Histopathological Signatures Associated With Postoperative Recurrence in Pediatric Chronic Rhinosinusitis With Nasal Polyps

OBJECTIVE: Pediatric chronic rhinosinusitis with nasal polyps (CRSwNP) exhibits a high rate of postoperative recurrence, yet the histopathological determinants are not well defined. This study investigated recurrence-associated pathology to elucidate persistent disease mechanisms. STUDY DESIGN: A retrospective clinical study. SETTING: Recurrent group and non-recurrent group. METHODS: 228 pediatric CRSwNP patients were included, and clinical variables and histopathological features were systematically assessed. All patients were followed for more than 2 years and classified as recurrent CRSwNP (rCRSwNP) or nonrecurrent CRSwNP (non-rCRSwNP). Associations between clinicopathological characteristics and postoperative recurrence were evaluated using Cox regression and Kaplan-Meier survival analyses. RESULTS: Based on follow-up results, 153 pediatric patients were categorized into the rCRSwNP group and 75 patients were divided into non-rCRSwNP group. Baseline demographic did not differ significantly between groups, while comorbid allergic rhinitis was more frequent in rCRSwNP group. Histopathological analysis revealed that goblet cell hyperplasia and basement membrane thickening were more pronounced in the rCRSwNP group compared to the non-rCRSwNP group. Cox regression analyses identified the severity of goblet cell hyperplasia as an independent risk factor for CRSwNP recurrence. Kaplan-Meier analysis further showed that moderate to severe goblet cell hyperplasia was associated with significantly higher postoperative recurrence risk. CONCLUSION: Histopathological profiling indicated that pediatric rCRSwNP was characterized by basement membrane thickening and goblet cell hyperplasia. The degree of goblet cell hyperplasia independently predicts postoperative recurrence, providing a clinically actionable marker for identifying high-risk patients.