Ameloblastoma: Epidemiology and Development of New Treatment Options

Ameloblastoma is one of the most common epithelial odontogenic benign tumors in the jaws, locally invasive, and has a high recurrence rate if not treated adequately. Several studies published over many years report the incidence of ameloblastoma in many nations. Nevertheless, no study has been conducted on the global incidence of ameloblastoma. Therefore, Chapter 2, we undertook a systematic review and meta-analysis (SRMA) to examine worldwide incidents across five decades and present an updated profile of ameloblastoma patients throughout the previous 26 years. We discovered that the global incidence rate was 0.92 per million person-years. The mandible was the favored location, with a slight male preference. The average age was 34, with the highest incidence occurring in the third decade of life. When compared to Africa and South America, ameloblastoma was more common in older people in Europe and North America. Solid/multicystic ameloblastoma was the most prevalent type, and follicular and plexiform histopathologic patterns predominated. Chapter 3, we conducted a retrospective study to assess the incidence, treatment, and complication profiles of ameloblastoma patients in East Indonesia. The mean age was 39.7 years, and most tumors were located in the posterior part of the mandible. The most common type was multicystic ameloblastoma; most cases were treated conservatively. For patients receiving radical treatment, reconstructions were done without bone grafts and only with titanium plates. We discovered that the most typical pre-operative complication is swelling. Chapter 4, we performed a SRMA s to evaluate the results of radical and conservative treatment methods for solid/multicystic and unicystic ameloblastoma concerning recurrence rates. We discovered that after radical therapy, the pooled recurrence rate of solid/multicystic ameloblastomas was 8%, compared to 41% after conservative treatment. These percentages were 3% and 21% for unicystic ameloblastomas, respectively. Following radical treatment, the risk of recurrences for both types of ameloblastomas was significantly lower than for conservative patients. The solid/multicystic variety revealed more recurrences than the unicystic type, but it is essential to remember that this research only included retrospective observational studies, which makes the evidence weaker than ideal. Chapter 5, for the first time in the ameloblastoma research field, we conducted a network meta-analysis (NMA) to evaluate and compare the efficacy of these various treatment modalities simultaneously for solid/multicystic ameloblastoma. According to the results, segmental resection ranked highest for lowering the recurrence rate, followed by curettage with cryotherapy and marginal resection. However, the evidence's certainty was deemed low for all comparisons by the Confidence in Network Meta-Analysis (CINeMa) technique because of imprecision and within-study bias. Our NMA revealed segmental resection as the most effective surgical method for decreasing recurrence in patients with multicystic ameloblastoma. Combining different conservative approaches is recommended if the patient cannot afford a radical treatment. However, the findings should be interpreted with caution. Knowing the specific tumor receptors targeted by the drug delivery system is one of the necessities for targeted therapy for cancers. Therefore, we carried out surface proteomic analyses in Chapter 6 to look for potential biomarkers that could act as beneficial extracellular targets for the targeted transport and delivery of therapeutic agents to ameloblastoma cells. The ameloblastoma cell line (AM-1)'s biotinylated surface and flow-through fractions were isolated and subjected to gel electrophoresis and nano LC-MS/MS. Protein-protein interactions diagram, gene ontology, and protein clusters were explored to understand the ameloblastoma tumor biology. Based on the screening of multiple variables, 17 proteins were determined to be high-confidence surface proteins. These results were compared to the public normal tissue dataset to assess protein expression in the healthy oral mucosa. Ultimately, we revealed five potential biomarkers with minimal expression in oral mucosa: PTPRF, PLXNA1, PLNA2, DCBLD2, and EPHB4

A network meta-analysis assessing the effectiveness of various radical and conservative surgical approaches regarding recurrence in treating solid/multicystic ameloblastomas

