Recurrence rate following treatment for primary multicystic ameloblastoma: systematic review and meta-analysis

Almeida, Renata de Albuquerque Cavalcanti; Andrade, Emanuel Sávio de Souza; Barbalho, Jimmy Charles Melo; Vajgel, André; Vasconcelos, Belmiro Cavalcanti do Egito

doi:10.1016/j.ijom.2015.12.016

Cited by 84 publications

(94 citation statements)

References 60 publications

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“…In a recent study of 305 patients with ameloblastoma and longterm follow-up, Hong et al [9] found that patients managed by marginal resection demonstrated significantly higher recurrence rate when compared to those who underwent segmental resection or maxillectomy (11.6 vs. 4.5 %, p = 0.004). However, the latest meta-analysis of solidmulticystic ameloblastomas showed no significant difference in recurrence rates of tumors managed with a primary marginal resection and segmental resection (11.9 vs. 12.1 %), while there was a significantly higher recurrence rate in enucleated and curetted tumors (40 %) [13]. Our study supports observations of Hong et al demonstrating significantly lower recurrence rates (6.1 %) in patients managed with primary segmental resection, maxillectomy or mandibulectomy when compared to a marginal excision, enucleation and curettage (52 %).…”

Section: Discussionmentioning

confidence: 95%

“…Multiple studies have consistently indicated that the initial surgical approach most strongly correlates with tumor recurrence [1,[9][10][11][12][13]. While curettage and enucleation with or without adjuvant Carnoy's solution and marsupialization may be acceptable therapies for some unicystic ameloblastomas, most experts currently believe that these treatment modalities have no role in management of solid/multicystic ameloblastoma [4,10].…”

Section: Discussionmentioning

confidence: 99%

“…Despite these findings, the debate on an ideal management that would achieve cure without unnecessary compromise of cosmesis and function, is ongoing. The continued controversy stems in part from the outcome data generated by the small retrospective case series without sufficient patient follow-up [13].…”

Section: Introductionmentioning

confidence: 99%

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Ameloblastoma: 25 Year Experience at a Single Institution

Milman

Ying

Pan

et al. 2016

Head and Neck Pathol

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Ameloblastoma is a rare, locally aggressive odontogenic neoplasm, accounting for fewer than 1 % of head and neck tumors. Recent literature suggests that the initial surgical approach and histologic growth patterns are the most important prognostic determinants in ameloblastoma. The aim of this study was to compare the clinical presentation, management, and outcomes of patients with ameloblastoma with data reported in the literature; the study spanned 2 decades at a single institution. The institution's database was searched for all patients with pathologically confirmed ameloblastoma, diagnosed between 1990 and 2015. The data collected included sex, age, clinical and imaging findings, management, histologic pattern, clearance of surgical margins, length of follow-up, time to recurrence, and disease-related mortality. The potential risk factors of recurrence were evaluated using log-rank test, proportional hazard model, and Fisher exact test. Review of the database yielded 54 patients with pathologically confirmed ameloblastoma and follow-up. Recurrence was noted in 13 (24 %) patients. Surgical approach was associated with the risk of recurrence (6.1 % following radical resection vs. 52 % following limited surgery, p = 0.002). There were trends toward higher recurrence rate in the group with pathologically documented positive margins (p = 0.054) and in follicular ameloblastoma (p = 0.35). Transformation into ameloblastic carcinoma was identified in two patients. There was no disease-related mortality. Our study confirms the recent data regarding the importance of radical surgical resection in management of ameloblastoma. Surgical approach appears to be the strongest predictor of tumor clearance.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Ameloblastoma: 25 Year Experience at a Single Institution

Milman

Ying

Pan

et al. 2016

Head and Neck Pathol

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“…The cystic or unilocular ameloblastomas are the only variants appropriate for curettage and chemical cauterization with Carnoy’s solution because the other subtypes require aggressive resections (10). The overall recurrence rate of ameloblastoma with current methods of treatment is approximately 10% (7), and recurrent cases are malignant (11). This result is relatively high for a benign tumor.…”

Section: Introductionmentioning

confidence: 99%

Recurrence and cancerization of ameloblastoma: multivariate analysis of 87 recurrent craniofacial ameloblastoma to assess risk factors associated with early recurrence and secondary ameloblastic carcinoma

