Background: The relationship between insurance status and interhospital transfers has not been adequately researched among cancer patients. Hence this study aimed for understanding this relationship using a nationally representative database.Methods: A retrospective analysis was conducted using National Inpatient Sample (NIS) data collected during 2010–2016 and included all cancer hospitalization between 18 and 64 years of age. Interhospital transfers were compared based on insurance status (Medicare, Medicaid, private, and uninsured). Weighted multivariable logistic regressions were used to calculate the odds of interhospital transfers based on insurance status, after adjusting for many covariates.Results: There were 3,580,908 weighted cancer hospitalizations, of which 72,353 (2.02%) had interhospital transfers. Uninsured patients had significantly higher rates of interhospital transfers, compared to those with Medicare (P = 0.005) and private insurance (P < 0.001). Privately insured patients had significantly lower rates of interhospital transfers, compared to those with Medicare (P < 0.001) and Medicaid (P < 0.001). Logistic regression analyses showed that the odds of having interhospital transfers were significantly higher among uninsured (adjusted odds ratio [aOR], 1.57, 95% CI: 1.45–1.69), Medicare (aOR, 1.38, 95% CI: 1.32–1.45) and Medicaid (aOR, 1.23, 95% CI: 1.16–1.30) patients when compared to those with private insurance coverages.Conclusion: Among cancer patients, uninsured and Medicare and Medicaid beneficiaries were more likely to experience interhospital transfers. In addition to medical reasons, factors such as affordability and socioeconomic status are influencing interhospital transfer decisions, indicating existing healthcare disparities. Further studies should focus on identifying the causal associations between factors explored in this study as well as additional unexplored factors.

Background: This study aims to assess the oncologic outcomes of unplanned versus planned excision in patients with high-grade soft tissue sarcoma. Methods: A retrospective review was conducted, including 147 patients surgically treated for non-metastatic high-grade soft tissue sarcoma at a single institution between 2010 and 2021. Perioperative, clinical, and surveillance data were collected. Outcomes were compared between patients with unplanned (n = 53) and planned (n = 94) excisions. Multivariate analyses controlled for tumor characteristics and adjuvant therapies. Results: The cohort included 53 patients treated with unplanned excision and 94 patients with planned excision, with a mean follow-up of 65.3 months postoperatively. Demographic variables, tumor size, type, histological grade, and margin status were statistically comparable between the planned and unplanned excision groups based on univariate analysis. Unplanned excisions were associated with significantly higher rates of local recurrence (39.6% vs 7.4%, p < 0.001) and metastasis (18.9% vs 5.3%, p = 0.009) compared to planned excisions. On multivariate analysis, planned excision conferred a decreased risk for local recurrence (HR 0.12, 95% CI 0.05-0.31, p < 0.001) and metastasis (OR 0.22, 95% CI 0.05-1.02, p = 0.05). Final positive margins were strongly associated with local recurrence (HR 18.26, 95% CI 6.80-48.99, p < 0.001). Over 90% of re-excision specimens after unplanned excision contained residual disease. Patients with microscopic or macroscopic disease identified in the re-excision specimen had a 42% and 44% risk of local recurrence, respectively, in comparison to those patients with no residual disease identified as having no incidence of local recurrence. Conclusion: This study highlights the importance of a proper primary excision by an orthopedic oncologist for patients with high-grade soft tissue sarcoma. Unplanned excisions often result in tumor beds with either gross or residual microscopic disease and have a significantly increased risk of local recurrence, distant metastasis, and shortened survival.

Background: This study aims to assess the clinical and oncologic outcomes of high‐dose brachytherapy (BRT) versus both preoperative and postoperative external beam radiation therapy (EBRT) in the setting of high‐grade soft tissue sarcoma. Methods: This is a retrospective cohort study of 144 patients treated surgically for soft tissue sarcoma at the same institution from 2010 to 2021. Patients treated for a soft tissue sarcoma with surgery and radiation therapy in the form of BRT, Neoadjuvant EBRT (Neo‐EBRT) or adjuvant EBRT (AD‐EBRT) were included. Results: 56 patients were treated with BRT, 42 with Neo‐EBRT, and 46 with AD‐EBRT. There was a greater incidence of grouped wound complications in Neo‐EBRT with 50% compared to both BRT with 25% and AD‐EBRT with 28.3% ( p = 0.02). Univariate and multivariate analysis showed that there was an increased risk of wound complications with Neo‐EBRT when compared to brachytherapy ( p = 0.03 and p = 0.007, respectively). Univariate and multivariate analysis showed that there was no difference in risk of LR between treatment groups ( p = 0.28). Conclusion: Brachytherapy is a valuable treatment modality that offers clinical and logistical advantages when compared to the conventional Neo‐EBRT in soft tissue sarcomas. Brachytherapy offers a lower risk of wound complications and a comparable local control. This manuscript presents decision‐making strategies for determining the appropriate radiation modality for specific circumstances.

The determination of upper and lower bounds for topological indices in molecular graphs provides critical insights into the structural properties of chemical compounds. These bounds facilitate the estimation of the ranges of topological indices based on molecular structural parameters. This study presents novel inequalities for the Gutman-Milovanović index, which generalizes several significant indices such as the first and second Zagreb indices, the Randić index, the harmonic index, the geometric-arithmetic index, the general second Zagreb index, and the general sum-connectivity index. Moreover, we derive and characterize extremal graphs for many of these inequalities. Additionally, we explore the application of the Gutman-Milovanović index in modeling the physicochemical properties of 22 polycyclic aromatic hydrocarbons. Our results demonstrate that the topological index $ M_{\alpha, \beta} $ provides accurate predictions for these properties, with $ R^2 $ values ranging from 0.9406 to 0.9983, indicating a strong correlation between the index and experimental data. The findings underscore the versatility of $ M_{\alpha, \beta} $ in chemical applications.

Background: The prognostic value of treatment-induced necrosis in soft STS remains uncertain. This study evaluated whether MRI-based changes in necrosis (Δ necrosis) between pre- and post-neoadjuvant chemotherapy scans correlate with pathologic necrosis and clinical outcomes. Methods: In this retrospective cohort, 27 patients with STS who received neoadjuvant chemotherapy and underwent pre- and post-treatment MRI were analyzed. Necrosis was graded categorically (95%), and Δ necrosis was calculated as the change in estimated necrosis between scans. Correlations between MRI-derived and pathologic necrosis were assessed using Spearman’s rank coefficient. Survival analyses (progression-free, local recurrence-free, and disease-specific overall survival) were performed using Kaplan–Meier and log-rank tests. Results: Post-treatment MRI necrosis moderately correlated with pathologic necrosis (ρ = 0.44, p = 0.028), whereas Δ necrosis showed a weaker, nonsignificant correlation (ρ = 0.24, p = 0.24). Neither MRI-based nor pathologic necrosis thresholds were associated with survival outcomes. Conclusions: MRI-based Δ necrosis did not predict pathologic necrosis or oncologic outcomes in STS, suggesting that radiologic changes in necrosis may not serve as reliable markers of therapeutic response. Future studies integrating quantitative imaging and standardized pathology protocols together with future exploration of molecular tools such as ctDNA are needed to refine treatment assessment in STS.