Patterns of Care and Survival Outcomes for Odontogenic Cancers

Objectives: Our understanding of odontogenic cancers is limited primarily to case studies given the rarity of these head and neck neoplasms. Using the National Cancer Database, we report the treatment patterns and survival outcomes for one of the largest cohorts of patients with odontogenic cancers. Methods: Patients with odontogenic tumors who did not have metastatic disease and received at least part of their care at the reporting facility were included. Patient and treatment variables were assessed using logistic regression. Survival was assessed using Cox proportional hazard models. Results: We identified 437 patients with odontogenic cancers, the majority of which had malignant ameloblastoma (n = 203) or odontogenic carcinoma (n = 217). Median follow-up was 44.8 months. On multivariate analysis, improved survival was associated with age <57 years (Hazard ratios [HR] 0.44, P =.012), lower comorbidity scores (HR 0.40, P =.008), surgical resection (HR 0.08, P <.001) and absence of lymph node metastasis (HR 0.23, P <.001). The 5-year overall survival was 87.1% for debulking surgery, 88.6% for radical resection and 26.6% for no surgical resection (P <.001). Lymph node metastases were associated with tumor size ≥5 cm (P =.006), malignant odontogenic histology (P =.025), and moderate/poor differentiation (P <.001). Conclusion: In this large series of odontogenic cancers, any type of surgical resection was associated with improved survival. Lymph node metastases, although infrequent, were associated with significantly worse survival. Level of Evidence: Level 3 Laryngoscope, 131:E1496–E1502, 2021.