Yang

Liu

Gokavarapu

et al. 2017

Chinese Journal of Cancer Research

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ObjectiveThe recurrence and progression of ameloblastoma are unpredictable. Therefore, we examined the influence of clinical factors on recurrence time and analyzed the clinical factors associated with early recurrence and cancerization. We then developed a staging system to predict early recurrence and cancerization.MethodsAll of the primary craniofacial ameloblastoma patients treated in Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine were recorded. There were 87 recurrent cases used to create a staging system and tested in a Cox regression analysis for risk factors associated with early recurrence or cancerization following surgery.ResultsThere were 890 craniofacial ameloblastoma patients, and 72 cases had recurrence. There were also 15 cases with cancerous recurrence. The overall recurrence rate was 9.78%, and the cancer rate was 1.69%. The primary cases were classified into the following 3 stages based on clinicopathological features: stage I, the maximum tumor diameter ≤6 cm; stage II, the maximum diameter of tumor >6 cm or tumor invasion to the maxilla sinus/orbital floor/soft tissue; and stage III, tumor invasion of the skull base or metastasis into regional lymph nodes. When the method of surgery was controlled by partial correlation, the staging had significance with recurrence time (P=0.004). The Cox analysis showed the tumor stage was correlated with recurrence time (P=0.027) and cancerization time (P=0.002). However, the surgical method did not influence the recurrence time when adjusted for cofounding variables.ConclusionsTumor larger than 6 cm and invasion to soft tissues or adjacent anatomical structures are associated with early recurrence. This staging system can be used to predict the risk factors of early recurrence and cancerization in ameloblastoma patients.

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“…Regarding treatment, many authors advocate resection with margins as model because of the high rates of recurrence and likelihood of distant metastasis. 5,6 In cases of unilocular variant, these tumours can be classified into 3 variants, according to their histological appearance: luminal, intraluminal, and mural. Some authors suggest that the mural variant has a more aggressive behaviour and should be treated more amply.…”

Section: Discussionmentioning

confidence: 99%

Can ameloblastomas arise from odontogenic keratocysts?

et al. 2015

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| Background:The ameloblastoma is a locally aggressive odontogenic tumour that has high recurrence rates. It rarely presents a histological aspect similar to the odontogenic keratocyst, because of the presence of keratinised areas. This study aimed to report a case of ameloblastoma in the mandible, diagnosed and treated incorrectly as an odontogenic keratocyst because of unusual macroscopic characteristics and rare histological aspects that impaired a correct diagnosis. Case report: A 57-year-old female patient, presenting an asymptomatic lesion at the left mandibular angle, was treated by incisional biopsy and decompression. The histological sections showed an aspect suggesting odontogenic keratocyst. At the 3-year postoperative period, the patient returned with a new lesion on the left side of the mandible and was then subjected to curettage. The histological sections showed a pattern of ameloblastoma and, because of this, the patient remained with a 6-month follow-up. At the 4-year postoperative period after the second operation, the patient returned with a new recurrence. The biopsy showed an ameloblastoma and the patient was submitted to mandibular resection and reconstruction as treatment. After the final procedure, the recovery was uneventful and the patient is now undergoing a postoperative period of four years, without recurrences. Conclusion: This case highlights the importance of carrying out a proper biopsy and an adequate examination by a specialised professional, because of the possibility of atypical lesions occurring restricted to the head and neck region.DESCRIPTORS | Ameloblastoma; Jaw; Odontogenic Tumors. RESUMO | Os ameloblastomas podem surgir a partir dos queratocistos odontogênicos? • Introdução: O ameloblastoma é um tumor odontogênico localmente agressivo, com altas taxas de recorrência. Raramente o ameloblastoma apresenta aspecto histológico semelhante ao queratocisto odontogênico devido à presença de áreas queratinizadas. O objetivo deste estudo é relatar um caso de ameloblastoma na mandíbula, diagnosticado e tratado incorretamente como um queratocisto odontogênico devido a características macroscópicas incomuns e aspectos histológicos raros que prejudicaram um correto diagnóstico. Relato de caso: Paciente do sexo feminino, 57 anos, apresentando lesão assintomática no ângulo mandibular esquerdo tratado inicialmente com biópsia incisional e descompressão. Os achados histológicos mostraram um aspecto sugestivo de queratocisto odontogênico. No pós operatório de 3 anos, a paciente retornou com uma nova lesão no lado esquerdo da mandíbula e foi então submetida a curetagem. Desta vez, as seções histológicas mostraram um padrão de ameloblastoma e, devido a este fato, a paciente permaneceu com um seguimento de 6 meses. No pós operatório de 4 anos da segunda operação, a paciente retornou apresentando nova recidiva. A biópsia mostrou um ameloblastoma e a mesma foi submetida a ressecção mandibular e reconstrução como tratamento. Após o procedimento final, a recuperação foi sem intercorrênc...

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Recurrence rate following treatment for primary multicystic ameloblastoma: systematic review and meta-analysis

Cited by 84 publications

References 60 publications

Ameloblastoma: 25 Year Experience at a Single Institution

Ameloblastoma: 25 Year Experience at a Single Institution

Recurrence and cancerization of ameloblastoma: multivariate analysis of 87 recurrent craniofacial ameloblastoma to assess risk factors associated with early recurrence and secondary ameloblastic carcinoma

Can ameloblastomas arise from odontogenic keratocysts?

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