Postoperative Polyp Scale (POPS): Development of a New Sinonasal Polyp Grading Scale

Sinonasal Symptom Correlation With the Postoperative Polyp Scale (POPS)

BACKGROUND

Commonly used endoscopic nasal polyp grading scales have been shown to correlate poorly with symptom scores and quality of life metrics. The recently described Postoperative Polyp Scale (POPS) is a grading system that more accurately characterizes polyp recurrence in postoperative sinus cavities by describing incremental recurrence in relation to the surgically opened sinus cavities.

OBJECTIVE

The objective of this study was to determine if the POPS correlated with sinonasal symptoms.

METHODS

CRSwNP patients were prospectively administered SNOT-22 questionnaires and graded according to the POPS starting at their 1-month postoperative appointments. Total POPS scores (sum of each side) and Max POPS score (larger value of left and right) were correlated with SNOT-22 total scores and subdomains using Kendall correlation testing.

RESULTS

A total of 127 patients were enrolled in the study. Both Total POPS or Max POPS were significantly correlated to the SNOT-22 total score (P < .001, P < .001), Rhinologic (P < .001, P < .001), Extra-Nasal Rhinologic (P < .001, P < .001), Ear/Facial (P < .001, P < .001), and Psychologic (P = .028, P = .017) subdomains. Kendall's tau indicated strong correlation (≥0.3) with Rhinologic subdomain, moderate correlation (.21-.29) with Extra-Nasal Rhinologic and Ear/Facial subdomains, and weak correlation (.1-.19) with Psychologic subdomain.

CONCLUSION

Previous endoscopic nasal polyp grading scales poorly correlate with symptoms and patient reported outcome measures. The new POPS moderately correlates with the total SNOT-22 score and strongly correlates with the Rhinologic subdomain, indicating that it may have good potential as a tool to evaluate postoperative CRSwNP patients.

Overexpression of AXL on macrophages associates with disease severity and recurrence in chronic rhinosinusitis with nasal polyps

BACKGROUND

Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by high tissue heterogeneity and risk of postoperative recurrence, but the underlying mechanisms are poorly elucidated. This study aims to explore the expressions of AXL on macrophages and their roles in the pathogenesis of CRSwNP, and evaluate their associations with disease severity and recurrence.

METHODS

Healthy controls (HCs), chronic rhinosinusitis without nasal polyps (CRSsNP) and CRSwNP patients were recruited in this study. Protein and mRNA levels of AXL and macrophage markers were detected in tissue samples, and their relationships with clinical variables and risk of postoperative recurrence were assessed. Immunofluorescence staining was conducted to confirm the location of AXL and its co-expression with macrophages. Regulated AXL in THP-1 and peripheral blood mononuclear cells (PBMC)-derived macrophages, and evaluated their polarization and cytokine secretion.

RESULTS

We found that AXL was enhanced in the mucosa and serum samples of CRSwNP patients, especially in recurrent cases. Tissue AXL levels were positively correlated with peripheral eosinophil count and percentage, Lund-Mackay score, Lund-Kennedy score, and macrophage M2 markers levels. Immunofluorescence staining results demonstrated that AXL was augmented and predominantly expressed on M2 macrophages in the tissues of CRSwNP, particularly in recurrent cases. In vitro experiment, overexpression of AXL promoted the M2 polarization of THP-1 and PBMC-derived macrophages, and facilitated the production of TGF-β1 and CCL-24.

CONCLUSIONS

AXL driving the M2 macrophage polarization exacerbated the disease severity and contributed to the postoperative recurrence in CRSwNP patients. Our findings supported AXL-targeted prevention and treatment of recurrent CRSwNP.