Abstract Multiple treatment approaches have been undertaken to reduce the incidence of recurrence in solid/multicystic ameloblastoma (SMA), both conservative and radical. A network meta-analysis (NMA) was conducted to assess and compare the effectiveness of these various treatment approaches concurrently. This study was reported based on the Preferred Reporting Items for Systematic Reviews for Network Meta-Analysis (PRISMA-NMA) statement. PubMed (MEDLINE), ScienceDirect, Scopus, and Web of Science were searched until August 10, 2021. The NMA was conducted using the STATA program. Of 1153 records identified in the search, seven observational studies with 180 patients were included. Six different treatment approaches were identified. Segmental resection ranked highest for reducing the recurrence rate with the highest SUCRA score (77.7), followed by curettage with cryotherapy (66.9) and marginal resection (49.3). Network inconsistencies and publication bias appeared to be absent. According to the Confidence in Network Meta-Analysis (CINeMa) method, the evidence's certainty was low for all comparisons due to imprecision and within-study bias. In conclusion, this study is the first NMA in the field of ameloblastoma. Segmental resection seemed to be the most effective treatment approach for minimizing recurrence in SMA patients. Nevertheless, weak certainty of evidence makes that the results must be regarded with caution

Radical vs conservative treatment of intraosseous ameloblastoma: Systematic review and meta-analysis

OBJECTIVES: The aim of the present study was to assess the outcomes of radical and conservative treatment approaches of solid/multicystic and unicystic ameloblastoma in terms of recurrence rates. MATERIAL AND METHODS: A systematic review and meta-analysis was conducted based on the PRISMA statement. Search was performed using PubMed, Embase, SCOPUS, and Web of Science for articles published from January 1969 until March 2018. Quality assessment of the selected articles was conducted using the Quality Appraisal of Case Series Studies Checklist. The meta-analysis was performed using the MedCalc program. RESULTS: The search strategy yielded 6,984 articles; 20 studies met the eligibility criteria and were included in the meta-analysis. The pooled recurrence rate of solid/multicystic ameloblastomas following radical treatment was 8%, while conservative treatment caused recurrences in 41%. For unicystic ameloblastomas, these values were 3% and 21%, respectively. The risk of recurrences in both types of ameloblastomas following radical treatment was lower than following conservative treatment. CONCLUSIONS: The present study showed statistically significant differences in recurrence favoring radical treatment for both unicystic and solid/multicystic ameloblastoma. The solid/multicystic type showed more recurrences than the unicystic type. Unfortunately, since only retrospective studies were available, the evidence is less strong as wished for

Global incidence and profile of ameloblastoma: A systematic review and meta-analysis

Objectives: To evaluate the global incidence of ameloblastoma and to provide a profile of ameloblastoma patients. Material and Methods: A systematic review and meta-analysis was conducted. Searches were performed in PubMed, EMBASE, SCOPUS, and Web of Science for articles published from 1969 to 2018 for the global incidence and from 1995 to 2018 for the profile of ameloblastoma patients. Results: Seven studies on the incidence rate of ameloblastoma were included in the meta-analysis. These studies only covered Europe, Africa, and Australia. The pooled incidence rate was 0.92 per million person-years (95% CI: 0.57–1.49), with significant heterogeneity between studies. Forty-two articles provided profile data of 6,446 ameloblastoma patients. Mean age was 34 years and the peak age incidence in the third decade of life. In Europe and North America, ameloblastoma mostly occurred at an older age when compared to Africa and South America. A slight male preference (53%) was found, and the mandible appeared to be the preferred site. The most common type of ameloblastoma was multicystic. The histopathologic patterns were mostly follicular and plexiform. Conclusions: This is the first study assessing the global incidence of ameloblastoma. The pooled incidence rate was determined to be 0.92 per million person-years

Colorectal cancer patients’ outcome in correlation with dietary and nutritional status: a systematic review

AbstractColorectal cancer (CRC) is one of the most common cancers worldwide and it involves various biomolecular and cellular levels. CRC has possibly happened due to aging, urbanization, and diet. Different foods have varying effects on the gastrointestinal cells, that’s why additional research is necessary to create effective medical interventions. This review aimed to evaluate the correlation between dietary and nutritional status on the outcome of CRC patients. Study results showed that a healthy diet such as fruit and vegetables is the best diet for improving colorectal cancer outcomes. Moreover, nutritional status affected CRC patients’ outcomes, where high BMI increases the risk of having CRC. However, low BMI was associated with CRC progression and poor quality of life