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Multifactorial Predictors of Ameloblastoma Recurrence: A Retrospective Observational Study
Beatrice Pulli1, Chiara Marras1, Giuseppe Spinelli2
1Department of Maxillo-Facial Surgery, Careggi University Hospital, Florence, Italy; Department of Maxillo-Facial Surgery, University of Siena, Siena, Italy.
Background:
Ameloblastoma is a benign yet locally aggressive odontogenic neoplasm characterized by local invasion and a substantial risk of recurrence. Effective management balances resection for cure and functional preservation.
Purpose:
The purpose of this study was to estimate recurrence-free survival (RFS) following treatment of ameloblastoma, to evaluate the association between extraction of teeth involved within the lesion and RFS, and to identify factors associated with time to recurrence.
Study Design, Setting, Sample:
A retrospective cohort study was conducted at Careggi University Hospital (Florence, Italy) between 2014 and 2024. Eligible patients were screened and subjects with histologically confirmed ameloblastoma and complete clinical and radiologic follow up were included.
Predictor Variable:
The primary predictor variable was treatment modality categorized as resection or nonresection surgery.
Main Outcome Variable(S):
The primary outcome variable was time to recurrence, defined as the interval between primary surgical treatment and clinical, radiologic, or histologic evidence of recurrence.
Covariates:
Covariates included age, sex, smoking status, anatomic site, radiographic appearance, and extraction of teeth involved within the lesion.
Analyses:
RFS was estimated using Kaplan-Meier methods and compared using the log-rank test. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs. Statistical significance was set at P value < .05.
Results:
The final sample included 33 subject with a mean age of 52.6 years (SD 18.5); 72.7% (n = 24) were male. During a median follow up of 124 months (interquartile range 82 to 171), recurrence occurred in 6 subjects (18.2%). Five-year and 10-year RFS rates were 87.5 and 82.6%, respectively. Treatment modality was not associated with RFS in the unadjusted Cox model (HR = 1.14; 95% CI, 0.21 to 6.29; P = .900). In the secondary analysis of subjects with recorded tooth extraction status, absence of extraction of teeth involved within the lesion was associated with an increased hazard of recurrence. (HR = 11.93; 95% CI, 1.08 to 132.18; P = .043; log-rank P = .010).
Conclusions And Relevance:
Within the limitations of this retrospective study, treatment modality was not associated with RFS in this cohort, whereas extraction of teeth involved within the lesion was associated with improved RFS.