Abstract：
Odontogenic keratocysts (OKC) are benign but aggressive lesions. As there is a lack of well randomized clinical studies assessing the effectiveness of the different treatment options for OKC, a network meta-analysis (NMA) was performed to identify the best treatment option with the lowest recurrence rate. An electronic search was performed following the PRISMA guidelines to identify all clinical studies comparing treatment options against enucleation alone. The outcome variable was recurrence. The predictor variables were treatments. The eight included treatments were: enucleation with peripheral ostectomy/curettage (E + PO/curettage); enucleation with cryotherapy (E + CRYO); enucleation with/without PO followed by modified Carnoy\'s solution (E ± PO+MCS); enucleation with PO and with topical 5-fluorouracil (E + PO+5FU); enucleation with/without PO followed by original Carnoy\'s solution (E ± PO+CS); marsupialization alone (MARS); marsupialization followed by secondary enucleation with/without PO (MARS+2°E ± PO); and resection. The odds ratio was used to estimate the recurrence rate. A frequentist NMA was performed using Stata software. A total of 2989 patients in 40 studies were included. Both direct pairwise meta-analysis and NMA showed that E + 5FU+PO was significantly superior to E ± PO+MCS. However, no statistically significant difference was found between E ± PO+CS vs E + 5FU+PO, E ± PO+MCS, and resection, respectively (all very low quality evidence). The three most effective treatments in reducing the recurrence rate were E + PO+ 5FU (98.1%; very low quality evidence), resection (83.5%; very low quality evidence), and E ± PO+CS (63.8%; moderate quality evidence). The findings from this study suggest that CS remains the most effective fixative agent after enucleation and PO until proven otherwise. Additionally, 5FU appears to be an effective method with promising results that needs further research. Finally, the efficacy of MCS remains controversial; further in vivo and in vitro studies are required to determine new protocols. As this NMA included retrospective studies, the results should be interpreted with great caution (level of evidence: type III).
摘要：
牙源性角化囊肿（OKC）是良性但侵袭性病变。由于缺乏评估OKC不同治疗方案有效性的随机临床研究，我们进行了网络荟萃分析(NMA),以确定复发率最低的最佳治疗方案.根据PRISMA指南进行电子搜索，以确定所有临床研究，将治疗方案与单独的摘除进行比较。结果变量为复发。预测变量为治疗。包括的八种治疗方法是：周围切除术/刮宫术（EPO/刮宫术）的摘除；冷冻治疗的摘除（ECRYO）；有/没有PO的摘除，然后是改良的Carnoy\'s溶液（E±POMCS）；用PO和局部5-氟尿嘧啶（EPO5FU）进行摘除，然后是E/无去核，然后再进行2比值比用于估计复发率。使用Stata软件进行频率NMA。共纳入40项研究中的2989名患者。直接配对荟萃分析和NMA均显示E+5FU+PO明显优于E±PO+MCS。然而,E±PO+CS与E+5FU+PO之间无统计学差异，E±PO+MCS,切除，分别(所有质量非常低的证据)。降低复发率的三种最有效的治疗方法是E+PO+5FU（98.1%；证据质量非常低），切除（83.5%；质量很低的证据），和E±PO+CS（63.8%；中等质量证据）。这项研究的结果表明，在摘除和PO后，CS仍然是最有效的固定剂，除非另有证明。此外,5FU似乎是一种有效的方法，有希望的结果需要进一步研究。最后,MCS的疗效仍存在争议;需要进一步的体内和体外研究来确定新的方案.由于这项NMA包括回顾性研究，应非常谨慎地解释结果(证据水平:III型).
