title: Prognostic factors for recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps.
abstract: OBJECTIVE
  In this study, we aimed to clarify the prognostic factors affecting the ethmoid condition during a long-term follow-up after endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).
  
  
  METHODS
  Thirty-six patients with CRSwNP underwent surgery from December 2008 to February 2012. All surgeries were performed by one surgeon, and all patients were followed up for at least 2 years postoperatively. We investigated the association of postoperative endoscopic findings with clinical parameters, mucosal eosinophil count and mRNA expression of CCL11, IL-5, and IFN-gamma in nasal polyps.
  
  
  RESULTS
  Seventeen patients (47.2%) had severe mucosal edema, and the patency of each sinus was not confirmed during the >2-year follow-up. The mucosal eosinophil count and two eosinophil-associated factors, namely the CCL11 and IL-5 mRNA levels, were higher in the severe mucosal edema group than in the control group. The severe mucosal edema group was divided into two subgroups: the steroid-responsive and -resistant groups. Five patients (13.9%) had frank polyp formation because the oral steroids were less effective. The mucosal eosinophil count was significantly different among the four groups, including the control group (p=0.001); however, the CCL11, IL-5, and IFN-gamma mRNA levels were not significantly different. Although the IL-5 mRNA level was not significantly different among the four groups, it tended to increase when the sinus condition worsened. In the severe mucosal edema group, a higher IL-5 mRNA level was associated with earlier severe mucosal edema in the ethmoid cavity.
  
  
  CONCLUSIONS
  The IL-5 mRNA level is associated with the time of severe edema formation in the ethmoid cavity. This finding permits early intervention on the postoperative course and would prevent polyp recurrence.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Dokkyo Medical University, Tochigi, Japan; Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan. Electronic address: nakayama-t@jikei.ac.jp.
authors.forename: Tsuguhisa
authors.initials: T
authors.lastname: Nakayama
authors.affiliation: Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Daiya
authors.initials: D
authors.lastname: Asaka
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kanaya
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Dokkyo Medical University, Tochigi, Japan; Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Akihito
authors.initials: A
authors.lastname: Kuboki
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Haruna
mesh_terms: D000328:Adult; D000368:Aged; D054413:Chemokine CCL11 / Q000235:genetics / Q000276:immunology; D002908:Chronic Disease; D004804:Eosinophils / Q000166:cytology* / Q000276:immunology; D006801:Humans; D007371:Interferon-gamma / Q000235:genetics / Q000276:immunology; D015848:Interleukin-5 / Q000235:genetics / Q000276:immunology; D018655:Lymphocyte Count; D008875:Middle Aged; D009297:Nasal Mucosa / Q000166:cytology* / Q000276:immunology; D009298:Nasal Polyps / Q000235:genetics / Q000276:immunology / Q000601:surgery*; D010256:Paranasal Sinuses / Q000276:immunology / Q000378:metabolism; D011379:Prognosis; D011446:Prospective Studies; D012333:RNA, Messenger / Q000378:metabolism*; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012220:Rhinitis / Q000235:genetics / Q000276:immunology / Q000601:surgery*; D012852:Sinusitis / Q000235:genetics / Q000276:immunology / Q000601:surgery*
chemical_list: C515456:CCL11 protein, human; D054413:Chemokine CCL11; C508599:IL5 protein, human; D015848:Interleukin-5; D012333:RNA, Messenger; D007371:Interferon-gamma
keywords: CCL11; Chronic rhinosinusitis; Endoscopic sinus surgery; IL-5; Recurrence