The Effectiveness of Decompression in Ameloblastoma Treatment: A Systematic Review and Meta-Analysis.

BACKGROUND

There is a critical trade-off in ameloblastoma management: balancing the significant tissue-preserving benefits of decompression treatment against its potential for higher recurrence compared to radical resection.

PURPOSE: The study purpose was to evaluate the therapeutic effects of decompression treatment for managing ameloblastoma.

STUDY SELECTION: A systematic search was conducted across multiple databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A meta-analysis of proportions was performed using a random-effects model in RStudio to pool data on size reduction and time to recurrence rates. Heterogeneity was assessed using I2 and Tau statistics.

RESULTS

Nine studies met the inclusion criteria. The analysis included 555 ameloblastomas (381 unicystic ameloblastoma, 174 multicystic ameloblastoma). Decompression treatment yielded a significant mean size reduction of 55.3% (range: 7.5 to 93.02%). Recurrence outcomes were evaluated using time-to-event analysis where individual patient data were available (n = 287). The overall recurrence rate was 3.8 per 100 person-years (95% CI: 2.4 to 6.1). A stark difference was observed between histological subtypes: unicystic ameloblastoma demonstrated a recurrence rate of 2.1 per 100 person-years (95% CI: 1.1 to 4.0) compared to 8.9 per 100 person-years (95% CI: 5.4 to 14.6) for multicystic ameloblastoma (hazard ratio [HR] = 3.2; 95% CI: 1.8 to 5.7; P = .008). Longer decompression duration (>12 months) was associated with a significantly reduced recurrence hazard (HR = 0.52; 95% CI: 0.31 to 0.87; P = .012). Prolonged decompression (>12 months) was associated with a 48% reduction in recurrence hazard (HR = 0.52; 95% CI: 0.31 to 0.87; P = .012).

CONCLUSIONS AND RELEVANCE: Decompression treatment is effective for reducing ameloblastoma size, facilitating minimally invasive treatment. However, recurrence risk is significantly higher in multicystic and mural subtypes, with multicystic variants demonstrating a 3.2-fold increased hazard of recurrence compared to unicystic variants. These findings support a tailored surgical approach based on histology and clinical presentation, though they should be interpreted with caution due to the high heterogeneity among the included studies.