Prognosis Efficacy Of Conservative Treatment For Keratocystic Odontogenic Tumors:a Systematic Review And Meta-analysis

ObjectivesThe aim of this manuscript is to present a systematic review of the clinicopathologic features and outcomes of conservative surgical treatment(decompression/marsupialization±secondary enucleation vs enucleation±adjuvant therapy)for Keratocystic odentogenic tumor(KCOT)and assess the recurrence rates through a meta-analysis,in order to indicate a theoretical basis for the selection of the appropriate conservative surgical approach in clinical for KCOTs.MethodsAn extensive electronic search of major Databases was conducted using the PubMed,Cochrane Library,CNKI,Wangfangdata,and VIP databases from inception to August 2017,and relevant articles were selected based on specific inclusion criteria.The PICOS criteria(Population:nonsyndromic patients with KCOT,with histopathological diagnosis and adequate follow-up period;Intervention and Comparison:marsupialization/decompression with or without enucleation,and enucleation with or without adjuvant therapy;Outcome:recurrence rates;Study design:randomised controlled trials,prospective study,retrospective studies,and case series containing at least 10 cases of KCOT)were employed.The screening process of articles and eligibility of retrieved articles were reviewed by two independent reviewers.Meta-analysis was performed by using software RevMan 5.3.A pooled odds ratio(OR)was computed through the Mantel-Haenszel test(M-H)with 95%confidence intervals(CI).ResultsA total of 17 studies were identified for the Meta-analysis after being screened according to inclusion and exclusion criteria,and all of them were retrospective studies.1093 KCOTs were treated by conservative surgical treatments,and 179 cases(16.4%)presented recurrence.The recurrence rates for decompression/marsupial-ization±secondary enucleation and enucleation±adjuvant therapy were 15.1%(30of 199 cases)and 16.7%(149 of 894 cases)respectively.As between-study heterogeneity was not observed(P=0.25,I~2=18%),a fixed effects model was used for analysis.There were no statistically significant in recurrence rate between decompression/marsupialization±secondary enucleation and enucleation±adjuvant therapy(P=0.42).ConclusionStatistically significant differences between the recurrence rates of cases treated by decompression/marsupialization±secondary enucleation and by enucleation±adjuvant therapy were not observed in this study.Due to no published randomised controlled trials relevant to this review question,there is a need for well designed and conducted randomised controlled trials to evaluate the recurrence rates of conservative surgical treatments for KCOTs.