Journal of Prevention and Treatment for Stomatological Diseases ›› 2020, Vol. 28 ›› Issue (7): 416-420.DOI: 10.12016/j.issn.2096-1456.2020.07.002

• Expert Forum • Previous Articles     Next Articles

Logic and clinical significance of the new WHO classification of ameloblastoma in 2017

TAO Qian(),YANG Yaocheng   

  1. Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
  • Received:2019-06-18 Revised:2020-01-30 Online:2020-07-20 Published:2020-06-04
  • Contact: Qian TAO

2017年WHO成釉细胞瘤新分类的逻辑性与临床指导意义

陶谦(),杨耀成   

  1. 中山大学光华口腔医学院·附属口腔医院,广东省口腔医学重点实验室,广东 广州(510055)
  • 通讯作者: 陶谦
  • 作者简介:陶谦,医学博士,中山大学光华口腔医学院·附属口腔医院口腔颌面外科教授,博士生导师,主任医师。擅长口腔颌面部肿瘤、外伤和唾液腺相关疾病的诊断与治疗。主持和参加国家自然科学基金及省、市科研基金等多项研究工作。现任广东省口腔医学会口腔颌面外科专业委员会常委,《中华口腔医学研究杂志》(电子版)和《口腔疾病防治》编委。主编专著《颌骨肿瘤的诊断与治疗》,在SCI杂志和国内专业杂志发表论文75篇。
  • 基金资助:
    广东省科技计划基金项目(2017A020211025)

Abstract:

A substantial revision of the classification of ameloblastoma was made by the World Health Organization (WHO) in the fourth edition of the Classification of Head and Neck Tumors in 2017, which was based on the review and summary of much clinical research data and prospective evaluation of the latest results of genetic research. The new classification is simpler and more practical. It retains two subtypes, the unicystic type and extraosseous/peripheral type, classifies the remaining types as ameloblastoma (classic), defines metastatic ameloblastoma as a benign tumor and simplifies the classification of ameloblastic carcinoma, which has important guiding significance for clinical diagnosis and treatment. Moreover, the new classification included the latest advances in the genetic research on ameloblastoma, demonstrating that the BRAF gene mutation was found in approximately 60% of ameloblastoma cases. The classification provides a new concept and direction for studying the pathogenesis of ameloblastoma, and BRAF-targeted therapy may be an emerging therapy for some ameloblastoma patients with multiple recurrence or surgical contraindications. This article analyzes the intrinsic logic of these changes via a review of the relevant literature and combination of clinical experiences to better understand the new classification. In 2017, the WHO′s new classification of ameloblastoma summarized the experience and achievements in histopathology and clinical treatment of ameloblastoma in the prior 10 years, indicating that BRAF-targeted treatment may bring new treatment options and hope for patients with recurrent or inoperable ameloblastoma.

Key words: ameloblastoma, metastatic ameloblastoma, benign odontogenic tumor, odontogenic epithelial origin, pathology, genetics, classification, BRAF gene mutation, molecular targeted therapy, World Health Organization

摘要:

2017年,世界卫生组织(WHO)发布的第四版《WHO头颈部肿瘤分类》对成釉细胞瘤分类做了较大幅度的修订,在回顾总结大量临床研究资料的基础上,又前瞻性地吸收遗传学研究的最新成果。新分类简洁实用,保留单囊型和外周型两种亚型,其余统一称为成釉细胞瘤(经典型),同时明确转移性成釉细胞瘤为良性肿瘤,还简化了成釉细胞癌的分类,对临床诊疗具有重要指导意义。而且,新分类首次增加了成釉细胞瘤的遗传学研究进展,指出约60%的成釉细胞瘤中存在BRAF基因突变,一方面为了解成釉细胞瘤的发病机制提供了新的研究思路和方向,另一方面,BRAF靶向治疗可能成为多次复发或无法耐受手术的成釉细胞瘤患者新的治疗选择。本文复习相关文献并结合临床经验和体会,分析这些变化的内在逻辑,以更好地理解新分类。2017年WHO成釉细胞瘤新分类总结了过去10余年成釉细胞瘤在组织病理和临床治疗等方面的经验及成果,预示BRAF靶向治疗可能为复发性或无法手术的成釉细胞瘤患者带来新的治疗选择和希望。

关键词: 成釉细胞瘤, 转移性成釉细胞瘤, 牙源性良性肿瘤, 牙源性上皮, 病理学, 遗传学, 分类, BRAF基因突变, 分子靶向治疗, 世界卫生组织

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