disease, eosinophilic CRSwNP, asthma, extent of surgery, and eosinophils in nasal polyposis (>50/high-power field). This study identified 10 key prognostic factors for recurrence and clarified the definition of recurrence in CRSwNP as the reappearance or worsening of sinonasal symptoms (>3 points on a visual analog scale and/or ≥12 points in the 22-item Sino-Nasal Outcome Test) and/or objective evidence of inflammation (nasal polyposis grade ≥1 or other endoscopic or radiological signs of persistent mucosal inflammation) after initial postoperative improvement (baseline postoperative assessment 1 month after surgery, recurrence evaluated 6 months thereafter), excluding persistence and suboptimal surgical outcome.