Gasparro Roberta, Giordano Francesco, Campana Maria Domenica, Aliberti Angelo, Landolfo Elena, Dolce Pasquale, Sammartino Gilberto, di Lauro Alessandro E
Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Oral Surgery, University of Naples Federico II, 80131 Naples, Italy.
Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy.
J Clin Med. 2024 Sep 9;13(17):5339. doi: 10.3390/jcm13175339.
Ameloblastoma is a rare, benign, but locally aggressive odontogenic tumor that originates from the epithelial cells involved in tooth development. The surgical approach to treating an ameloblastoma depends on the type, size, location, and extent of the tumor, as well as the patient's age and overall health. This umbrella review's aim is to summarize the findings from systematic reviews (SRs) and meta-analyses on the effect of radical or conservative treatment of ameloblastoma on the recurrence rate and quality of life, to evaluate the methodological quality of the included SRs and discuss the clinical management. Three electronic databases (PubMed, Scopus, The Cochrane Library) were checked. The primary outcome was the recurrence rate after surgical treatment, while the secondary outcomes were the post-operative complications, quality of life, esthetic, and functional impairment. The methodological quality of the included SRs was assessed using the updated version of "A Measurement Tool to Assess Systematic Review" (AMSTAR-2). Eighteen SRs were included. The quality of the included reviews ranged from critically low (three studies) to high (eight studies). Four studies were included in meta-analysis, and they revealed that the recurrence rate is about three-times more likely in the conservative treatment group compared to the radical treatment group, and this result is statistically significant. Despite the high recurrence rate, the latter was more appropriate in the case of smaller lesions and younger patients, due to better post-operative quality of life and reduced functional and esthetic impairments. Based on the results of this overview, conservative treatment may be recommended as the first-line approach for intraosseous ameloblastoma not involving soft tissue. However, given the expectation of a higher recurrence rate, it is advisable to reduce the interval between follow-up visits. However, further prospective studies are needed to establish the best treatment choice and follow-up period.
成釉细胞瘤是一种罕见的、良性但具有局部侵袭性的牙源性肿瘤，起源于参与牙齿发育的上皮细胞。治疗成釉细胞瘤的手术方法取决于肿瘤的类型、大小、位置和范围，以及患者的年龄和整体健康状况。本伞状综述的目的是总结关于成釉细胞瘤根治性或保守性治疗对复发率和生活质量影响的系统评价（SRs）和荟萃分析的结果，评估纳入的SRs的方法学质量，并讨论临床管理。检索了三个电子数据库（PubMed、Scopus、Cochrane图书馆）。主要结局是手术治疗后的复发率，次要结局是术后并发症、生活质量、美观和功能损害。使用更新版的“系统评价评估测量工具”（AMSTAR-2）评估纳入的SRs的方法学质量。纳入了18项SRs。纳入综述的质量范围从极低（三项研究）到高（八项研究）。四项研究纳入了荟萃分析，结果显示保守治疗组的复发率比根治性治疗组高约三倍，且该结果具有统计学意义。尽管复发率高，但对于较小病变和年轻患者，后者因术后生活质量更好以及功能和美观损害减少而更合适。基于本综述的结果，对于不涉及软组织的骨内成釉细胞瘤，保守治疗可作为一线治疗方法推荐。然而，鉴于预期复发率较高，建议缩短随访间隔时间。然而，需要进一步的前瞻性研究来确定最佳治疗选择和随访期。
