VEGF mRNA Expression as a Powerful Independent Predictor for Recurrence in Ameloblastoma: Integrating Molecular Profiling with Surgical Outcome Analysis

Abstract

Objective: To investigate vascular endothelial growth factor (VEGF) mRNA expression as an independent biomarker for predicting recurrence in ameloblastoma (AM), and to evaluate its potential for guiding surgical strategy.

Methods: A retrospective cohort study was conducted involving 200 patients with primary AM undergoing initial surgery during January 2021-December 2023. Patients were categorized into curettage (n = 77) and extended resection (n = 123) groups. Relative VEGF mRNA expression in the tumor cyst wall was quantified using RT-qPCR. Kaplan-Meier analysis and Cox regression were used to analyze recurrence-free survival (RFS) and risk factors. Perioperative outcomes and complications were compared between groups. Univariate and multivariate analyses were performed using Cox proportional hazards regression models.

Results: VEGF mRNA expression was significantly elevated in the recurrence group (4.66 ± 1.42) versus the non-recurrence group (3.24 ± 2.02, P < 0.001). ROC curve analysis identified an optimal VEGF cutoff value of 4.88 for predicting recurrence (AUC = 0.694). This molecular stratification revealed a profound disparity: the 2-year RFS was significantly lower in the VEGF-high group (77.4%) compared to the VEGF-low group (94.9%, P < 0.001). While extended resection provided a higher 2-year RFS than curettage (96.0% vs. 79.5%, P<0.001), it incurred greater operative burden and complication risks. Crucially, multivariate analysis established high VEGF expression as the most powerful independent predictor of recurrence (HR = 45.15, P < 0.001), with a risk magnitude exceeding that of curettage (HR = 37.22, P < 0.001).

Conclusion: High VEGF mRNA expression is a powerful, independent biomarker for AM recurrence, with a prognostic impact surpassing surgical choice. Preoperative VEGF assessment holds significant potential for guiding individualized surgical planning and optimizing follow-up strategies.

Keywords: Ameloblastoma; Biomarker; Curettage; Extended resection; Prognostic factor; Recurrence; Vascular endothelial growth factor.