Recurrence Patterns and Prognostic Determinants of Odontogenic Tumors Following Radical Surgical Management: A Retrospective Cohort Study

Introduction: Odontogenic tumors exhibit a wide spectrum of biological behaviors ranging from indolent benign lesions to aggressive malignant neoplasms with significant recurrence potential. Despite advances in surgical management, recurrence remains a major clinical challenge, particularly in tumors with aggressive histology and large sizes. Identifying reliable clinicopathological predictors is essential for optimizing treatment strategies and improving long-term outcomes. This study aimed to evaluate recurrence patterns and recurrence-free survival in odontogenic tumors and to identify independent predictors of recurrence following radical surgical treatment. Materials and methods: This single-center retrospective cohort study was conducted using anonymized records of patients treated between January 2011 and December 2022. A total of 465 patients' records were screened, and 127 met the eligibility criteria. Data on demographic variables, tumor characteristics, treatment details, and outcomes were collected. The primary outcome was tumor recurrence, and recurrence-free survival was analyzed. Statistical analysis was performed using R software (The R Core Team, R Foundation for Statistical Computing, Vienna, Austria), employing Kaplan-Meier survival analysis, the log-rank test, and Cox proportional hazards and logistic regression models. Results: Of 127 patients, 72 (56.6%) had benign tumors and 55 (43.4%) had malignant tumors. Recurrence occurred in 27 (21.26%) patients, with significantly higher rates in malignant tumors than in benign tumors (p < 0.001). The median time to recurrence was shorter for malignant tumors (18 months) than for benign tumors (32 months) (p < 0.001). Malignant tumor type (hazard ratio (HR) = 3.51), tumor size (HR = 1.29 per cm), lymph node metastasis (HR = 4.57), and positive surgical margins (HR = 9.62) were significant predictors (p < 0.001). Multivariable analysis confirmed that tumor type (odds ratio (OR) = 3.76), size (OR = 1.25), nodal status (OR = 4.41), and margin status (OR = 3.89) were independent predictors. Conclusion: Recurrence in odontogenic tumors is primarily determined by tumor aggressiveness and the adequacy of surgical clearance. Malignant tumors, larger sizes, nodal involvement, and inadequate margins significantly increase the risk of recurrence. Careful preoperative evaluation and appropriate surgical planning are critical for improving long-term outcomes.