Recurrence probability for keratocystic odontogenic tumors: An analysis of 6427 cases.

PURPOSE: To investigate and compare the probability of recurrence of keratocystic odontogenic tumors (KCOTs) for different variables and treatment protocols. MATERIALS AND METHODS: An electronic search was undertaken in April 2016 that included clinical series of KCOTs reporting recurrences. Untransformed proportions and meta-analyses were performed to estimate the probability/risk of recurrence, according to several variables. RESULTS: A total of 94 publications were included (6427 KCOTs, 1464 recurrences). Probability of recurrence: all lesions, 21.1%; nevoid basal cell carcinoma syndrome, 35.4%; males, 20.3%; females, 19.3%; maxilla, 15.3%; mandible, 21.5%; unilocular, 14.7%; multilocular, 24.4%; marsupialization/decompression, 28.7%; decompression + enucleation +/- additional therapy, 18.6%; enucleation/curettage, 22.5%; enucleation + peripheral ostectomy, 18.6%; enucleation + Carnoy's solution, 5.3%; enucleation + cryotherapy, 20.9%; marginal/segmental resection, 2.2%. The recurrence was not statistically significantly affected by lesion location (maxilla vs. mandible, risk ratio [RR] 0.92, P = 0.32) or patient's sex (male vs. female, RR 0.94, P = 0.44), but by locularity (unilocular vs. multilocular, RR 0.67, P = 0.007). Recurrence risk for surgical managements: marsupialization vs. enucleation (RR 1.65, P = 0.0006), marsupialization vs. resection (RR 3.17, P = 0.009), enucleation alone vs. enucleation + peripheral ostectomy (RR 1.66, P = 0.05), enucleation alone vs. enucleation + Carnoy's solution (RR 1.94, P = 0.03), enucleation alone vs. enucleation + cryotherapy (RR 0.88, P = 0.56). CONCLUSIONS: KCOTs have a considerable rate of recurrence, which varies significantly according to some clinical, radiographic, and histopathological features, as well as surgical management.