The diagnosis and prognostic outcome of STS pose a therapeutic challenge in an interdisciplinary setting. The treatment protocols are still discussed controversially. This systematic meta-analysis aimed to determine prognostic factors leading to the development and recurrence of STS. Eligible studies that investigated potential risk factors such as smoking, genetic dispositions, toxins, chronic inflammation as well as prognostic relapse factors including radiation, chemotherapy and margins of resection were identified. Data from 24 studies published between 1993 and 2019 that comprised 6452 patients were pooled. A statistically significant effect developing STS was found in overall studies stating a causality between risk factors and the development of STS (p < 0.01). Although subgroup analysis did not meet statistical significances, it revealed a greater magnitude with smoking (p = 0.23), genetic predisposition (p = 0.13) chronic inflammation, (p = 0.20), and toxins (p = 0.14). Secondly, pooled analyses demonstrated a higher risk of relapse for margin of resection (p = 0.78), chemotherapy (p = 0.20) and radiation (p = 0.16); after 3 years of follow-up. Therefore, we were able to identify risk and relapse prognostic factors for STS, helping to diagnose and treat this low incidental cancer properly.

Background: Sex-associated differences in early surgical care may occur within individual sarcoma entities. We examined recorded tumor characteristics, initial resection location, margin status, and re-excision in extremity leiomyosarcoma. Methods: This exploratory retrospective study included 79 patients with initial resection during 2000–2015 who ultimately received treatment at a tertiary sarcoma center. The primary endpoint was initial R1 versus R0 resection. Analyses used Firth penalized logistic regression and Bayesian marginal standardization; treatment-location, re-excision, and survival analyses were exploratory. Results: Initial R1 occurred in 34/46 men (73.9%) and 13/29 women (44.8%; absolute difference 29.1 percentage points; P = 0.015). Men more frequently underwent initial outside-center surgery (72.3% vs. 41.4%) and re-excision (82.6% vs. 50.0%). Recorded tumors <5 cm were more frequent in men (64.6% vs. 35.5%). The male-sex odds ratio decreased from 3.41 (95% CI 1.31–9.24) after age and site adjustment to 2.43 (0.82–7.41) after additional size and depth adjustment. The fully standardized difference was 16.6 percentage points (95% credible interval −2.5 to 37.4), compatible with no difference as well as a clinically substantial difference. Among patients with known location and R0/R1 status, R1 occurred after 37/44 outside-center and 9/29 index-center resections. All 47 patients with initial R1 underwent re-excision; definitive R0 was achieved in all 79 patients. Conclusion: Men in this selected, exploratory cohort had higher observed frequencies of outside-center resection, initial R1, and re-excision. Adjustment attenuated the association, with substantial residual uncertainty. These findings do not establish inequity, differential access, biological causation, or mediation and require prospective multicenter validation.

Anastomotic angle and flow allocation change together in end-to-side junctions, complicating interpretation of angle-dependent wall shear. We used MITOS Flow Lab, a two-dimensional D2Q9 two-relaxation-time lattice-Boltzmann environment, to examine this coupling in steady, rigid-walled, Newtonian models at Re ≈ 91. Angles of 30–120° were compared under equal outlet pressures and at approximately matched branch-flow fractions of 0.25 and 0.21, achieved with angle-specific static outlet-pressure offsets. Under equal outlet pressures, the branch-flow fraction decreased from 0.356 to 0.151 across this angle range, while the minimum normalized signed recipient-floor shear increased from 0.140 to 0.450. Matching flow allocation substantially reduced angle-associated variation in this endpoint and in the sub-toe response, whereas sub-heel and sub-ostial responses remained angle dependent under the adjusted boundary conditions. This qualitative contrast persisted when the lumen resolution was increased from 32 to 64 nodes for the 0.25 target, although minimum-shear attenuation changed from approximately 83% to 74%. The 0.21 target was examined only on the production grid. These experiments demonstrate that the interpretation of angle-associated shear depends on the flow-allocation condition used for comparison. They do not identify a boundary-independent geometric effect or a causal mediation fraction. Absolute values and attenuation magnitudes remain sensitive to discretization and have not been independently validated. These controlled comparisons provide a framework for interpreting angle-associated shear together with achieved flow allocation and the specified outlet conditions.