How Well Do We Manage the Odontogenic Keratocyst?

Abstract

To answer the clinical question: Among patients treated for odontogenic keratocysts (OKCs), what is the overall 5-year disease-free rate and what factors are associated with disease recurrence? The investigators implemented a retrospective cohort study and enrolled a sample composed of patients presenting for the evaluation and management of previously untreated OKCs. The predictor variables were grouped into demographic, medical, radiographic, and operative categories. The primary outcome variable was time to lesion recurrence. Data analyses were performed using univariate and bivariate or multivariate Cox proportional hazards models. The study sample was composed of 31 patients (31 OKCs) with a mean age of 41.0 years. Of the 31 OKCs treated, 19 (61.3%) were treated with decompression with or without residual cystectomy and 12 (38.7%) were treated with enucleation with or without adjunctive therapy. There were 8 recurrences in 8 patients, with a median time to recurrence of 17.8 months (interquartile range, 13.4 to 26.4 months). The 5-year disease-free estimate was 51.2% (95% confidence interval, 37.2%-65.2%). Multiloculated lesions were 33.6 times more likely to recur than unilocular lesions. This may be the first study looking at disease recurrence after treatment of OKCs using appropriate statistical analyses for a time-dependent outcome (disease recurrence). The risk for recurrent disease is higher in this report than in many other studies and raises the issue that other reports may have underestimated the risk for recurrent disease owing to inappropriate statistical methods for assessing time-dependent outcomes.