In CQ and LN cohorts, core-gene expression correlated with SNOT-22 (Spearman r = 0.402-0.569, P ≤ 0.021).<h4>Conclusions</h4>SPP1, PTHLH, and IGFBP3 are robustly validated EMT core genes in CRSwNP across multiple cohorts and dual-center histology, closely linked to immune microenvironment alterations and mucosal remodeling. Here, IGFBP3 is linked to lobular neoplasia.